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Contents lists available at ScienceDirect

Women and Birth

journal homepage: www.elsevier.com/locate/wombi

ORIGINAL RESEARCH – QUANTITATIVE

The effect of acupressure on the initiation of labor:

A randomized controlled trial
Shahnaz Torkzahrani a, Fatemeh Mahmoudikohani b,*, Kiarash Saatchi c,
Reyhaneh Sefidkar d, Mojdeh Banaei b
a
Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
b
Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
c
Acupuncturist, Acupuncture Medicine Association, Tehran, Iran
d
School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

A R T I C L E I N F O A B S T R A C T

Article history: Background: Induction of labor is a common obstetric procedure. Acupressure is a natural method that is
Received 7 March 2016 used for inducing uterine contractions. Nevertheless, few studies have examined the impact of
Received in revised form 19 June 2016 acupressure on the induction of labor.
Accepted 1 July 2016
Aim: The aim of this study was to evaluate the effect of acupressure on the initiation of labor.
Material and methods: In this randomized clinical trial, 162 nulliparous pregnant women were admitted
Keywords: to the hospital. They were categorized into 3 groups; acupressure, sham acupressure and control.
Initiation of labor
Acupressure points SP6, BL 60 and BL 32 were pressured bilaterally. The intervention was done by the
Term pregnancy
researcher every other day between 9 am and 11 am. The intervention was carried out on women in the
Acupressure
Sham acupressure afternoon and the following day. Subjects were examined to determine the initiation of labor
Labor symptoms48 and 96 h after the start of intervention and at the time of hospitalization. Data were
analyzed using the ANOVA, Kruskal–Wallis and Chi-square tests (p < 0.05).
Results: There was no significant difference among the groups for spontaneous initiation of labor within
48 h (P = 0.464), and 49–96 h after beginning the intervention (P = 0.111) and 97 h after beginning the
intervention to the time of hospitalization for the spontaneous initiation of labor (P = 0.897). There were
no significant differences in the secondary outcomes between the groups.
Conclusion: According to the finding of this study, it seems that acupressure treatment was not effective
in initiating labor as compared with the sham acupressure and the routine care groups.
ß 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Summary of Relevance:
What is already known

Problem Within the scope of maternity care, women increasingly look

forward to a natural, non-invasive intervention, to enhance their
The use of interventions in labor has increased over the past pregnancy experience and to achieve a natural birth.
decade. The pharmacological induction of labor increases the
rate of intervention in labor and the risk of excessive uterine
activity, fetal distress and cesarean birth. What this paper adds
Pharmacological induction of labor is associated with adverse
birth outcomes whereas non-pharmacologic methods are safe
and have no side effects. This study evaluated the effect of
* Corresponding author at: Student Research Committee, School of Nursing and
acupressure on the initiation of labor.
Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Tel.: +98 9138543127.
E-mail address: mahmodi2020@yahoo.com (F. Mahmoudikohani).

http://dx.doi.org/10.1016/j.wombi.2016.07.002
1871-5192/ß 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Torkzahrani S, et al. The effect of acupressure on the initiation of labor: A randomized controlled trial.
Women Birth (2016), http://dx.doi.org/10.1016/j.wombi.2016.07.002
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2.2. Ethical consideration

