Acupuncture, induction, and why I don’t know how much to squirm

We’ve attended a few birth classes here in New York, and they’ve been very good. The first was just an introduction to the Birthing Center at Roosevelt Hospital, but it included some general advice about low-interventionist birth. The second was a series of classes organised by Birthday Presence, which gave a broad overview of what to expect in giving birth, and how to cope with labour. We’ve been impressed, we’ve enjoyed attending, and we’d strongly recommend these classes. However, one thing has made me squirm a little: the frequent claims (in both classes) that acupuncture is a good, drug-free, way of inducing labour if the baby’s taking its time. These claims comes from both the teachers and the students. Apparently, acupunctural stimulation (actually moxibustion) of the little toes can also work wonders for turning a breech baby round.

This makes me squirm because there’s no scientific evidence for either of these claims. There’s also no good reason to think it would work.

And consider this: any expectant mother trying acupuncture as a means of inducing labour is likely to be pretty late in her pregnancy in any case, which means that she’s bound to go into labour pretty soon after any technique she tries. And she’s likely to be trying other techniques, some of which have some evidence behind them. In other words, most pregnant women will go into labour not very long after having acupuncture treatment to induce labour, which is a nice example of why correlation shouldn’t be taken to imply causation. Similarly, most babies turn around of their own accord eventually in any case (only about 3% to 4% of babies are breech at birth), and if they do so shortly after acupuncture treatment, then the parents are likely to associate the two things.

But I should be honest. I said there’s no evidence that it works, or reason to think that it should. What I really mean is that there’s no evidence that applying acupuncture needles (or warm mugwort) to particular special points of the body should do anything that other similarly dramatic rituals wouldn’t do. The point is that acupuncture is a relatively dramatic intervention, and there is good scientific evidence that dramatic interventions are associated with proportionally strong placebo effects. In fact, the placebo effect is really fascinating and much more powerful than people imagine. It would not be in the least surprising if labour could be induced by placebo (placebo does not mean that the effect is imaginary or “all in the head”). So while all the qi stuff and talk of special acupuncture points may be nonsense, acupuncture might in fact play a role in inducing labour. We might add that the ritual of acupuncture is also likely to be relatively calming, and to have something in common with grooming, which encourages the release of oxytocin, which helps induce labour (this is why having sex is supposed to help).

So maybe I shouldn’t squirm quite as much as I do.

You can read more about the evidence base of acupuncture here, by the way.

2 Comments

Filed under Life events, Thoughts and rants

2 responses to “Acupuncture, induction, and why I don’t know how much to squirm

  1. I am a former acupuncturist. We were taught not to do acupuncture on pregnant women especially because it had a high risk of inducing labor.

    Mechanism proposed for treatment were that signals going up from certain leg points would reflex off the pelvis plexus and stimulate the pelvic organs. This mechanism did not seem far fetched to me.

    But, as you say, the proof is in the testing and most study have small numbers or poor design.

    Remember, just because YOU can’t imagine a mechanism, doesn’t mean one doesn’t exist. Just as when theists say, “I can’t imagine how evolution could create all of this.” they tell us more of their lack of imagination and knowledge than they do about the truth of evolution.

    Does acupuncture turn a fetus? Like you, I doubt it — but perhaps not with as much adamant certainty.

    Best wishes on the birth training.

  2. Thank you for the good wishes, Sabio. You make a very fair point about imagination and the lack of it. And I agree that simply because I can’t imagine a mechanism, that doesn’t mean that there isn’t one. Indeed, the main point of my post was to stress that, while there seems to be no scientific basis to “qi” and the traditionally stated mechanisms of acupuncture (the fact that “sham acupuncture” seems to work just as well as acupuncture points away from these), that doesn’t mean that acupuncture doesn’t work. In fact (and perhaps I should have mentioned this) there’s quite good evidence that acupuncture DOES work, at least for pain relief. And, as I thought I’d made clear in my post, it’s not at all unreasonable to think it might help induce labour.

    My pet hypothesis, as hinted in the post, is that the physical response to acupuncture is related to our evolved response to conspecific grooming (plus the placebo effect more generally, although it may not be possible to entirely separate these). But as far as I know, this hypothesis is untested, and I’m not very sure how you would test it.

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