title: Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial.
abstract: BACKGROUND
  Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective.
  
  
  METHODS
  A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals . 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC).
  
  
  METHODS
  labour pain, assessed by Visual Analogue Scale (VAS).
  
  
  RESULTS
  relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women.
  
  
  RESULTS
  Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67).
  
  
  CONCLUSIONS
  Acupuncture does not reduce women's experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated. These findings were obtained in a context with free access to other forms of pain relief.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01197950.
authors.affiliation: Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Retzius väg 13A, 171 77 Stockholm, Sweden. linda.vixner@ki.se.
authors.forename: Linda
authors.initials: L
authors.lastname: Vixner
authors.forename: Erica
authors.initials: E
authors.lastname: Schytt
authors.forename: Elisabet
authors.initials: E
authors.lastname: Stener-Victorin
authors.forename: Ulla
authors.initials: U
authors.lastname: Waldenström
authors.forename: Hans
authors.initials: H
authors.lastname: Pettersson
authors.forename: Lena B
authors.initials: LB
authors.lastname: Mårtensson
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D015360:Analgesia, Epidural; D004558:Electric Stimulation; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000628:therapy*; D008137:Longitudinal Studies; D010146:Pain; D059408:Pain Management; D010147:Pain Measurement; D011247:Pregnancy; D012063:Relaxation; D055815:Young Adult