2020 Cochrane Review Findings:

A 2020 Cochrane Review (1) looked at evidence from 15 acupressure studies. The studies all used a fixed set of acupoints, meaning that every laboring person in each individual study had the same points stimulated. The points were not chosen based on the individual or their feedback. However the points used were not the same in each study. The most commonly used points across all studies were LI 4 and SP 6, though these points were not used in every study. The acupressure group was compared to either sham acupressure (light touch, gentle massage or stimulation of non-acupressure points), usual care or a combined control of both. The researchers measured outcomes such as pain intensity, the amount of pharmacological analgesia used, length of labor, c-section rates and overall satisfaction with pain relief. Researchers measured the intensity of pain using a rating system called a Visual Analog Scale (VAS), in which the person in labor rated their pain on a scale of either 1 to 10 or 1 to 100, with lower numbers indicating less pain.

The Cochrane Review authors concluded that acupressure may help relieve pain and reduce c-sections. When compared to sham acupressure, there was low certainty of the evidence for an effect on pain intensity and rate of assisted vaginal birth, and little to no effect found on the use of pharmacological analgesia. Researchers found moderate certainty that acupressure reduces c-section rates (4 trials with 313 women). When acupressure was compared to usual care, there was low certainty evidence of an effect on pain intensity or satisfaction with pain relief. There was also low certainty that there is little to no effect on c-section rates. More studies are needed comparing acupressure to usual care overall. When acupressure was compared to a combined control, moderate certainty evidence exists that acupressure slightly decreases pain intensity and low certainty evidence exists for any effect on pharmacological analgesia used, satisfaction with childbirth, assisted vaginal birth rates or c-section rates. We need more high quality studies that compare acupressure to sham or usual care in order to reach firm conclusions about whether or not acupressure during labor has an effect on any of these outcomes. The Cochrane Review authors also called for more studies which looked at outcomes on sense of control in labor, satisfaction with childbirth experience and with pain relief.

Notable findings from other studies:

One study published in 2016 by Kate Levett’s group (4) had a very interesting design and encouraging results. The well designed study was a randomized controlled trial with 176 low risk, nulliparous participants in Australia. Roughly half were assigned to attend a 2 day antenatal education course where they were taught 6 techniques for pain management during labor called The Complementary Therapies for Labor and Birth Protocol (CTLB). This included education in acupressure, visualization and relaxation, breathing, massage, yoga techniques and facilitated partner support. The other half, the control group, received standard care alone. The participants in the CTLB group had a statistically significant reduction in epidural use and cesarean section rate as well as a statistically significant reduction in rates of labor augmentation, length of the second stage of labor and reduced perineal trauma. Although this is just one study, it was well designed and demonstrates the potential impact of using a variety of noninvasive, non-pharmacological complementary techniques which are tailored to the individual in labor.  

The acupressure points and their descriptions can be found in this simple guidebook created by one of my mentors, Debra Betts.

In addition to the desire for better outcomes and higher satisfaction with the labor and delivery process, practical measures such as cost-savings (both to payers and patients) are useful to explore. In conjunction with their 2016 study, Levett et al examined the cost savings associated with a reduction in cesarean sections for women who participated in a 2 day antenatal education course (9). The women and a support person were taught a variety of complementary support techniques. Although the exact cost savings will differ based on the country and the health insurance payer (this could be government funded or private insurance), this particular analysis which took place in Australia found significant savings when a cesarean section was avoided. While not all c-sections are preventable, when it is possible, there is obvious benefit both to the health of the birthing person as well as to the payer.