Acupuncture induction of labor and pain medication reduction

Smith, CA & Crowther, CA (2009) Acupuncture for induction of labour, Cochrane Database of Systematic Reviews, 1, 1-26

The pregnant woman is induced when the pregnancy is becoming dangerous either for herself or for the unborn child. Generally done by drugs, Smith and Crowther (2009) reviewed the effects of induction that has been impelled by acupuncture which has been historically used to help induce labor and to reduce labor pain. Smith and Crowther (2009) conducted a review that included three trials involving 212 women. They concluded that clinical evidence of the effectiveness of acupuncture as applied to this situation is limited, although some qualitative small studies do suggest that women who receive acupuncture receive fewer methods of induction than do women who receive the standard care of induction.

This article is particularly significant given that we are living in a period when increasingly more people turn to holistic or alternative medicines for help in curing their symptoms, in treating pain, or in preventing certain symptoms (MacLennan, 2002). On the whole, however, science has provided us with very little clinical evidence about the effects of alternative medicine, and much of this is mixed. Some practitioners state acupuncture to be helpful. Acupuncture may not be helpful for chronic or intense pain, but it has been conclusively revealed to diminish nausea and certain types of pain, but otherwise several review articles conclude it to have a placebo effect (Ernst, 2006). In this way, medical practitioners are skeptical about the medical effects of acupuncture and are cautious in prescribing it. Given these mixed reviews and given the potentially significant effect of acupuncture to the medical profession, it is important that more thorough and reliable research be performed.

Smith and Crowther (2009) have attempted to do so using the subject of labor induction and reduction of pain during the process, as theme for their review. They have reported that nurses (as seen in a recent review by Allaire, 2000)) record the growing prevalence of acupuncture during pregnancy. In that review, at least 20% of the 82 surveyed midwives reported using acupuncture during some moment of the procedure. If acupuncture were shown to be harmful, its usage needs to be stopped. On the other hand, if it were demonstrated to be helpful (as other studies mainly occurring in Asia show), practitioners may consider integrating it in their practice labor. This is particularly so since acupuncture, along with other complementary practices, is considered less intrusive, and more comfortable as well as natural than conventional medicine leading users to prefer them. This may be specifically the case during prolonged labor when patients may feel less frightened by acupuncture than by conventional surgery or means.

Smith and Crowther (2009) accepted three trials of 212 women for inclusion about the analysis of the effects of acupuncture during labor. Their standards were admirably rigorous. They looked for clinical studies that studied the results of acupuncture within the format of a control group. This was good since it would eliminate the problem of acupuncture acting as a placebo (which may have been why previous studies reported success). They also defined their sample thoroughly. Inclusive variables included pregnant women due for third trimester induction of labor, carrying a viable fetus. The way that the acupuncture was administered was also clearly defined as well as clinically relevant outcomes that had been defined by an authoritative source. They outline a list of five primary outcomes and followed that with another list of 24 secondary items. They also searched numerous relevant data bases, as well as investigating off-line trail reports and reviews. The terms that they used included: acupuncture, electro acupuncture, TENS, induction of labor. They may have included these particular terms since basic strategies of pain control include nonsteroidal anti-inflammatory drugs and aspirin (that block pain through intervention at the periphery), transcutaneous electrical nerve stimulation (TENS), as well as spinal-cord stimulation (that inhibit pain at the spinal cord and brain) (Melzack & Wall, 1982), and the researchers wished to assess whether, and to what extent, acupuncture compared to these interventions in relieving pain. All in all, the researchers went out of their way to ensure that they were defining their search terms as tightly as possible so that they would zone in on precisely the population that they wished to assess and that, therefore, their conclusions could be as valid as possible.

Meta analyses are helpful in that they tie up all the existent information on a certain topic, limit it, choose the most reliable studies and give us a clear picture of conditions in the field so that we can know how to, if at all, apply them in our practice. On the other hand, meta analyses fail in that they have to, of necessity, ignore certain studies that may have been helpful to them, as well as that researchers are subjective in choosing certain studies (therefore it is they who decide which studies to choose), and there are various other problems as recorded by Eysenck (1994).

As conclusion, the 2009 study conducted by Smith and Crowther is beneficial in that it poses an important question -- whether or not acupuncture can be used in inducing birth -- screens through the mass of studies on the subject and selects that which the authors consider the most reliable for us to use.