1. Introduction
The protocol for this study was approved by the ethics and
Among most women, spontaneous labor pains start automati-
research committee of Shahid Beheshti University of Medical
cally in the near term and it leads to childbirth, but in some women
Sciences (No. SBMU2.REC.1394.48, Date 8/03/2015). The trial is
due to medical and obstetric problems during pregnancy, cervical
registered at Iranian Registry of Clinical Trials, number
ripening and induction of labor before the start of spontaneous
IRCT2015042321904N1.
labor is necessary.1
After obtaining freely informed written and oral consent,
Induction of labor, becomes necessary when the benefit of
pregnant women were allocated by the researcher using a
induction of labor to the mother or fetus outweigh the potential
computer-randomization system, in their groups. Data was
risks of continuing with the pregnancy.2,3 Induction of labor is a
preserved in lock and key, and data entry was done using
common obstetric procedure.4–6 Among common indicators for
password protected computers. The questionnaires included only
induction of labor, gestational hypertension and prolonged
identity codes. Participants were allowed to leave the study at any
pregnancy are the most common indications.7
point in time.
Pregnancy that extends beyond the 40th week of gestation is
known to be a risk factor for maternal and neonatal mortality and
2.3. Intervention
morbidity.8 Induction of labor is practiced to prevent these
problems and improve the health outcome of mothers and
Subjects were randomized into the ‘no-treatment’ control
infants.9
group. The researcher alone was aware of the intervention group.
The methods of labor induction include pharmacological and
Routine care and data collection was performed by the two
non-pharmacologic methods. Pharmacologic methods include
research assistants (with 10 years of work experience) who were
oxytocin, prostaglandins, such as misoprostol, and mechanical
unaware of the research groups. The randomization code was only
methods that include artificial rupture of membranes, stripping of
revealed after completing the clinical study.
membranes, etc.10
Inclusion criteria were age 18–35 years, nulliparous, low risk
The main problem encountered during pharmacological
pregnancy, gestational age 39–40 weeks as estimated by ultra-
induction of labor is uterine hyper-stimulation because it may
sound before the 12th week, singleton cephalic presentation,
cause both maternal and fetal distress, which may lead to an
normal BMI, Bishop score 4, biophysical profile score of 8/8 and a
increased risk of cesarean birth.11,12 Acupressure is a natural
normal amniotic fluid index, not taking herbal or chemical drugs
method of labor induction that is used for softening the cervix and
36 h before and up to the end of the study, and not having sexual
inducing uterine contractions.13
intercourse 24 h before and up to the end of study. Exclusion
The mechanism by which acupuncture and acupressure induce
criteria included taking chemical or herbal drugs, having sexual
labor is known as the theory of uterine stimulation by hormonal
intercourse, and not doing acupressure on schedule.
changes or the nervous system. Acupuncture increases the
The intervention groups were asked by the researcher to refer to
discharge of hormones from thalamic nuclei and the hypothalamic
the hospital 0/5 until 1 h after breakfast, between 9 am and 11 am
anterior pituitary system. According to another theory, neuronal
for acupressure and sham acupressure. Acupressure and sham
stimulation with acupuncture may increase uterine contractions
acupressure were performed by the researcher every other day
either by central oxytocin discharge or by parasympathetic
between 9 am and 11 am. Acupressure and sham acupressure were
stimulation of the uterus.14
performed by the mother and her participant after training. These
The study conducted by Gribble et al.15 showed that acupunc-
methods were carried out between the hours of 3 and 5 pm and the
ture brought about induction of labor within 24 h after the
following day of the intervention in the morning and afternoon. In
application of acupuncture on the mother while the research
the sham acupressure group, three ineffective acupuncture and
conducted by Neri et al.13 did not show any significant differences
acupressure points on the hands and legs were pressed.
between the acupuncture group and the control group.
In the acupressure group, bladder 32, spleen 6 and bladder 60
Based on the limited studies on the effect of acupressure on the
spots were used. Bladder 32 is located on the bladder meridian16
initiation of labor and the effects of participation of pregnant
and in the region of the sacrum, medial and inferior to the posterior
women in their care process, this trial was designed to evaluate the
superior iliac spine in the second sacral foramen, and the pressure
effect of acupressure on the initiation of labor in pregnant women,
at this point is indicated for low back pain, dysmenorrhea, irregular
who were referred to Shahid Akbar-Abadi hospital in Tehran.
menstruation, pain and induction of labor.17
Spleen 6 is located on the spleen meridian16 and 5 cm above
2. Methods the inside ankle on the Tibia, and acupressure at this point can be
used to treat of dysmenorrhea, labor pain and softening the
2.1. Sample recruitment cervix.18–21
Bladder 60 is located on the bladder meridian16 and at the
The present study was performed in Shahid Akbar Abadi midpoint between the prominence of the lateral malleolus and the
hospital in Tehran at the Iran University of Medical Sciences, Achilles tendon, which is pressured at this point to reduce anxiety,
between April 2015 and November 2015. pain and softening the cervix.22,23
The sample size was calculated at the 5% level of significance In acupressure and sham acupressure groups, pressure was
and a power of 80% based on a pilot study (n = 10 in each group). In applied on the points for 1 min and it was interrupted for 1 min as
this double-blind clinical trial, 162 pregnant women who were rest time, so that each point should be pressed 5 times.
referred to the Shahid Akbar Abadi hospital in Tehran were Acupressure and sham acupressure points were subjected to
enrolled by the researcher in the study. Finally, 150 mothers pressure respectively, and after the completion of acupressure and
completed the study. After obtaining freely informed written and sham acupressure at each point, the next point was pressed. The
oral consent, pregnant women were divided into 3 groups by the total intervention time was 30 min. The routine care group also
researcher using a computer-randomization system. The 3 groups received routine healthcare services.
were acupressure (n = 54), sham acupressure (n = 55) and routine The bilateral method of pressure was applied on the points with
care (n = 53). appropriate force (half of the fingernails turned white) and this

