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Using Acupuncture in Labor Pain and Childbirth-Related
Issues: A Narrative Review
Fung Kei Cheng

BACKGROUND: Latent threats, such as prolonged labor duration and postpartum hemorrhage,
endanger women and newborns during and post childbirth, which produce burdens on natal care and
public health expenditures. Acupuncture, a traditional Chinese medical practice, has increasingly been
used for labor delivery in various countries to cope with these problems.
METHOD: This narrative review searched 29 English and Chinese electronic databases. Thirty-one
empirical studies, carried out in Asia, America, Africa, the Middle East, Europe, and Australia were
reviewed according to inclusion and exclusion criteria.
RESULTS: Acupuncture is adopted with positive signs toward labor pain relief, delivery mode, labor
duration, postpartum hemorrhage, APGAR score (an evaluation for a neonatal evaluation), and birth
weight.
DISCUSSION: With support of earlier studies, the satisfactory effects of acupuncture on labor delivery
reviewed in this research have been noted by obstetric researchers and scholars, physicians, nurses, and
midwives.
CONCLUSION: This review recommends the use of acupuncture in obstetric profession with respect to
maternal-related healthcare.
KEYWORDS: childbirth; complementary and alternative therapy; narrative review; obstetrics and
gynecology; pain management; traditional Chinese medicine

INTRODUCTION postnatal care for both mother and newborn (World

Despite being a joyful familial event, childbirth is poten-
tially associated with adverse health issues during and
post-pregnancy (Boryri, Noori, & Yughobinia, 2016),
including the prevalence of labor pain (Kwok, Moo, Sia,
Razak, & Sng, 2015), postpartum physical symptoms
(Ansara, Cohen, Gallop, Kung, & Schei, 2005), compli-
cations (Mathai et al., 2017), and maternal emotional
wellness (Brown & Lumley, 2000). Some of these are
life-threatening toward mother (Camargo et al., 2011)
and infant (Aboud & Yousafzai, 2016), and can be result
in financial (Black, Walker, Laxminaraya, & Temmer-
man, 2016) and social (Ezeh et al., 2016) costs. Thus,
the medical field urges prenatal (Viellas et al., 2014) and
Health Organization, 2014).
Having encouraging prospects for assisting child-
birth, complementary and alternative approaches are
increasingly being adopted (Muñoz-Sellés, Vallès-
Segalés, & Goberna-Tricas, 2014), such as yoga (Sun,
Hung, Chang, & Kuo, 2010) and hydrotherapy (Amer-
ican Academy of Pediatrics, & American College of
Obstetricians and Gynaecologists, 2014). In particu-
lar, these nonpharmacological interventions (Levett,
Smith, Bensoussan, & Dahlen, 2016; Simkin & Bold-
ing, 2004) are popular in managing labor pain (Smith,
Collins, Cyna, & Crowther, 2006; Tournaire & Theau-
Yonneau, 2007), among which traditional Chinese
medical delivery practices are increasingly being used

