Labor Pain Treated with Acupuncture or Acupressure

This review article, published in 2016, examines the efficacy of acupuncture and acupressure in managing labor pain, with a special focus on women with a history of substance use disorder. The context is particularly relevant considering that opioid-dependent women have an unplanned pregnancy rate of 80%-90%, nearly twice the general rate. Neonatal abstinence syndrome occurred in 5.8 per 1,000 hospital births in 2012, making non-pharmacologic management of labor pain especially recommended for patients with a history of substance use disorder. The review analyzed randomized clinical trials from 2012 onward, finding consistent evidence that bilateral electroacupuncture at specific points such as JiaJin or Sanyinjiao significantly reduces visual analog scale pain scores 30 minutes after intervention (p < 0.01) and shortens the time of the active first stage of labor (p < 0.05).

Electroacupuncture has been shown to achieve a shorter second stage of labor than patient-controlled epidural analgesia (p = 0.05) and pain scores 10 points lower with reduction in the cesarean rate compared with controls without analgesia (p < 0.05). Among the acupuncture points studied, Hegu (LI-4) was effective in reducing pain perception through stimulation of endorphin release, while Sanyinjiao (SP-6) demonstrated the ability to shorten labor through increased uterine contractility via stimulation of pituitary oxytocin release. JiaJin (EX-B2), located bilaterally between T10-L3, was particularly effective for women experiencing labor with low back pain, acting through inhibitory or excitatory A fibers of the spinal cord dorsal horn. The studies reviewed included diverse methodologies, from traditional manual acupuncture to electroacupuncture with different frequencies and intensities.

One identified limitation was the heterogeneity in the pain scales used and in the criteria for defining the onset of the active phase of labor. Current evidence indicates that electroacupuncture should have a role in the non-pharmacologic management of labor pain, and that acupressure may have a similar role. The review highlights that future studies with computer-controlled randomization, intention-to-treat analysis, and larger sample sizes could strengthen the case for greater use of electroacupuncture and acupressure in non-pharmacologic management of labor pain.