Summary of findings for the main comparison. Acupuncture compared to sham control for pain management in labour.
| Acupuncture compared to sham control for pain management in labour | ||||||
| Patient or population: pain management in labour Setting: hospital Intervention: acupuncture Comparison: sham control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with sham control | Risk with acupuncture | |||||
| Pain intensity
assessed with VAS scales 1‐100. Lower scores indicate less pain intensity |
The mean pain intensity ranged across control groups from 52.94 to 91.4 | The mean pain intensity score in the intervention group was 4.42 lower (12.94 lower to 4.09 higher) | 325 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| Satisfaction with pain relief in labour assessed with: number of women stating they were satisfied with their pain relief. | Study population | RR 2.38 (1.78 to 3.19) | 150 (1 RCT) | ⊕⊕⊕⊝ MODERATE3 | ||
| 387 per 1000 | 920 per 1000 (688 to 1000) | |||||
| Sense of control in labour ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Satisfaction with childbirth experience ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Use of pharmacological analgesia | Study population | RR 0.75 (0.63 to 0.89) | 261 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 4 | ||
| 767 per 1000 | 576 per 1000 (483 to 683) | |||||
| Assisted vaginal birth | Study population | RR 1.10 (0.41 to 2.97) | 261 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 4 5 6 | ||
| 163 per 1000 | 179 per 1000 (67 to 483) | |||||
| Caesarean section | Study population | RR 1.11 (0.49 to 2.48) | 411 (3 RCTs) | ⊕⊕⊝⊝ LOW7, 8 | ||
| 49 per 1000 | 54 per 1000 (24 to 122) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; VAS: visual analogue scale | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Downgraded one level due to serious risk of bias: one study high or unclear risk of bias on six domains.
2 Downgraded one level due to serious inconsistency: substantial heterogeneity present I2 = 87%
3 Downgraded one level due to serious imprecision: small sample size (150)
4 Downgraded one level due to serious risk of bias: one study did not blind participants to group allocation. Should not affect sham arm outcome but blinding integrity not reported.
5 Downgraded one level due to serious inconsistency: substantial heterogeneity present I2 = 72%
6 Downgraded one level for imprecision due to small sample size and wide confidence intervals crossing the line of no effect
7 Downgraded one level for imprecision due to small number of events and wide confidence intervals crossing the line of no effect
8 Downgraded one level due to serious risk of bias: one study did not blind participants to group allocation and two studies at high risk of other bias