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to improve prenatal and postnatal care. For example,
the benefits of using cupping therapy, acupoint massage
(Yazdanpanahi, Ghaemmaghami, Akbarzadeh, Zare, &
Azisi, 2017), or hydropuncture (injecting physiologic
solution into acupoints) include the alleviation of labor
pain (Dabiri & Shahi, 2014; Hajiamini, Masoud, Ebadi,
Mahboubh, & Matin, 2012; Minelli et al., 2007) and a
reduction in average length of delivery time (Lee, Chang,
& Kang, 2004), and are lower risky to both mother and
baby (Calik & Komurcu, 2014).
Acupuncture, a major traditional Chinese med-
ical method, has been utilized for over 3,000 years
in China, and is documented in classical texts (Ma,
2000) such as the A-B Classic of Acupuncture and
Moxibustion (Li & Zhang, 2015). It involves the inser-
tion of sterile needles into one or a few acupoints
(specific points) at a depth of 4–25 mm along 14
meridians throughout the body for a few seconds
or minutes. It stimulates nerve endings, consequently
balancing life energy and restoring health (Ernest, 2006).
Research indicates its effectiveness on various illnesses
across age groups: for instance, weight control (Cheng,
2018a), dementia (Cheng, 2018b), Parkinson’s disease
(Cheng, 2017b), and autism (Cheng, 2017a). With the
advantage of modern technology, acupuncture has fur-
ther developed with the use of cutting-edge devices,
including electro-acupuncture, the Han’s acupoint nerve
stimulator (HANS), and the transcutaneous electrical
nerve stimulator (TENS) (Bedwell, Dowswell, Neilson,
& Lavender, 2011). This treatment is safe (Cho, Lee,
& Ernst, 2010), even during early pregnancy (Betts &
Budd, 2011; Carr, 2015; Park, Sohn, White, & Lee, 2014;
Soliday & Hapke, 2014).
Recent studies report the effects of acupunc-
ture on reproductive issues (Smith & Carmady, 2010),
although the results are still debatable (Lim, Wilkin-
son, Wong, & Cheng, 2009). They have shown that
acupuncture likely helps cervical ripening (Schlaeger
et al., 2016), labor pain relief (Levett, Smith, Dahlen,
& Bensoussan, 2014), decreases in using epidu-
ral analgesia (Nesheim & Kinge, 2006) and post-
partum hemorrhage (Djakovic, Djakovic, Bilic, &
Kosec, 2015), an increase in parturient satisfaction
(Carr & Lythgoe, 2014), and cost-effective postpartum
care (Soliday & Hapke, 2013). Hence, midwives willingly
recommend this method for childbirth (Mårtensson &
Wallin, 2006), especially recommending the combined
use of manual and electro-acupuncture (Vixner, Schytt,
& Mårtensson, 2017).
This literature review analyzes projects with either
Chinese or non-Chinese participants and then offers an
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evidence-based overview of how acupuncture can work
on labor pain and childbirth-related issues during and
after labor and delivery. It not only integrates research
results that from both English and Chinese academic
articles, but also possibly provides healthcare practition-
ers and midwives with an adjunctive measure to enhance
postpartum care.
RESEARCH METHOD
This review searched 27 electronic databases, includ-
ing the British Nursing Index, Medical Database,
MEDLINE, and ProQuest Medical Library, from the
date these sources start until 2017. It input the key-
words “acupuncture” and “labor pain,” listing 65 arti-
cles. It also used two Chinese digital databases—the
China National Knowledge Infrastructure and Tai-
wan Electronic Periodical Services—by typing “針 灸”
and “分 娩 痛 OR 陣 痛 OR 產 痛,” retrieving nine
manuscripts.
The inclusion criteria involved human-based
quantitative studies published in peer-reviewed and
scholarly journals. However, duplicated works, liter-
ature reviews, book reviews, dissertations, editorials,
letters to the editor, commentaries, and pilot trials with-
out research results were excluded. According to the
eligibility criteria, the author was also the reviewer who
reviewed 31 studies (n = 29 in English, n = 2 in Chinese)
(refer to Figure 1).
FINDINGS AND DISCUSSION
This review involved 5,685 women aged 17–35 in Africa
(Nigeria = 1), Asia (China = 7, Taiwan = 1), Europe
(Cyprus = 1, Denmark = 2, Norway = 1, Sweden =
6, the Netherlands = 1, United Kingdom = 1), North
America (United States = 2), Australia = 1, and the
Middle East (Iran = 4, Israel = 1, Turkey = 2). Although
it focused on investigating the efficacy of acupunc-
ture on labor pain relief, it simultaneously found that
this Chinese medical practice is also favorable to both
parturient women and infants, covering a wide range
of effects including delivery mode, labor duration,
postpartum hemorrhage relief, better APGAR scores
(Appearance, Pulse, Grimace, Activity, Respiration; an
assessment for evaluating effects of maternal anesthesia
on health of newborns), and improved birth weights
(refer to Appendix). As a result, many women who have
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FIGURE 1. Selection process.
tried acupuncture for childbirth prefer this intervention
in future deliveries.
Labor Pain Relief
Labor pain is the most severe pain that women can expe-
rience (Sahile et al., 2017) but it is meaningful for many
mothers (Whitburn, Jones, Davey, & Small, 2017). It
involves both visceral pain and somatic pain due to uter-
ine contraction and innervations of the vaginal surface
respectively (Labor & Maguire, 2008). Pain assessment
(Burckhardt & Jones, 2003; Haefeli & Elfering, 2006)
collectively evaluates pain intensity, chronicity, and pain
experience. Common tools used comprise the Visual
Analogue Scale, Numerical Rating Scale, Verbal Rating
Scale, and McGill Pain Questionnaire.
Since labor pain negatively impacts not only par-
turient women but also neonates (Ebirim, Buowari, &
Ghosh, 2012), labor pain relief is desirable through a
number of methods, including adjunctive therapies such
as music therapy (Dehcheshmeh & Rafiei, 2015) and a
body-mind-behavior model (Dixon, Skinner, & Foureur,
2013). Being an effective approach, acupuncture is used
Pdf_Folio:122
as analgesia (Cheng & Zou, 2010; Kong, Schnyer, John-
son, & Mackey, 2013) for pain management (Wilkinson
& Faleiro, 2007), including for emergency care (Cohen
et al., 2017) and childbirth-induced pain (Khanahmadi,
2013).
In a recent project, 85 women were randomly allo-
cated to acupuncture, drug, and no painkiller groups
(Allameh et al., 2015). They assessed pain levels 30 min-
utes after intervention, and reported significantly lower
pain levels for the acupuncture group than in the remain-
ing groups. By comparing the effects of acupuncture with
analgesia in another 150 women who received music
therapy for labor pain (Yao et al., 2014), 88% of the
acupuncture group (with music therapy) indicated they
experienced discomfort at the second pain grade with
none registering the fourth grade pain, whereas 68% of
the analgesia group (with music therapy) complained
of third grade pain, and 25% of the analgesia group
(with music therapy) experienced fourth grade pain.
Furthermore, 12% in the manual acupuncture group
and 67% in electro-acupuncture group in Vixne’s project
(2014) claimed they had experienced a subjective feel-
ing of pain relief. This hinted at better effects for mod-
ern technology than for conventional application when