Please cite this article in press as: Torkzahrani S, et al. The effect of acupressure on the initiation of labor: A randomized controlled trial.
Women Birth (2016), http://dx.doi.org/10.1016/j.wombi.2016.07.002
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method was continued to create stimulation reactions such as
hotness, drowsiness, sore, numbness, pinching and pressing.
Subjects were examined to determine the initiation of labor
symptoms 48 and 96 h after the start of intervention and at the
time of hospitalization. The intervention and routine care in
subjects were continued when the mother has not shown
childbirth symptoms until the end of 41 weeks in accordance
with the country guidelines, and if childbirth failed to start,
pharmacological induction was applied.
During the study, subjects were asked to refer to the hospital
and call the researcher if they had any bleeding, rupture of
membrane, decreased fetal movement, onset of labor pain and any
other problems. In each group, routine care during labor, fetal non-
stress test and record of information related to the labor process
and data collection was performed by two research assistants
(with 10 years of work experience) who were unaware of the
research groups.
2.4. Assessment tools
Data was collected using demographic and obstetric data
questionnaires, daily record and follow up forms. The validity of
questionnaires was assessed through content validity. Daily record
form was confirmed via test-retest reliability by Cronbach’s
Coefficient Alpha 0.81. The reliability of the observation and
examination form was measured by simultaneous observation
(kappa = 0.935). The reliability of the researcher’s work was
confirmed by observing at the same time with the acupuncturist
in ten individuals and completing the relevant form (kappa = 0.81).
3. Statistical analysis
Analysis of demographic variables was performed in relation to
age, educational background gestational age, pre-pregnancy body
mass index (BMI), Participation in childbirth preparation classes,
Bishop score before entry into the study and infant weight.
Statistical analysis was performed using the SPSS 22.0. Means and
standard deviations (SD) were computed. ANOVA was used to
Fig. 1. The flow of participants through the study. Legend: SP6 – Spleen 6 spot.
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3
compare groups if the data were normally distributed and for un-
paired groups with non-parametric data, Kruskal–Wallis and
Mann–Whitney tests were used. Data were analyzed by Analysis of
Chi-squared, analysis of variance (ANOVA) and Kruskal–Wallis
tests (P  0.05).
4. Results
162 consenting participants who fulfilled the entry criteria
were enrolled in this study. A total of 150 participants were able to
complete the study and their data are included in the final analyses
(Fig. 1).
The mean maternal age was 23.75  3.55 and the mean
gestational age at enrollment of subjects was 39.7  0.3. The women’s
pre-pregnancy body mass index (BMI) was 24.87  2.33. The mean
Bishop score before entry into the study was 2.24  1.08, 2.02  1.24,
and 2.02  1.19 for the acupressure, sham acupressure and control
groups. There were no significant differences among the three groups
for maternal age, gestational age, BMI and Bishop score before entry
into the study. No differences were observed between three groups in
terms of education, profession, prenatal care and Participation in
childbirth preparation classes (Tables 1 and 2).
Spontaneous initiation of labor 48 h after beginning the
intervention occurred in 15 women (30%) in the acupressure
group, 10 women (20%) in the sham acupressure group and 11
women (22%) in the routine care group. There was no significant
difference among the three groups for spontaneous initiation of
labor 48 h after commencing intervention (P = 0.464).
Statistical test showed no significant difference among the 3
groups for spontaneous initiation of labor 49–96 h after the
commencement of intervention (P = 0.111) and 97 h to the time of
hospitalization (P = 0.897).
The mean interval from procedure to birth in the acupressure
group was 124.88 + 75.93 h, 135.39 + 70.09 h in the sham acu-
pressure group and 114.16 + 52.64 h in the routine care group. The
Kruskal–Wallis test did not show any significant difference in
interval from procedure to birth among the groups (P = 0.565).
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Table 1
Demographic characteristics of participants.

