title: Acupuncture and acupressure for pain management in labour and birth: a critical narrative review of current systematic review evidence.
abstract: BACKGROUND
  Reviews of maternity services highlight the need for a reduction of medical interventions for women with low risk pregnancies and births to prevent the potential cascade of interventions and their associated risks. Complementary medicines (CM) such as acupuncture and acupressure have claimed to be effective in reducing interventions in labour; however, systematic reviews of evidence to date are conflicting.
  
  
  OBJECTIVE
  To examine current evidence from systematic reviews on the topic of acupuncture and acupressure for pain management in labour and birth, and to evaluate the methodological and treatment frameworks applied to this evidence.
  
  
  METHODS
  A search limited to systematic reviews of the MEDLINE, CINAHL, PUBMED, EMBASE and Cochrane databases was performed in December 2013 using the keywords 'CAM', 'alternative medicine', 'complementary medicine', 'complementary therapies', 'traditional medicine', 'Chinese Medicine', 'Traditional Chinese Medicine', 'acupuncture', 'acupressure', cross-referenced with 'childbirth', 'birth', labo*r', and 'delivery'. The quality of the evidence is also evaluated in the context of study design.
  
  
  RESULTS
  The RCTs included in these systematic reviews differed in terms of study designs, research questions, treatment protocols and outcome measures, and yielded some conflicting results. It may be inappropriate to include these together in a systematic review, or pooled analysis, of acupuncture for labour with an expectation of an overall conclusion for efficacy. Trials of acupuncture and acupressure in labour show promise, but further studies are required.
  
  
  CONCLUSIONS
  The use of current systematic reviews of the evidence for acupuncture and acupressure for labour and birth may be misleading. Appropriate methods and outcome measures for investigation of acupuncture and acupressure treatment should more carefully reflect the research question being asked. The use of pragmatic trials designs with woman-centred outcomes may be appropriate for evaluating the effectiveness of these therapies.
authors.affiliation: National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia. Electronic address: K.Levett@uws.edu.au.
authors.forename: K M
authors.initials: KM
authors.lastname: Levett
authors.affiliation: National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia. Electronic address: Caroline.Smith@uws.edu.au.
authors.forename: C A
authors.initials: CA
authors.lastname: Smith
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales, Australia. Electronic address: H.Dahlen@uws.edu.au.
authors.forename: H G
authors.initials: HG
authors.lastname: Dahlen
authors.affiliation: National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia. Electronic address: A.Bensoussan@uws.edu.au.
authors.forename: A
authors.initials: A
authors.lastname: Bensoussan
mesh_terms: D019050:Acupressure; D015670:Acupuncture Therapy; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000628:therapy*; D059408:Pain Management; D011247:Pregnancy
keywords: Acupressure; Acupuncture; CAM; CAM for labour and birth; Intervention cascade; Labour and birth; Pragmatic trials; Pregnancy and childbirth; Systematic reviews