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Using Acupuncture in Labor Pain and Childbirth-Related Issues Cheng
applying acupuncture, which is also supported by other
research (Chao et al., 2007). One pain score measure-
ment taken 30 minutes after treatment indicated a 7.9 in
the electro-acupuncture group (39 participants) and an
8.7 in the control group (39 participants) (Mucuk et
al., 2013), in spite of the research finding that the dif-
ference between these two groups was little statistical
significance (i.e., p > .05). With support from these
results, it is reflected that utilizing acupuncture will result
in significantly less need for further pain management
than using pharmaceutical methods (Nesheim et al.,
2003).
Mode of Delivery
Research exhibits lower average birth weights for Cae-
sarean section than in natural child delivery, which
may result in increased neonatal mortality and stillbirth
(Chen et al., 2016). Instrumental delivery increases
detrimental consequences during labor (Simic, Cnat-
tingius, Petersson, Sandström, & Stephansson, 2017).
Thus, many women prefer to undertake natural
childbirth, which is favorable for both mother and child
(Lothian, 2000).
In contrast, 90% of another 30 participants in the
HANS group completed natural vaginal delivery, com-
pared to 86% in both the intravenous analgesia (PICA)
(n = 30) and epidural analgesia (PCEA) (n = 30) groups
and 66% in the control group (Liu et al., 2015). Moreover,
6% of the participants underwent operative or instru-
mental delivery across all these groups. Three percent
(3%) in the HANS group undertook Caesarean section,
and 6%, 6%, and 26% in PICA, PCEA, and control
groups, respectively. Similar results were presented in
other studies; for example, Chen et al. (2014). However,
better outcomes were shown for manual acupuncture
than for sham acupuncture (Ajori et al., 2013; Smith et
al., 2008).
Labor Duration
Prolonged labor duration is positively associated with
severe postpartum hemorrhage (Nyfløt, Stray-Pedersen,
Forsen, & Vangen, 2017), potentially causing mater-
nal deaths (Ngwenya, 2016). The birth whole process
lasted for a shorter time for the acupuncture group (5.3
hours) than for the conventional analgesia group (5.6
hours) (Ramnero et al., 2002), which was supported
by other projects such as Lyrenäs et al. (1987). This
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123
was also reflected in the first (Kaplan et al., 1998), sec-
ond (Citkovitz et al., 2009), and third (Dong et al.,
2015) labor stages, but an opposite result was demon-
strated in another research project (Borup et al., 2009).
Although the outcomes were weak, acupuncture con-
tributed slightly to a shorter labor duration.
Postpartum Hemorrhage
Blood loss over 500 mL after delivery is defined as
postpartum hemorrhage, a cause of maternal death
(Ramanathan & Arulkumaran, 2006). The mean for
postpartum bleeding in the TENS group (Peng et al.,
2010) and HANS group (Liu et al., 2015) were lower
than this indicator (127 mL). The research conducted by
Allameh and team reported only 4% severe postpartum
hemorrhage in the acupuncture group compared to 8%
in the control group (Allameh et al., 2015). The effects
were coincident for both normal and sham acupuncture
(Modlock et al., 2010).
Newborn Scoring System
The APGAR score, developed by Virginia Apgar in 1952,
is a quick test usually performed at 1 and 5 minutes
after birth for newborns, and can reflect the impact of
obstetric anesthesia (Apgar, 1966), involving appearance
(skin color) (A), pulse rate (P), reflex irritability grimace
(G), activity (A), and respiration (R) (Persson, Razaz,
Tedroff, Joseph, & Cnattingius, 2018). A score of 7–10
is considered reassuring (Committee on Obstetric Prac-
tice, & American Academy of Pediatrics-Committee on
Foetus and Newborn, 2015). As early as the 1990s, the
APGAR at 1 minute was reported to be 9.6 for electro-
acupuncture (Martoudis & Christofides, 1990). In a com-
parison study, informants reported 8.9 and 8.7 in the
APGAR scores at 1 minute for acupuncture and sham
acupuncture groups respectively, and 9.4 and 9.5 on the
APGAR scale at 5 minutes correspondingly (Ajori et al.,
2013). Such effects were valid when applying acupressure
(Akbarzadeh et al., 2016).
Birth Weight
The normal birth weight lies between 2.5 and 4 kg
(Jin, 2015). Infants who weigh less than 2,500 g are con-
sidered low birth weight babies and if under 1,500 g
are very low birth weight: this influences child develop-
ment (Saeidi et al., 2016) and lifelong health (Negrato &
Gomes, 2013). The mean infant birth weight was 3,670 g
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in an acupuncture group, whereas it was 3,760 g in
the same study’s conventional analgesia group (Ramnero
et al., 2002). This was substantiated by a study in which
the mean birth weight was 3,509 g in the manual
acupuncture group, 3,593 g in the electro-acupuncture
group, and 3,656 g in the standard care group (Vixne et
al., 2014). These data display that acupuncture has no
harmful effects on the normal weight of newborns.
Use in Future Delivery
In addition to the above mentioned outcomes, using
acupuncture during labor has no major adverse effects
(Elden et al., 2008; Ternov et al., 2001). Therefore, 80%
of informants claimed willingness to use acupuncture in
future delivery (Umeh, 1986). Over 60% of the partici-
pants in recent studies also agreed (Kvorning et al., 1998;
Smith et al., 2008; van der Ploeg et al., 1996; Vixne et al.,
2014). Since a high percentage of parturients required
pain relief in childbirth (Ogboli-Nwasor, Adaji, Bature,
& Shittu, 2011), acupuncture is seeing increased popu-
larity in the field of midwifery.
Acupoints
Acupuncture, as analgesia, achieves a neuromodulatory
effect, resulting in better functioning of the peripheral
and central nervous system (Fargas-Babjak, 2004). LI4
(hegu) is an important acupoint for pain treatment
(Mastilović, Dimitrijević, & Konstantinović, 2015);
hence, it is adopted for analgesic purpose during labor
induction (Asher et al., 2009). More than one-third out
of 79 nulliparous women did not use further analgesia
when they received either manual acupuncture, electro-
acupuncture, or sham acupuncture at LI4 (MacKenzie
et al., 2011). Also, SP6 (sanyinjiao) is used for women’s
health and pain reduction (Mehta, Dhapte, Kadam, &
Dhapte, 2017), which was supported by the research
project by Ma et al. (2011). Although there were no sig-
nificant variations in pain scores between two groups,
the mean labor duration was 162 minutes in the 32
parturients who received acupuncture at LI4 and SP6,
whereas it was 280 minutes in the control group (Asadi
et al., 2015), as result of synergism generated in the
central nervous system and having a direct influence
on the uterus (Qu & Zhou, 2007). Furthermore, Mucuk
and Baser (2014) claimed a lower pain score and shorter
delivery duration at LI4 than SP6.
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RECOMMENDATIONS
This review raises methodological and practical impli-
cations to substantiate the effects of acupuncture on
baby delivery. Research on this topic needs further well-
design empirical studies (Citkovitz, Schnyer, & Hoskins,
2010; Ewies & Olah, 2002) to collect more reliable data
with statistical significance including p value; for exam-
ple, randomized controlled trials, larger sample size, and
longitudinal projects. Meanwhile, standardized eval-
uation of clinical effects (Chen, Zhang, Fang, & Yang,
2014) may develop a protocol for using this interven-
tion (Ormsby, 2016), which may accelerate training for
practitioners.
Equally important, this review suggests combined
therapy; that is, adopting acupuncture with other non-
drug measures, especially for women with medication
allergies. This approach can potentially extend a wider
spectrum of treatment available to obstetricians.
CONCLUSION
This review presents the contribution of acupuncture
(perhaps with the aid of advanced technology) to labor
pain relief, delivery mode, labor duration, postpartum
hemorrhage, APGAR scores, and birth weight. Aside
from its effectiveness, acupuncture is economical and
safe, all of which are advantageous not only for women’s
pre- and postnatal health but also public health expense.
This offers a choice of alternative measures to the field of
obstetrics and gynaecology.
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Disclosure. The authors have no relevant financial interest or
affiliations with any commercial interests related to the subjects
discussed within this article.
Funding. The author(s) received no specific grant or financial
support for the research, authorship, and/or publication of this
article.
Correspondence regarding this article should be directed to
Fung Kei Cheng, PhD, Hong Kong. E-mail: oasischeng@
yahoo.com
Fung Kei Cheng, PhD, independent researcher, Hong Kong.
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Using Acupuncture in Labor Pain and Childbirth-Related Issues Cheng