Variablesa Acupressure Sham acupressure Routine care P-value

Maternal age (years) 23.94  3.89 23.82  3.7 23.48  3.07 0.899
BMI 24.68  2.27 25.06  2.39 24.88  2.36 0.727
Highest frequency mother education (high school) 23 (46%) 24 (48%) 25 (50%) 0.169
Highest frequency husband’s education (high school) 23 (46%) 26 (52%) 28 (56%) 0.098
Highest frequency mother’s profession (housewife) 47 (94%) 49 (98%) 48 (96%) 0.594
Highest frequency huasband’s profession (free work) 37 (74%) 38 (76%) 36 (72%) 0.572
a
Values are given as mean  standard deviation (SD) and number (%).

Table 2
Obstetrics characteristics of participants.

Variablesa Acupressure Sham acupressure Routine care P-value

Gestational age (week) 39.71  0.27 39.67  0.34 39.73  0.28 0.654
Participation in childbirth preparation classes 4 (8%) 3 (6%) 3 (6%) 0.898
Prenatal cares (>5 times) 47 (94%) 48 (96%) 48 (96%) 0.862
Bishop score before trial entry 2.24  1.08 2.02  1.24 2.02  1.19 0.508
a
Values are given as mean  standard deviation (SD) and number (%).

There was no significant difference among the three groups for
type of birth, 56% of subjects in acupressure group, 48% of subjects
in the sham acupressure group and 52% of subjects in the routine
care group were delivered vaginally.
There were no significant differences among the three groups
for maternal and fetal complications, 1 and 5 min Apgar scores
(Table 3).
5. Discussion
Recently, the use of complementary and alternative medicine
has become popular in many countries. Many pregnant women
prefer to replace these drug treatments with complementary
therapies such as acupressure and acupuncture because the side
effects are lesser than drug treatment. The mechanism for
acupressure and acupuncture is unknown; however the limited
observation of uterine activity during acupressure and acupunc-
ture treatment did not show increased uterine activity.
The factors such as nulliparity, fetal abnormality, gestational
age and BMI may effect on initiation of labor. There were no
significant differences among the groups for these factors. This
study evaluated the effect of acupressure on the initiation of labor.
The results showed that the initiation of labor was not significant
after 48 h of commencing the intervention, 49–96 h after
commencing the intervention, and 97 h after commencing the
intervention to the time of hospitalization in the acupressure,
sham acupressure and routine care groups. This study did not show
statistically significant differences between the three groups for
the type of birth and fetal complications. In the study of Smith
et al.24 titled ‘‘Acupuncture to Induce Labor’’, women did not differ
in their need for induction methods between acupuncture group
and sham acupuncture group for 45 min during the 2 days of
intervention (P = 0.68). Such a difference might be attributed to the
short duration of intervention, higher gestational age of the
subjects (41 weeks), subjects were multiparous and nulliparous,
the variable Bishop score ranging from 0 to 7 and the lack of control
group.
In the study of Azhari et al.25 titled: ‘‘Efficacy of acupressure
on initiating labor in term pregnant women’’, it was shown that
the percent of initiation of labor was significant in the first 48 h
after the intervention among the pressure, touch and usual care
groups, so that the percent of initiation of labor in the first 48 h in
the acupressure group was significantly higher than the touch
(P < 0.007) and the control groups (P < 0.003). In their research,
the acupressure intervention period was shorter and the
research units were nulliparous and multiparous with gesta-
tional age 40 weeks or greater, which is different from the criteria
of this study.
The studies of Ajori et al.26 and Asher et al.8 which investigated
the effect of acupuncture on the initiation of labor showed that
acupuncture was not effective in labor initiation as compared with
sham acupuncture. Asher et al., showed that there were no
statistically significant differences among the groups for rates of
spontaneous labor (p = 0.66), time from enrollment to birth
(p = 0.20) and rate of cesarean birth (p = 0.37). Ajori et al., found
that acupuncture was not effective in labor initiation (P = 0.430). In
this study, the interval from procedure to birth in the acupuncture
group was less than the sham acupuncture group, but there was no
significant statistical difference between the two groups. In the
research of Asher et al., the gestational age of women was 38 weeks
or greater. The duration of intervention was 24 h and shorter.
Maternal weight and Bishop’s score were not recorded.

