Main results

This updated review includes 22 trials, reporting on 3456 women. The trials using manual or electro-acupuncture were compared with usual care (eight trials, 760 women), sweeping of membranes (one trial, 207 women), or sham controls (seven trials, 729 women). Trials using acupressure were compared with usual care (two trials, 151 women) or sham controls (two trials, 239 women). Many studies had a moderate risk of bias.

Overall, few trials reported on primary outcomes. No trial reported vaginal delivery not achieved within 24 hours.

Acupuncture versus usual care

There was no clear difference in caesarean sections between groups (average RR 0.77, 95% CI 0.51 to 1.17, eight trials, 760 women; low-quality evidence). There was an increase in cervical maturation for the acupuncture (electro) group compared with control (MD 1.30, 95% CI 0.11 to 2.49, one trial, 67 women) and a shorter length of labour (minutes) in the usual care group compared to electro-acupuncture (MD 124.00, 95% CI 37.39 to 210.61, one trial, 67 women).

There appeared be a differential effect according to type of acupuncture based on subgroup analysis. Electro-acupuncture appeared to have more of an effect than manual acupuncture for the outcomes caesarean section (CS), and instrumental vaginal and spontaneous vaginal birth. It decreased the rate of CS (average RR 0.54, 95% CI 0.37 to 0.80, 3 trials, 327 women), increased the rate of instrumental vaginal birth (average RR 2.30, 95%CI 1.15 to 4.60, two trials, 271 women), and increased the rate of spontaneous vaginal birth (average RR 2.06, 95% CI 1.20 to 3.56, one trial, 72 women). However, subgroup analyses are observational in nature and so results should be interpreted with caution.

Acupuncture may promote a more favourable state of the cervix within 24 hours in the two trials (192 women) that looked at this.

4 studies included in this review that used electro acupuncture:

1. A randomized controlled trial of acupuncture for initiation of labor in nulliparous women.

J Matern Fetal Neonatal Med. 2006 Aug;19(8):465-70.

Harper TC, Coeytaux RR, Chen W, Campbell K, Kaufman JS, Moise KJ, Thorp JM

There was a difference in intervention to delivery interval of 62 hours in favour of the treatment group. Furthermore, women in this group had shorter labours by a mean of 2 hours and 20 minutes. J Obstet Gynaecol Can. 2008 Dec;30(12):1118-1123. doi: 10.1016/S1701-2163(16)34021-X.

2. Effectiveness of acupuncture for the initiation of labour at term: a pilot randomized controlled trial.

Gaudet LM, Dyzak R, Aung SKH, Smith GN.

Our results showed that electroacupuncture can be used to obtain cervical ripening, with similar results as compared with misoprostol, with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications. Arch Gynecol Obstet. 2011 Jun;283(6):1233-8. doi: 10.1007/s00404-010-1526-x. Epub 2010 Jun 8.

3. Electroacupuncture for cervical ripening prior to labor induction: a randomized clinical trial.

Gribel GP, Coca-Velarde LG, Moreira de Sá RA.

Acupuncture at 41+ weeks of gestation did not reduce the need for induction.

J Perinat Med. 2013 Sep 1;41(5):555-60. doi: 10.1515/jpm-2012-0289.

4. Acupuncture and/or sweeping of the fetal membranes before induction of labor: a prospective, randomized, controlled trial.

Andersen BB, Knudsen B, Lyndrup J, Fælling AE, Illum D, Johansen M, Borgen A, Jager H, Bjerre C, Secher NJ.  https://doi.org/10.1515/jpm-2012-028

Birth Preparation

Romer A, Weigel M, Zieger W, Melchart F. Prenatal acupuncture: effects on cervical maturation and duration of labour. Geburtshilfe und Frauenheilkunde 2000;60(10):513-8

This study found birth preparation acupuncture starting at 36 weeks resulted in more softening of the cervix, shorter labours less pain relief required and less foetal distress in labour.