APPENDIX: ANALYSIS OF THE 31 REVIEWED STUDIES

SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Akbarzadeh, To compare the 150 women, Randomly distributed First stage (mean): 161.7, Iran
Masoudi, effects of aged 18–35 to acupressure 157, and 281 minutes in
Zare, and acupressure (n = 50), supportive acupressure, supportive care,
Kasraeian and supportive care group (n = 50), and control groups,
(2016) care on and control respectively.
reducing labor (n = 50) groups Second stage (mean): 56.1,
duration 58.9, and 128.4 minutes in
acupressure, supportive care,
and control groups,
respectively.
APGAR 1 > 8: 74%, 86%, and
40% in acupressure,
supportive care, and control
groups, respectively.
APGAR 5 > 8: 96%, 98%, and
78% in acupressure,
supportive care, and control
groups, respectively.
Allameh, To compare the 85 parturients, Randomly assigned Pain score before intervention Iran
Tehrani, effects of aged 18–35. to acupuncture (mean): 6.07 in acupuncture
and acupuncture (n = 28), pethidine group, 6.7 in pethidine group,
Ghasemi and pethidine (n = 30), 6.33 in control group.
(2015) on labor pain. and control (no Pain score 30 minutes after
painkiller) intervention (mean): 5.77 in
(n = 27) groups. acupuncture group, 6.87 in
Acupuncture: 20–30 pethidine group, 7.8 in
minutes Pethidine: control group.
50 mg Pain score at the end of the first
intramuscular phase (mean): 8.87 in
medicine. acupuncture group, 9.4 in
pethidine group, 9.43 in
control group.
Average duration of active labor
phase: 175.8 minutes
(45–300 minutes) in
acupuncture group, 175. 13
minutes (60–300 minutes) in
pethidine group, 243.77
minutes in control group.
Mild postpartum hemorrhage:
80% in acupuncture and
pethidine groups, 64% in
control group.  

(Continued)

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Using Acupuncture in Labor Pain and Childbirth-Related Issues Cheng

SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Moderate postpartum
hemorrhage: 16% in
acupuncture group, 20% in
pethidine group, 28% in
control group.
Severe postpartum hemorrhage:
4% in acupuncture group,
0% in pethidine group, 8% in
control group.
APGAR 1 (mean): 8.57 in
acupuncture group, 8.13 in
pethidine group, 8.5 in
control group.
APGAR 5 (mean): 9.90 in
acupuncture group, 9.97 in
pethidine group, 9.77 in
control group.
Asadi et al. To examine the 63 parturients Randomly distributed No statistical significance of Iran
(2015) effects of to acupuncture decrease in pain score in both
acupuncture (n = 32) and control groups.
on labor (n = 31) groups. No difference of serum cortisol
Both groups used level between both groups.
fentanyl Duration of labor (mean): 162
50 ug. minutes in acupuncture
Acupuncture: 20 group, 280 minutes in control
minutes. group.
Dong, Hu, To examine the 180 parturients, Assigned to VAS score reduction >3: 33% in China
Liang, effects of aged 20–35 acupuncture at EX-B2 group, 22% in SP6
and electro- EX-B2 (jiaji) group, 2% in routine
Zhang acupuncture (n = 60), intrapartum care group.
(2015) on labor pain acupuncture at SP6 Use of oxytocin: 55% in EX-B2
(sanyinjiao) group, 53% in SP6 group,
(n = 60), and 65% in routine intrapartum
routnine care group.
intrapartum care Duration of the third labor stage
(n = 60) groups. (mean): 9.9 minutes in EX-B2
group, 10.2 minutes in SP6
group, 11.1 minutes in routine
intrapartum care group.
APGAR 1 (mean): 9.90 in EX-B2
group, 9.93 in SP6 group,
9.88 in routine intrapartum
care group.
APGAR 5 (mean): 9.99 in EX-B2
group, 10 in SP6 group,
9.97 in routine intrapartum
care group.

(Continued)

Pdf_Folio:131
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Using Acupuncture in Labor Pain and Childbirth-Related Issues Cheng

SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Liu et al. To evaluate the 120 parturients, Randomly distributed Duration of the third stage of China
(2015) effects of Han’s aged 20–29 to acupuncture labor: 8.9 minutes in
acupoint nerve with HANS HANS group, 9.1 minutes in
stimulator on (n = 30), PCIA group, 9.4 minutes in
reducing labor intravenous PCEA group, 9.3 minutes in
pain analgesia (PCIA) control group.
(n = 30), epidural APGAR 1 and 5: no significant
analgesia (PCEA) differences among these
(n = 30), and groups.
control (n = 30) Neonatal weight (mean): 3,301
groups. g in HANS group, 3,276 g in
Acupuncture: PCIA group, 3,205 g in PCEA
30 minutes. group, 3,311 g in control
PCIA: ondansetron group.
(8 mg) for 5 Natural delivery: 90% in HANS
minutes, then group, 86%in PCIA group,
tramadol (1.5 86% in PCEA group, 66% in
mg/kg; 50 mL, control group.
background Instrumental delivery: 6% in all
infusion 2 mL/h, groups.
PCA dose of 2 mL, Caesarean section: 3% in HANS
lockout interval of group, 6%in PCIA group, 6%
10 minutes. in PCEA group, 26% in
PCEA: intrathecal control group
injection Use of oxytocin: 40% in HANS
ropivacaine group, 20%in PCIA group,
(3 mg), and 43% in PCEA group, 46% in
epidural catheter control group.
with 100 mL Postpartum hemorrhage: 127 mL
ropivacaine (0.1%) in HANS group, 133 mL in
and sufentanil PCIA group, 125 mL in PCEA
(50 ug), patient group, 140 mL in control
controlled group.
analgesia (PCA) Complication rate: 7% in HANS
dose of 5 mL, group, 27%in PCIA group,
lockout interval of 13% in PCEA group, 7% in
10 minutes. control group
Control group: no
analgesia.
Chen, Zhao, To investigate 500 parturients, Randomly distributed Normal vaginal delivery: 92% in China
and Yang the effects of aged 23–35 to acupuncture acupuncture with relaxation
(2014) acupuncture with relaxation (n = group, 78% in conventional
with relaxation 250) methods group.
techniques on and conventional Instrumental delivery: 2% in
labor methods (e.g., deep acupuncture with relaxation
breathing) (n = group, 7% in conventional
250) groups. methods group.
Caesarean section: 6% in
acupuncture with relaxation
group, 15% in conventional
methods group.
Delivery time: 6 hours in
acupuncture with relaxation
group, 8 hours in
conventional methods group.
Pdf_Folio:132

(Continued)
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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Mucuk and To investigate the 120 parturients Distributed to Pain score: 8 in Turkey
Baser effects on transcutaneous LI4 group, 9 in SP6 group,
(2014) transcutaneous electrical nerve 10 in no TENS group.
electrical nerve stimulator (TENS) at Duration of delivery (mean): 6
stimulator LI4 (n = 40), hours in LI4 group, 7 hours in
(TENS) at LI4 acupuncture at SP6 SP6 group, 8 hours in no
and SP6 on (n = 40), and no TENS group.
labor TENS (n = 40)
groups.
Yao, Qian, To examine the 150 parturients Randomly allocated First grade pain: 6% in China
and Luo effects of to acupuncture acupuncture with music
(2014) acupuncture with music therapy therapy group, 0% music
with music (n = 75) and music therapy with analgesia group.
therapy on therapy Second grade pain: 88% in
labor pain with analgesia acupuncture with music
(n = 75) groups. therapy group, 6% music
Acupuncture: 15–30 therapy with analgesia group.
minutes. Third grade pain: 5% in
acupuncture with music
therapy group, 68% music
therapy with analgesia group.
Fourth grade pain: 0% in
acupuncture with music
therapy group, 25% music
therapy with analgesia group.
Vixne et al. To compare the 253 parturients Randomly assigned to Pain worse than expected: 52% Sweden
(2014) effects of manual in manual acupuncture
acupuncture, acupuncture group, 54% in
electro- (n = 83), electro- electro-acupuncture group,
acupuncture, acupuncture 66% in standard care group.
and standard (n = 87), and Pain scores: manual
care on labor standard care acupuncture group < electro-
(n = 83) groups. acupuncture group about 120
Acupuncture: 40 and 270 minutes, standard
minutes. care group < acupuncture
groups about 360 minutes.
Use of epidural analgesia: 61%
in manual acupuncture
group, 46% in
electro-acupuncture group,
70% in standard care group.
Use of sterile water injection:
12% in manual acupuncture
group, 5% in
electro-acupuncture group,
10% in standard care group.

(Continued)

Pdf_Folio:133
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Using Acupuncture in Labor Pain and Childbirth-Related Issues Cheng

SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Subjective feeling of pain relief:

44% in manual acupuncture
group, 67% in
electro-acupuncture group, no
data in standard care group.
Relaxation: 59% in manual
acupuncture group, 73% in
electro-acupuncture group, no
data in standard care group.
Electro-acupuncture group used
less analgesia than manual
acupuncture and standard care
groups.
APGAR 5 < 7: 1.2% in manual
acupuncture group, 2.3% in
electro-acupuncture group, 0%
in standard care group.
Adverse effect: 10% in manual
acupuncture group, 7% in
electro-acupuncture group.
Request same treatment in future
delivery: 61% in manual
acupuncture group, 68% in
electro-acupuncture group, no
data in standard care group.
Vaginal delivery: 75% in
3three groups. Instrumental
delivery: 17% in manual
acupuncture group, 20% in
electro-acupuncture group, 12%
in standard care group.
Caesarean section: 8% in manual
acupuncture group, 6% in
electro-acupuncture group, 13%
in standard care group.
Duration of labor (mean): 378
minutes in manual acupuncture
group, 319 minutes in
electro-acupuncture group, 398
minutes in standard care group.
Infant birth weight (mean): 3,509 g
in manual acupuncture group,
3,593 g in electro-acupuncture
group, 3,656 g in standard care
group.

