Acupressure as labor induction technique?

Acupressure is not an effective modality for inducing labor at full term in nulliparous women with uncomplicated pregnancies, according to the published results of a randomized controlled trial.¹

Based on the limited research available on the effect of acupressure on the initiation of labor, Fatemeh Mahmoudikohni, MD, and colleagues at Shahid Akbar Abadi Hospital, Iran University of Medical Sciences, Tehran, undertook a randomized study to evaluate this noninvasive intervention. A total of 162 women were assigned into one of 3 groups to receive acupressure, sham acupressure using sham points, or routine care.

Their analyses found no statistically significant differences between the 3 study groups in rates of initiation of spontaneous labor at various follow-up intervals, mean time to birth, delivery type (vaginal or cesarean), or fetal outcomes.

Women were eligible for the study if they were ages 18 to 35 years and were in weeks 39 to 40 of their pregnancy. Other inclusion criteria required a singleton cephalic presentation, normal maternal pre-pregnancy body mass index (BMI), Bishop score ≤4, biophysical profile score of 8/8, normal amniotic fluid index, no history of taking herbal or chemical drugs during the study or within 36 hours prior to enrollment, and no sexual intercourse during the study or in the prior 24 hours.

Acupressure and sham acupressure were performed twice daily (between 9 AM and 11 AM and again between 3 PM and 5 PM); the morning treatment was performed by the researcher on the first day and every other day thereafter while the remaining treatments were performed at home.

The spots used in the acupressure group were bladder 32, spleen 6, and bladder 60. Each active and sham session lasted 30 minutes with each spot pressed 5 times for 1 minute with a 1-minute rest interval between pressure applications. Labor was induced pharmacologically if it was not initiated by 41 weeks of pregnancy.

There were no statistically significant differences between the 3 study groups in mean maternal age, gestational age, pre-pregnancy BMI, or Bishop score. The 3 groups were also similar with respect to level of education, profession, prenatal care, and participation in childbirth preparation classes.

Rates of spontaneous labor within 48 hours of intervention initiation in the acupressure, sham acupressure, and standard care groups were 30%, 20%, and 22%, respectively, (P = 0.464). There were also no statistically significant differences between the 3 groups for rates of spontaneous labor initiation at 49-96 hours (14%, 34%, 24%, respectively) or at 97 hours to time of hospitalization (56%, 56%, 60%, respectively). Mean time to birth in the three groups was 124.88, 135.39, and 114.16 hours, respectively (P = 0.565).

Proportions of women delivering by a normal vaginal birth or having a cesarean delivery were also similar in the 3 study groups, as were mean Apgar scores at 1 and 5 minutes and mean fetal weight.

The investigators noted that a previously published study evaluating acupressure for initiating labor in term pregnant women found it had a significant benefit compared with touch intervention and usual care for initiating labor within 48 hours.² The earlier study involved a shorter acupressure intervention period and enrolled multiparous as well as nulliparous women who were also at a later gestational age (≥40 weeks).

References

1. Torkzahrani S, Mahmoudikohani F, Saatchi K, Sefidkar R, Banaei M. The effect of acupressure on the initiation of labor: A randomized controlled trial. Women Birth. 2016 July 18 [Epub ahead of print].

2. Azhari S, Abrishami L, Fadaee A, Shakeri MT. Efficacy of acupressure on initiating labor in term pregnant women. J Mashad School Nurs Midw. 2009;9(3):207-214.