Table 3
Maternal and Fetal Outcomes.

Variablesa Acupressure Sham acupressure Routine care P-value

Spontaneous initiation of labor

48 h 15 (30%) 10 (20%) 11 (22%) 0.464
49–96 h 7 (14%) 17 (34%) 12 (24%) 0.111
At the time of hospitalization 28 (56%) 28 (56%) 30 (60%) 0.897
Interval from procedure to Birth (h) 124.88  75.93 135.39  70.09 114.16  52.64 0.565

Normal vaginal birth 28 (56%) 24 (48%) 26 (52%) 0.726

Cesarean birth 22 (44%) 26 (52%) 24 (48%) 0.726
Apgar score, 1th min 8.30  0.46 8.34  0.48 8.40  0.49 0.574
Apgar score, 5st min 9.10  .0.30 9.08  0.27 9.06  0.24 0.736
Fetal weight (gr) 3332 + 188.38 3380 + 220.85 3384 + 229.56 0.402
a
Values are given as mean  standard deviation (SD) and number (%)

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The research of Gaudernack et al.27 investigated the effect of
acupuncture on the length of birth and use of oxytocin after
spontaneous rupture of membranes. In this study, 100 pregnant
women with spontaneous rupture of membranes were assigned to
the acupuncture and control groups. Acupuncture was performed
at three points, ST36, LR3, and CV4. The results of this study
showed that there was significant reduction in the need for
oxytocin infusion to augment labor in the acupuncture group as
compared with the control group.
There are a few previous studies have evaluated the effects of
acupressure on the initiation of labor at term pregnancy unlike
acupuncture. In this trial, some points of acupressure were used
which made the study different from prior studies.
6. Limitations
The limitations of our study included the trained researcher
that provided acupressure, who was not involved in subsequent
labor care, small sample size, and the fear of fetal complications by
subjects and their families was restricted factors in our trial.
7. Conclusions
Acupressure was not effective in stimulating spontaneous birth
or reducing the rate of cesarean delivery when compared to the
sham acupressure or the usual care groups.
Conflict of Interest
The authors have no conflict of interest.
Acknowledgements
This article is the result of a master’s thesis in midwifery unit of
Shahid Beheshti University of Medical Sciences. We appreciate the
department head and the deputy manager of the research
department and all the women who had cooperation with the
researchers of the study and all staff of prenatal clinic and birth
room of Shahid Akbar Abadi hospital, Tehran, Iran for facilitating
the recruitment of patients and the use of clinical data.
References
1. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rous DJ, Spong CY, editors.
Williams obstetrics. 23rd ed. New York: Maccraw-Hill; 2009.
2. Vogel JP, Souza JP, Gulmezoglu AM. Patterns and outcomes of induction of
labour in Africa and Asia: a secondary analysis of the WHO Global Survey on
Maternal and Neonatal Health. PLOS ONE 2013;8(6):e65612.
3. Sanchez-Ramos L. Induction of labor. Obstetr Gynecol Clin North Am 2005;32(2):
181–200. viii.
Please cite this article in press as: Torkzahrani S, et al. The effect of acupressure on the initiation of labor: A randomized controlled trial.
Women Birth (2016), http://dx.doi.org/10.1016/j.wombi.2016.07.002
5
4. Hall HG, McKenna LG, Griffiths DL. Complementary and alternative
medicine for induction of labour. Women Birth: J Aust Coll Midw 2012;25(3):
142–8.
5. Jozwiak M, Oude Rengerink K, Benthem M, van Beek E, Dijksterhuis MG, de
Graaf IM, et al. Foley catheter versus vaginal prostaglandin E2 gel for induction
of labour at term (PROBAAT trial): an open-label, randomised controlled trial.
Lancet 2011;378(9809):2095–103.
6. Karjane NW, Brock EL, Walsh SW. Induction of labor using a Foley balloon, with