(Continued)

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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Ajori, To compare the 75 parturients Randomly assigned to No significant difference in Iran

Nazari, effects of acupuncture labor induction between
and acupuncture (n = 38) and sham acupuncture and sham
Eliaspour and sham acupuncture acupuncture.
(2013) acupuncture on (n = 37) groups. Spontaneous labor: 95% in
labor induction Acupuncture: 30 acupuncture group, 90% in
minutes. sham acupuncture group.
Normal vaginal delivery: 92% in
acupuncture group, 81% in
sham acupuncture group.
Caesarean section: 8% in
acupuncture group, 19% in
sham acupuncture group.
Stimulation of labor: 28% in
acupuncture group, 36% in
sham acupuncture group.
Interval from procedure to
delivery: 7.8 days in
acupuncture group, 9.5 days
in sham acupuncture group.
APGAR 1 (mean): 8.9 in
acupuncture group, 8.7 in
sham acupuncture group.
APGAR 5 (mean): 9.4 in
acupuncture group, 9.5 in
sham acupuncture group.
Foetal distress: 3% in
acupuncture group, 5% in
sham acupuncture group.
Admission to neonatal intensive
care unit: 0% in both groups.
Mucuk, To assess the 78 parturients Randomly assigned to Level of adrenocorticotrophic Turkey
Baser, effects of electro- hormone (mean): 27 mL in
and electro- acupuncture acupuncture group, 64 mL in
Ozkan acupuncture (n = 39) and control control group.
(2013) on labor (n = 39) groups. Level of cortisol (mean): 17 dL
in acupuncture group, 22 dL
in control group.
Pain score after 30 minutes
(mean): 7.9 in acupuncture
group, 8.7 in control group.
Acupuncture: Pain score after 60 minutes
20 minutes. (mean): 8.2 in acupuncture
group, 8.9 in control group.

(Continued)

Pdf_Folio:135
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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Ma et al. To examine the 350 parturients, Randomly distributed Stage of labor: 443 minutes China
(2011) effects of aged 24–35 to acupuncture in acupuncture group,
acupuncture at (n = 116), sham 480 minutes in sham
SP6 on labor acupuncture (n = acupuncture group, 444
pain 117), and control minutes in control group.
(n = 117) groups. Labor pain scores in the
Acupuncture: 30 acupuncture groups < in
minutes. control group, labor pain
scores in the acupuncture
group < in sham acupuncture
group.
No adverse effects in
acupuncture groups.
MacKenzie To evaluate the 105 parturients Randomly allocated to No side effects or United
et al. effects of manual complications. Kingdom
(2011) acupuncture acupuncture Vaginal delivery: no significant
on labor pain (n = 26), electro- differences in the interval
acupuncture between the onset of labor
(n = 26), sham and delivery or the lengths of
acupuncture the first and second stages of
(n = 14), sham- labor between the
electro- acupuncture and control
acupuncture groups or the sham
(n = 13), and acupuncture and control
control groups.
(n = 26) groups. No analgesia: 31% in manual
Manual acupuncture: and electro-acupuncture
30–60 minutes. groups, 30% in sham groups,
Electro-acupuncture: 19% in control group.
30 minutes. Spontaneous vaginal delivery:
27% in manual and
electro-acupuncture groups,
48% in sham groups, 31% in
control group.
Instrumental delivery: 52% in
manual and
electro-acupuncture groups,
33% in sham groups, 35% in
control group.
Caesarean section: 21% in
manual and
electro-acupuncture groups,
19% in sham groups, 35% in
control group.
APGAR 1 < 4: 6% in manual
and electro-acupuncture
groups, 4% in sham groups,
0% in control group.
APGAR 5 < 8: 0% in groups.
Days to discharge: 2 days in
manual and

(Continued)

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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

electro-acupuncture groups,
1 day in sham groups, 2.5
days in control group.
Modlock, To look into the 125 parturients Randomly assigned to Length of labor (mean): 448 Denmark
Nielsen, effects of acupuncture minutes in acupuncture
and acupuncture on (n = 62) and sham group, 403 minutes in sham
Uldbjerg labor induction acupuncture acupuncture group.
(2010) (n = 63) groups. Postpartum bleeding: 25% in
Acupuncture: 30 acupuncture group, 24% in
minutes sham acupuncture group.
Natural delivery: 68% in
acupuncture group, 67% in
sham acupuncture group.
Caesarean delivery: 18% in
acupuncture group, 19% in
sham acupuncture group.
Peng et al. To examine the 305 parturients Distributed to Spontaneous vaginal delivery: China
(2010) effects of transcutaneous 80% in TENS group, 82% in
transcutaneous electrical nerve control group.
electrical nerve stimulator (TENS) Instrumental delivery: 9% in
stimulator on (n = 160) and TENS group, 7% in control
labor pain control group.
(n = 145) groups. Caesarean section: 11% in TENS
TENS: 30 minutes group, 12% in control group.
Use of oxytocin: 62% in TENS
group, 53% in control group.
Postpartum hemorrhage: 136 mL
in TENS group, 166 mL in
control group.
APGAR 1 > 7: 96% in both
groups.
APGAR 5 > 7: 99% in both
groups.
Asher et al. To compare the 89 parturients Randomly allocated Spontaneous labor: 67% in United States
(2009) effects of to acupuncture acupuncture group, 69% in
acupuncture, (n = 30), sham sham acupuncture group,
sham acupuncture 73% in control group.
acupuncture, (n = 29), and Caesarean section: 20% in
and routine control (n = 30) acupuncture group, 7% in
prenatal care groups. sham acupuncture group,
on labor All groups were 10% in control group.
induction offered routine Postpartum complications: 10%
prenatal care. in acupuncture group, 6% in
Acupuncture: 30 sham acupuncture group, 3%
minutes, maximum in control group.
5 sessions over 2 Intrapartum foetal distress: 23%
weeks. in acupuncture group, 34% in
sham acupuncture group,
20% in control group.

