Introduction
Acupuncture treatment during labour —a randomized controlled trial is an article that appears in BJOG- an International Journal of Obstetrics and Psychology and was authored by Agneta Ramnero, Ulf Hanson, and Mona Kihlgren. All three are professionals in the field of obstetrics and gynecology: Ramnero is a researcher in the Department of Obstetrics and Gynaecology, Orebro University Hospital, Orebro, Sweden, Hanson works at the Centre for Nursing Science at the same university while Kihlgren works in the Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden.
The authors have written many papers on gynecology and childbirth and their contribution to the paper is valuable as they are qualified, experienced and therefore competent. This paper has been cited by several researchers and this attests to its credibility.
The critique paper will employ the Research framework as put forward by Caldwell et al (2005). Acupuncture treatment during labour investigates the use of acupuncture to reduce pain and bring relaxation during labour, and to improve the labour experience (Ramnero et al, 2002). The authors mention that acupuncture has been used by the Chinese for thousands for years and has recently been used widely in Sweden during childbirth.
However, the effectiveness of this treatment method has not been ascertained through any randomized controlled trial experiment. Analgesic effects of acupuncture have been verified in some researches, however, other scientists differ on this finding. The divergent opinions stem from the application of different scientific methods. The World Health Organization (WHO) does not approve of this treatment method, rather, it mentions that further studies should be undertaken to ascertain its effectiveness.
Objective
In undertaking the research, the researchers seek to document the effectiveness of using acupuncture during labour concerning reducing pain, level of relaxation, and the result of the delivery in comparison with conventional analgesic method. The author’s subject of study was important since various studies done previously have had varying findings in the use of acupuncture during pregnancy, labour and childbirth.
Tempfer et al (1998) reported that “prenatal acupuncture treatment significantly reduced the duration of labour and may be proposed as a valuable tool in prenatal preparation”, Skilnand et al (2002) reported that acupuncture reduces labour pains and shortens delivery time, while Lyrenäsa et al (1987) reported that acupuncture treatment did not shorten delivery time, rather, this treatment method lengthened pregnancy and increased and prolonged labour. Therefore, the research aims at clearing out the confusion as to the use of acupuncture during labour.
Methods
The study was undertaken during a 14-month duration at a health centre in Sweden, the chosen health center has a mean of 2200 deliveries annually. The research used 100 women, a number that is low as it represents only 4.5% of all births in the hospital annually, and the research lasted 14 months.
A larger sample, say of 660 (30%) would give a better outcome. Indeed, a previous study undertaken by Borup et al (2009) on the effectiveness of acupuncture during delivery used a sample size of 607 women. In the present study, 51 women were given acupuncture treatment while 49 did not receive the treatment (control sample).
5 women from each sample were marked as missing since they did not meet the qualifications required of the samples. All data collected during the experiment were recorded by midwives during each delivery. The information included the use of analgesia, age of the participants, duration of labour, outcome of birth, and child birthweights.
Data Analysis and Results
The experimental data was analyzed using SPSS with a 95% confidence interval for both discrete and continuous data while differences between group means was measured using a Student’s t- Test and variations in frequencies calculated using the chi-squared test. Assessments of the levels of pain were made by the individual members of the sample (parturient) as they can give more accurate results than an observer. This was done to eliminate discrepancies in pain assessment between observer and parturient in previous studies (Rajan 1993).
The researchers report that there were no noteworthy variations in the labour process, i.e. frequency of vaginal births and length of labour. However, there was a considerable felling of relaxation arising from the use of acupuncture.
Discussion of Findings
The author’s conclusion that acupuncture had no effect on the outcome of the labour process ignored some important aspects. Duration of labour is affected by several factors, especially in the first stage. One factor is obstetric analgesia. Although Ramnero et al seem less bothered by the fact that women who received acupuncture treatment did not have a lower need for analgesics, these women may have received it afterwards if there was a belief that less analgesia would be essential.
The authors do not provide this information. The authors also fail to give vital information that would have affected the outcome of the study, these include the mean age of the sample size, parity (number of children delivered previously), and blood pressure.
Factors such as psychotherapy, stress reduction sessions, psychological support at home and at work, or any plausible intervention technique plays the same role as acupuncture.
Other factors that affect the duration of labour are not mentioned in the report, for example, the presence of a supportive companion is known to shorten the labour duration by up to 10 hours (Sosa et al 1980, Langer et al 1998), and a consideration of this factor would have the study more accurate.
A report of this nature should not have ignored the effects of psychosocial support, besides, it is unacceptable that the control sample group was not accorded any form of placebo intervention. Even if the findings of this report were positive on the use of acupuncture during the labour process, the findings in this setting would have been forced through non-clinical methods. There are more scientific, pleasant, and rational methods of eliciting responses during a research of this kind.
Conclusion
In choosing to undertake a study on the effects of acupuncture on the labour process, Ramnero et al sought to clear out the uncertainty as to whether acupuncture treatment affects this process with respect to the duration of birth, relaxation, and reduction of pain. Even though their findings and conclusion agree with those from previous studies, some fundamental aspects of experimental research were not attained, and these are likely to have affected the outcome.
Therefore, more research needs to be done on this topic. Future studies need to consider all variables that can affect the parturition process, these include the mean age of the sample size, parity, blood pressure, the presence of a supportive companion, and psychological support before the parturition process. Besides, a larger sample size spread over a wider geographical area will give better results.
References
Borup, L., Wurlitzer, W., Hedegaard, M., Kesmodel, S., and Hvidman L. (2009). Acupuncture as pain relief during delivery: a randomized controlled trial. Birth. 36(1): 5-12.
Caldwell, K., Hernshaw, L., and Taylor, G. (2005). Developing a Framework for Critiquing Health Research. Journal of Health, Social and Environmental Issues, Vol. 6, No. 1. 45-54.
Langer, A., Campero, L., Garcia, C., and Reynoso, S. (1998). Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers’ well-being in a Mexican public hospital: a randomized clinical trial. Br J Obstet Gynaecol. 105(10): 1056-1063.
Lyrenäsa, S., Lutschb, H., Hettac, J., Lindberga, B. (1987). Acupuncture before Delivery: Effect on labour. Gynecol Obstet Invest 24: 217-224.
Rajan, L. Perception of pain and pain relief in labour: the gulf between experience and observation. Midwifery, 9(3): 136–145.
Ramnero, A., Hansona, U., Kihlgren, M. (2002). Acupuncture treatment during labour—a randomized controlled trial. BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 109, pp. 637–644.
Skilnand, E., Fossen, D., Heiberg, E. (2002). Acupuncture in the management of pain in labour. Acta Obstetricia et Gynecologica Scandinavica, Volume 81, Issue 10. 943–948.
Sosa, R., Kennell, J., Klaus, M., Robertson, S., and Urrutia, J. (1980). The effect of a supportive companion on perinatal problems, length of labour, and mother-infant interaction. NEJM, 303:597-600.
Tempfer, C., Zeisler, H., Mayerhofer, K., Barrada, M., Husslein, P. (1998). Influence of Acupuncture on Duration of labour. Gynecol Obstet Invest 46: 22-25.