and without extra-amniotic saline infusion. Obstetr Gynecol 2006;107(2 (Pt
1)):234–9.
7. Haghollahi F, Khazardoost S, Hantoushzadeh S, Naghizadeh MM, Rashidi B.
Induction of labor using native (OXYTIP) in comparison to foreign oxytocin
(SYNTOCINON). J Family Reprod Health 2014;8(2):53.
8. Asher GN, Coeytaux RR, Chen W, Reilly AC, Loh YL, Harper TC. Acupuncture to
initiate labor (Acumoms 2): a randomized, sham-controlled clinical trial. J
Matern-Fetal Neonat Med: Off J Eur Assoc Perinat Med Fed Asia Oceania Perinat
Soc Int Soc Perinat Obstet 2009;22(10):843–8.
9. Gulmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for
improving birth outcomes for women at or beyond term. Cochr Database Syst
Rev 2012;6:CD004945.
10. Sultana A, Begum M, Sultana S, Asma K. Usefulness of polyherbal unani
formulation for cervical ripening and induction of labour: a uncontrolled study.
Altern Integ Med 2015;4(184):2.
11. Ziyauddin F, Hakim S, Beriwal S. The transcervical foley catheter versus the
vaginal prostaglandin e2 gel in the induction of labour in a previous one
caesarean section – a clinical study. J Clin Diagn Res: JCDR 2013;7(1):140–3.
12. Ingram J, Domagala C, Yates S. The effects of shiatsu on post-term pregnancy.
Complement Ther Med 2005;13(1):11–5.
13. Neri I, Monari F, Midwife CS, Facchinetti F. Acupuncture in post-date pregnan-
cy: a pilot study. J Matern-Fetal Neonat Med 2013;27(9):874–8.
14. Smith CA, Crowther CA, Grant SJ. Acupuncture for induction of labour. Cochr
Database Syst Rev 2013;8:CD002962.
15. Gribel GP, Coca-Velarde LG, Moreira de Sa RA. Electroacupuncture for cervical
ripening prior to labor induction: a randomized clinical trial. Arch Gynecol
Obstetr 2011;283(6):1233–8.
16. Yu S, Yang J, Yang M, Gao Y, Chen J, Ren Y, et al. Application of acupoints and
meridians for the treatment of primary dysmenorrhea: a data mining-based
literature study. Evid-Based Complement Altern Med 2014.
17. Suhrabi Z, Taghinejad H. Effect of acupressure (UB32) on pain intensity in
intramuscular injections. Iran J Nurs Midw Res 2014;19(1):24–7.
18. Dong C, Hu L, Liang F, Zhang S. Effects of electro-acupuncture on labor pain
management. Arch Gynecol Obstetr 2014:1–6.
19. Wu LL, Su CH, Liu CF. Effects of noninvasive electroacupuncture at Hegu (LI4)
and Sanyinjiao (SP6) acupoints on dysmenorrhea: a randomized controlled
trial. J Altern Complement Med 2012;18(2):137–42.
20. Mucuk S, Baser M. Effects of noninvasive electroacupuncture on labour pain and
duration. J Clin Nurs 2014;23(11-12):1603–10.
21. Yongxue S, Xiumei C, Ying Z, Lining Q, Linran M, Meihe C. Clinical analysis of
promote cervical ripening by Vaccaria seed pressing Hoku and Sanyinjiao
(Report of 240 cases). Med Res Educ 2011;2:017.
22. Chen Y-W, Wang H-H. The effectiveness of acupressure on relieving pain: a
systematic review. Pain Manage Nurs 2014;15(2):539–50.
23. Betts D. Inducing labour with acupuncture – crucial considerations. J Chin Med
2009;90(1):20–5.
24. Smith CA, Crowther CA, Collins CT, Coyle ME. Acupuncture to induce labor: a
randomized controlled trial. Obstetr Gynecol 2008;112(5):1067–74.
25. Azhari S, Abrishami L, Fadaee A, Shakeri MT. Efficacy of acupressure on initiating
labor in term pregnant women. J Mashhad School Nurs Midw 2009;9(3):
207–14.
26. Ajori L, Nazari L, Eliaspour D. Effects of acupuncture for initiation of labor: a double-
blind randomized sham-controlled trial. Arch Gynecol Obstetr 2013;287(5):
887–91.
27. Gaudernack LC, Forbord S, Hole E. Acupuncture administered after spontaneous
rupture of membranes at term significantly reduces the length of birth and use of
oxytocin. A randomized controlled trial. Acta Obstetr Gynecol Scand 2006;85(11):
1348–53.