(Continued)

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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Mean APGAR 1: 7.7 in

acupuncture group, 7.9 in
sham acupuncture group,
8.2 in control group.
Mean APGAR 5: 8.8 in
acupuncture group, 8.9 in
sham acupuncture group, 9 in
control group.
Borup, To compare the 490 parturients Randomly assigned to Significantly fewer women in Denmark
Wurlitzer, effects of acupuncture the acupuncture group were
Hedegaard, acupuncture (n = 272), TENS treated with nitrous oxide,
Kesmodel, with (n = 106), and pethidine, or sterile water
and transcutaneous traditional papules compared with the
Hvidman electric nerve analgesics traditional group and fewer
(2009) stimulation (n = 112) groups. chose sterile water papules
(TENS) and Acupuncture: 30–120 compared with the TENS
traditional minutes. TENS: 120 group.
analgesics on Z unit, 20–45 Significantly fewer women in the
labor pain minutes. acupuncture group received
pharmacological or invasive
pain relief, or both, compared
with the other groups.
No significant differences of
pain severity among the three
groups.
In the acupuncture group, 59%
of the women thought that
acupuncture gave some or
substantial pain relief, 55%
that it had a somewhat or
very calming effect, and 86%
that it had no side effects; in
connection with a future
delivery, 53% answered
positively.
In the TENS group, 34% of the
women reported that TENS
gave some or substantial pain
relief, 23% that it had a
somewhat or very calming
effect, and 84% that it had no
side effects; in connection
with a future delivery, 18%
answered positively.
The three groups assessed the
same degree of pain intensity
during labor. The women in
the acupuncture group
tended to report a lower score
2 hours postpartum.

(Continued)

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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Women in the acupuncture

group tended to report a
higher degree of relaxation
and control compared with
the other groups.
The duration of labor and the
need for augmentation with
oxytocin were similar among
the three groups.
Citkovitz et To examine the 172 parturients, Allocated to Non-caesarean section: 93% in United States
al. (2009) effects of aged 18–40 acupuncture acupuncture group, 80% in
acupuncture (n = 45) and control group.
on labor control AGPAR 1 < 7: 7% in
(n = 127) groups. acupuncture group, 5% in
control group.
AGPAR 5 < 7: 2% in
acupuncture group, 2% in
control group.
Episiotomy: 57% in acupuncture
group, 51% in control group.
Duration of second labor stage
(mean): 38 minutes in
acupuncture group, 32
minutes in control group.
Use of epidural analgesia: 62%
in acupuncture group, 34% in
control group.
Elden, To compare the 383 parturients Randomly allocated Use of oxytocin: 30% in Sweden
Ostgaard, effects of to acupuncture plus acupuncture plus standard
Fagevik- acupuncture, standard treatment treatment, 24% in standard
Olsen, stabilizing (n = 124), standard treatment plus specific
Ladfors, exercise, and treatment plus stabilizing exercises, 26% in
and standard specific stabilizing standard treatment alone
Hagberg treatment on exercises groups.
(2008) reducing pelvic (n = 130), standard Labor induction: 12% in
girdle pain in treatment alone acupuncture plus standard
pregnant (n = 129) groups. treatment, 9% in standard
women Acupuncture: treatment plus specific
10–30 minutes per stabilizing exercises, 5% in
session, twice a standard treatment alone
week, 6 weeks, groups.
total 12 weeks. Spontaneous delivery: 75% in
acupuncture plus standard
treatment, 82% in standard
treatment plus specific
stabilizing exercises, 83% in
standard treatment alone
groups.
Instrumental delivery: 4% in
acupuncture plus standard
treatment, 2% in

(Continued)

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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

standard treatment plus

specific stabilizing exercises,
2% in standard treatment
alone groups.
Caesarean delivery: 15% in
acupuncture plus standard
treatment, 14% in standard
treatment plus specific
stabilizing exercises, 12% in
standard treatment alone
groups.
Preterm delivery: 4% in
acupuncture plus standard
treatment, 5% in standard
treatment plus specific
stabilizing exercises, 5% in
standard treatment alone
groups.
No serious adverse effects.
Feeling good and very good:
77% in acupuncture plus
standard treatment, 73% in
standard treatment plus
specific stabilizing exercises,
67% in standard treatment
alone groups.
Feeling no effect on pelvic pain:
2% in acupuncture plus
standard treatment, 4% in
standard treatment plus
specific stabilizing exercises,
3% in standard treatment
alone groups.
Smith, To compare the 365 parturients Randomly distributed Spontaneous onset of labor: Australia
Crowther, effects of to acupuncture 28% in acupuncture group,
Collins, acupuncture (n = 181), and 31% in sham acupuncture
and and sham sham acupuncture group.
Coyle acupuncture (n = 183) groups. Artificial rupture of membranes:
(2008) on postterm Acupuncture: Two 38% in acupuncture group,
induction 30–45-minute 42% in sham acupuncture
sessions over 2–3 group.
days before Prostaglandin: 47% in
planned induction. acupuncture group, 38% in
sham acupuncture group.
Oxytocin: 20% in acupuncture
group, 22% in sham
acupuncture group.
Hours from treatment to
delivery: 69 hours in
acupuncture group, 65 hours
in sham acupuncture group.

(Continued)

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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

No use of painkillers: 11% in

acupuncture group, 14% in
sham acupuncture group.
Normal vaginal delivery: 65%
in acupuncture group, 61% in
sham acupuncture group.
Operative delivery: 16% in
acupuncture group, 15% in
sham acupuncture group.
Caesarean section: 19% in
acupuncture group, 23% in
sham acupuncture group.
Feeling relaxed during
treatment: 37% in
acupuncture group, 39% in
sham acupuncture group.
Anxious about health and baby:
2% in acupuncture group, 2%
in sham acupuncture group.
Definitely will use in future
delivery: 61% in acupuncture
group, 50% in sham
acupuncture group.
Definitely will not use in future
delivery: 0% in both groups.
Chao et al. To assess the 100 parturients Randomly distributed Pain reduction: 62% in Taiwan
(2007) effects of to electro- electro-acupuncture group,
electro- acupuncture 14% in placebo group.
acupuncture (n = 50) and Use of epidural analgesia: 4%
on labor placebo in electro-acupuncture group,
(n = 50) groups. 10% in placebo group.
Acupuncture: 30 Duration of the second labor
minutes. stage (mean): 31 minutes in
electro-acupuncture
group, 34 minutes in placebo
group.
Spontaneous vaginal delivery:
76% in electro-acupuncture
group, 92% in placebo group.
Instrumental delivery: 18% in
electro-acupuncture group,
4% in placebo group.
Caesarean delivery: 6% in
electro-acupuncture group,
4% in placebo group.
Willingness of using same
treatment in future: 96% in
electro-acupuncture group,
66% in placebo group.

