In this section, we’ll explore the question posed by P. Curtis et al (15) who asked: “Is there a fundamental difference between using acupuncture to help prepare for labor (weeks before the delivery date) and using acupuncture to initiate or induce labor?”

Acupuncturist and researcher Debra Betts has written articles and co-authored studies describing a theoretical framework for pre-birth acupuncture treatments which is supported by the experience of midwives and other acupuncturists as well as data on labor and birth outcomes (12, 13). She has found that approaching pre-birth treatments with a singular focus on trying to induce contractions in women near or past their due dates is both problematic and ineffective, stating that “I realized in hindsight that attempts to stimulate contractions in women facing a medical induction were of limited value if the underlying reason for delayed labor had not been addressed” (11). She recommends an emphasis on acupuncture and acupressure for optimizing baby’s position, offering symptomatic relief from physical discomforts (lower back and pelvic pain or fatigue, for example) and aiding in stress reduction and emotional readiness. It is only after these three things have been achieved (and ideally the Bishop Score indicates readiness for labor) should acupuncturists try to stimulate contractions (11).

Betts and Lennox conducted a naturalistic observational study in which they tracked the labor and birth outcomes of 169 New Zealand women who had this more comprehensive style of pre-birth acupuncture (12). The acupuncture treatments were administered weekly beginning at weeks 36 or 37 by their midwives (14 midwives participated in the study), and outcomes were compared to those who had no acupuncture but were also under midwifery-only care in the same area in New Zealand. They reported a 35% reduction in the need for inductions (43% reduction for first time moms), a 31% decrease in epidural use, a 32% decrease in emergency c-sections and a 9% increase in normal vaginal birth. Although there are limitations to the design of an observational study, the findings suggest that this model of acupuncture care may show more benefit than treatments with the goal of inducing labor.

Many of the studies analyzed in the Cochrane Research review used a treatment approach which skipped over points for labor readiness and went straight to initiating contractions. I would love to see more studies utilizing treatment provided on a schedule that would be considered clinically relevant by acupuncturists as described by Debra Betts. Using comparative effectiveness research techniques and a pragmatic trial design may prove to be better suited to determine the benefit this type of approach could provide.

A 2020 enhanced clinical audit retrospectively looked at over 6000 women who either received prebirth acupuncture starting at week 37 or usual care at an NHS hospital in England. Among those receiving acupuncture, a statistically significant reduction was found in the number of surgical births, use of intrapartum analgesia and number of components of induction of labor (16). A reduction in the length of hospital stay was also statistically significant. Patient surveys were collected from those who had at least 4 acupuncture sessions, with the majority of patients reporting they felt acupuncture greatly benefitted their health and wellbeing and the availability of acupuncture would influence their choice of hospital in the future.