Acupoint stimulation combined with transcutaneous electrical nerve stimulation on labour pain: A stepped wedge cluster randomised controlled trial.

BACKGROUND

Labour pain management remains a critical concern, as pharmacological methods often carry side effects and potential risks. Non-pharmacological approaches, such as acupoint stimulation and transcutaneous electrical nerve stimulation (TENS) are being explored as viable alternatives. However, evidence regarding their combined use and overall effect on maternal and fetal outcomes remains limited.

AIM

This study aimed to evaluate the effectiveness of acupoint stimulation combined with TENS on labour pain, delivery outcomes, and childbirth experience for women undergoing a trial of labour.

METHODS

A parallel multi-arm, stepped wedge cluster randomized controlled trial was conducted with 600 women randomized into four groups: TENS, acupoint stimulation, TENS combined with acupoint stimulation, and a control group. The study assessed Visual Analog Scale (VAS) scores, Non-Pharmacological to Pharmacological Pain Management Interval (NPI), the rate of epidural analgesia, delivery outcomes, and childbirth experience.

RESULTS

After intervention, women's VAS scores in the TENS, acupoint stimulation, and combined groups were significantly lower than the control group at multiple time points (at 30 , 90, 120, 150, 180, 210, 240, and 270 min, P < 0.05). Non-pharmacological to pharmacological pain management intervals (NPIs) were significantly longer in all intervention groups compared to the control group (P < 0.001), with median NPIs ranging from 178 to 183.5 min in the intervention groups versus 104 min in the control group. A positive correlation was observed between NPI and childbirth experience scores (r = 0.101, P < 0.05). No significant differences were found in epidural analgesia rates, delivery outcomes, postpartum bleeding, Apgar scores, labour duration, or perineal tear rates (all P > 0.05). Childbirth experience scores (CEQ) were significantly higher in the TENS and combined groups compared to the control group (P < 0.01).

CONCLUSION

Acupoint stimulation combined with TENS is an effective non-pharmacological approach for alleviating labour pain and enhancing the overall childbirth experience. This integrated method is recommended for incorporation into labour pain management protocols, providing women with a valuable alternative or adjunct to pharmacological interventions.