(Continued)

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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Birth weight (mean): 3,257 g in

electro-acupuncture group,
3,225 g in placebo group.
Qu and To examine the 36 parturients Randomly assigned to Better degree of relaxation and China
Zhou effects of electro- lower pain intensity in
(2007) electro- acupuncture electro-acupuncture group
acupuncture (n = 18) and no than no intervention group.
on labor intervention Significant higher
(n = 18) groups. concentration of serum ᆁ-EP
Acupuncture: 20 and 5-HT in the peripheral
minutes. blood at the end of the first
labor stage in
electro-acupuncture group
than no intervention group.
Nesheim et To evaluate the 390 parturients, Randomly distributed Acupuncture group: 89% no Norway
al. (2003) effects of aged 18–42 to acupuncture meperidine, 11% with
acupuncture (n = 106), no meperidine; but 34% no
on reducing the acupuncture other analgesia, 66% with
use of analgesia (n = 92), and other analgesia.
on labor control No acupuncture group: 63% no
(n = 92) groups. meperidine, 37% with
Acupuncture: meperidine; but 18% no
10–20 minutes. other analgesia used, 82%
Meperidine: with other analgesia.
25–100 mg. Control group: 71% no
meperidine, 29% with
meperidine; but 21% no
other analgesia, 79% with
other analgesia. Acupuncture
had no noticeable side
effects. 86% in acupuncture
group would willingly use
acupuncture during another
labor.
Ramnero, To compare the 90 parturients Randomly distributed No negative effects. Sweden
Hanson, effects of to acupuncture With epidural analgesia: 26% in
and acupuncture (n = 46) and acupuncture group, 50% in
Kihlgren and conventional conventional analgesia group.
(2002) conventional analgesia With warm rice bag for pain
analgesia on (n = 44) groups. relief: 15% in acupuncture
labor group, 52% in conventional
analgesia group.
Vaginal birth: 94% in
acupuncture group, 96% in
conventional analgesia group.
Duration of birth: 5.3 hours in
acupuncture group, 5.6 hours
in conventional analgesia
group.

(Continued)

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SOURCE RESEARCH SAMPLE SIZE INTERVENTION RESULTS RESEARCH

OBJECTIVE LOCATION

Infant birth weight: 3,670 g in

acupuncture group, 3,760 g in
conventional analgesia group.
APGAR 1: 0% in acupuncture
group, 4.5% in conventional
analgesia group.
APGAR 5: 0% in both groups.
Ternov, To assess the 167 Acupuncture was No major adverse effects, but Sweden
Grennert, adverse and parturients applied during the 17% suffered from minor
Åberg, analgesic second adverse effects such as
Algotsson, effects of and third trimesters dizziness, tiredness, and
and acupuncture of pregnancy. localized pain.
Åkeson on lower back Two to seven sessions About 3% reported no analgesic
(2001) pain and pelvic between weeks effect.
pain in late 13–36.
pregnancy
Kaplan et To assess the 104 parturients, Reductions in duration of the Israel
al. (1998) effects of aged 18–40 first labor stage, pain, and
transcutaneous use of analgesia.
electrical nerve No adverse effects on the
stimulator on mother and newborn baby.
labor
Kvorning, To examine the 180 parturients Distributed to No further pain treatment: 58% Sweden
Nilsson, effects of acupuncture in acupuncture group, 14% in
Löfberg, acupuncture (n = 90) and control control group. Willingness to
Algotsson, on labor (n = 90) groups. use same treatment in future:
and 94% in acupuncture group.
Åkeson
(1998)
van der To evaluate the 94 parturients Randomly assigned Labor pain reduction: 56% in The
Ploeg, effects of to TENS both groups. Netherlands
Vervest, transcutaneous (n = 46) and Spontaneous vaginal delivery:
Liem, electrical nerve placebo 63% in TENS group, 70% in
and van stimulator on (n = 48) groups. placebo group.
Leeuwen pain reduction Instrumental delivery: 17% in
(1996) during the first TENS group, 19% in placebo
stage of labor group.
Caesarean delivery: 20% in
TENS group, 10% in placebo
group.
Willingness to receive same
treatment in future: 61% in
TENS group, 56% in placebo
group.
APGAR 1 and 5: no significant
difference between two
groups.
No adverse effects. Birth weight
(mean): 3,360 g in TENS
group, 3,280 g in placebo
group.

(Continued)

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OBJECTIVE LOCATION

Martoudis To investigate the 168 parturients, Acupuncture: Very good analgesic effect: 47% Cyprus
and effects of aged 17–32 20–30 minutes. parturients, 63% nurses, 57%
Christofides electro- doctors.
(1990) acupuncture Medium analgesic effect: 25%
on labor parturients, 19% nurses, 25%
doctors.
Slight analgesic effect: 16%
parturients, 6% nurses, 6%
doctors.
Normal vaginal delivery: 68%.
Instrumental delivery: 25%.
Caesarean section: 7%.
APGAR 1: 9.6.
Lyrenäs, To investigate the 168 parturients Distributed Average lengths of the latent and Sweden
Lutsch, effect of to acupuncture active phase and the second
Hetta, acupuncture on (n = 56) and control stage of labor: 4.1, 3.4, and
and reducing length (n = 112) groups. 1.4 hours respectively in
Lindberg of delivery acupuncture group, 4.4, 3.5,
(1987) and 1.1 hours in control
group.
Umeh To examine the 30 parturients 63% participants reported Nigeria
(1986) effects of sacral analgesic effect, in which
acupuncture 32% reported no pain.
on labor pain 80% participants showed
willingness to use this
treatment in future.
HANS, Han’s acupoint nerve stimulator; APGAR, Appearance, Pulse, Grimace, Activity, Respiration.

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