Can Acupuncture in "Forbidden Points" Decrease Pain and Duration of Childbirth? No and Yes.

An Iranian study in the Journal of Acupuncture and Meridian Studies suggested that acupuncture given during childbirth significantly lowers the duration of labor with no significant variations in pain scores or serum cortisol levels between the acupuncture-administered and control groups.

As anecdotal evidence from pain patients has accumulated, accompanying clinical studies on the efficacy of acupuncture for treating pain have also increased.

However, the results of those studies have been conflicting, with many concluding that acupuncture is no better than sham acupuncture at treating pain. There has also been a great deal of unproven concern about the use of acupuncture in the SP-6 and LI-4 points, with many tall tales telling of “immediate abortions” resulting from acupuncture in those points.

The current study looked at 63 patients — 32 in the experimental group who received acupuncture in SP-6 and LI-4 points, and 31 control patients who received sham acupuncture. In both groups, Fentanyl was given intravenously as part of routine labor care. Active phase was defined by cervical dilation of 4 cm or more and three or more contractions lasting more than 40 seconds within 10 minutes.

The intervention group received acupuncture with a 0.25 × 40-mm stainless steel C-type needle at LI4 and SP6 for 20 minutes. Manipulation was performed until the patient reported the characteristic tingling or numbness, and then rotated clockwise every 5 min. In the control group, sham acupuncture was performed by superficial contact of needles in incorrect technical points. Patients were blinded to the type of acupuncture received.

Pain intensity was assessed by a linear visual analogue pain scale (VAS). The secondary outcome of this study was changing in serum cortisol level, before and immediately after intervention.

The pain score of each patient was assessed and recorded before starting the procedure, during the active phase, and immediately after the termination of acupuncture. Participants scored severity of pain from 0 (no pain) to 10 (worst imaginable pain) by participants. Change in pain score of each patient was calculated and used as the “gain score”. Decrease in pain score in the acupuncture group was slightly greater than the controls (2.5 vs. 2.38), but this did not reach statistically significant variation. But labor was significantly shorter in the intervention group (p < 0.001).

“Given the effect of cortisol on pain relief, our hypothesis is that lack of increasing cortisol is the main contributing factor related to lack of pain reduction,” the study authors note… “Different mechanisms were hypothesized to explain the effect of acupuncture on initiation of labor, one of which is increasing oxytocin secretion from anterior pituitary gland and thalamic nuclei...Notably, shortening the active phase of labor can decrease fatal complications such as low Apgar, nerve injury, infections and maternal complications including puerperal infection and postpartum hemorrhage.”

Study limitations include the small sample size and the fact that only those patients who entered active phase of labor between 6 pm and 10 pm were included, to eliminate the effect of diurnal pattern of variation of serum cortisol levels. No fetal detail on head circumference or birth weight was analyzed.