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Acupuncture and acupressure for pain management in labour and birth: A critical narrative review of current systematic review evidence

Levett KM, et al., Complementary Therapies in Medicine, 06/17/2014

 

Results

The RCTs included in these systematic reviews differed in terms of study designs, research questions, treatment protocols and outcome measures, and yielded some conflicting results. It may be inappropriate to include these together in a systematic review, or pooled analysis, of acupuncture for labour with an expectation of an overall conclusion for efficacy. Trials of acupuncture and acupressure in labour show promise, but further studies are required.The aim of this study is to examine current evidence from systematic reviews on the topic of acupuncture and acupressure for pain management in labour and birth, and to evaluate the methodological and treatment frameworks applied to this evidence. The use of current systematic reviews of the evidence for acupuncture and acupressure for labour and birth may be misleading. Appropriate methods and outcome measures for investigation of acupuncture and acupressure treatment should more carefully reflect the research question being asked, the use of pragmatic trials designs with woman–centred outcomes may be appropriate for evaluating the effectiveness of these therapies.

 

Methods

A search limited to systematic reviews of the MEDLINE, CINAHL, PUBMED, EMBASE and Cochrane databases was performed in December 2013 using the keywords ‘CAM’, ‘alternative medicine’, ‘complementary medicine’, ‘complementary therapies’, ‘traditional medicine’, ‘Chinese Medicine’, ‘Traditional Chinese Medicine’, ‘acupuncture’, ‘acupressure’, cross–referenced with ‘childbirth’, ‘birth’, labo*r’, and ‘delivery’.The quality of the evidence is also evaluated in the context of study design.

Recurrent miscarriage–outcome after supportive care in early pregnancy

coverLiddell HS et al, Aust N Z J Obstet Gynaecol. 1991 Nov;31(4):320-2.

This study did not use acupuncture or herbs, but it is interested to include it here as a way of managing early pregnancy in women who have had previous miscarriages. There is currently no known prevention therapy for unexplained recurrent miscarriage, but this study showed that emotional support and close supervision helped improve outcomes in subsequent pregnancies.

 

Abstract

One hundred and thirty three couples were investigated at a recurrent miscarriage clinic. In their next pregnancy 42 women (Group 1) with unexplained recurrent miscarriage were managed with a programme of formal emotional support and close supervision at an early pregnancy clinic. Two women were seen in 2 pregnancies (44 supervised pregnancies); 86% (38 of 44) of these pregnancies were successful. Four of the 6 miscarriages had an identifiable causal factor. Nine women (Group 2), also with unexplained recurrent miscarriage, acted as a control group. After initial investigation they were reassured and returned to the care of their family practitioner and did not receive formal supportive care in their subsequent pregnancy; 33% (3 of 9) of these pregnancies were successful (p = 0.005; Fishers Exact Test). Whilst acknowledging that there is a significant spontaneous cure rate in this condition, emotional support seems to be important in the prevention of unexplained recurrent miscarriage, giving results as good as any currently accepted therapy.