Summary of findings 2. Acupuncture compared to usual care for pain management in labour.
| Acupuncture compared to usual care for pain management in labour | ||||||
| Patient or population: pain management in labour Setting: hospital Intervention: acupuncture Comparison: care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care | Risk with acupuncture | |||||
| Pain intensity
assessed with VAS or NRS: lower scores indicate less pain
Scale from: 0 to 10 Mix of NRS and VAS scales so analysed using SMD |
The mean pain intensity score in the intervention group was 1.31 standard deviations lower (2.14 lower to 0.49 lower) | 495 (4 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | |||
| Satisfaction with pain relief in labour assessed with: number of women who reported satisfaction with pain relief | Study population | RR 1.07 (0.96 to 1.20) | 343 (2 RCTs) | ⊕⊕⊝⊝ LOW 3 | ||
| 787 per 1000 | 843 per 1000 (756 to 945) | |||||
| Sense of control in labour ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Satisfaction with childbirth experience ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Use of pharmacological analgesia | Study population | RR 0.72 (0.60 to 0.85) | 1059 (6 RCTs) | ⊕⊝⊝⊝ VERY LOW 4 5 | ||
| 833 per 1000 | 600 per 1000 (500 to 708) | |||||
| Assisted vaginal birth | Study population | RR 0.93 (0.70 to 1.24) | 1217 (6 RCTs) | ⊕⊕⊝⊝ LOW 6 8 | ||
| 127 per 1000 | 118 per 1000 (89 to 158) | |||||
| Caesarean section | Study population | RR 0.72 (0.47 to 1.09) | 861 (5 RCTs) | ⊕⊕⊝⊝ LOW 7 8 | ||
| 116 per 1000 | 83 per 1000 (54 to 126) | |||||
| *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; NRS: numeric rating scale; SMD: SMD: standardised mean difference; 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 two levels for very serious risk of bias: two of the three studies had high risk of performance bias and this was likely to influence a self‐reported outcome.
2 Downgraded two levels for very serious inconsistency: considerable heterogeneity present (I2 = 93%) not explained by subgroup analysis.
3 Downgraded two levels for very serious risk of bias: both studies had unclear or high risk of bias related to blinding and this was likely to influence a self‐reported outcome
4 Downgraded two levels for very serious risk of bias: all studies had unclear or high risk of performance bias and this was likely to influence the need for additional analgesia.
5 Downgraded one level for serious inconsistency: substantial heterogeneity (I2 = 70%) which is not explained by subgroups.
6 Downgraded one level for serious risk of bias: five of six studies at unclear or high risk of bias in both performance and detection bias. This may have influenced the outcome.
7 Downgraded one level for serious risk of bias: three of four studies at high or unclear risk of bias in both performance and detection bias. This may have influenced the outcome.
8 Downgraded one level for imprecision due to wide confidence intervals.