Do your Baby a Good Turn! Moxibustion for Breech Presentation

Adapted from Karen Pohlner

As a pregnancy progresses and the baby continues to grow, available space within the uterus reduces resulting in less room for the baby to move. The baby’s head eventually becomes heavier than its bottom and under normal circumstances around 32 weeks gestation the baby sinks down head first into the pelvis and engages in preparation for birth.

Breech presentation: The Incidence
Between 29-32 weeks 15% of all babies will be in a breech position. This means that the baby is presenting with its buttocks, knees or feet pointing down, essentially poised to come out bottom first. Only 3-4% of these presentations will stay in this position until labour.

As such breech presentation is considered normal in pre-term pregnancies and is not generally medically diagnosed until the last few weeks of pregnancy.

When is breech presentation a problem?
While the majority of breech babies turn spontaneously before birth, the longer a baby stays in the breech position with conditions becoming more cramped, the less likely it will be to turn of its own volition.

Vaginal birth for a breech baby is becoming less common as the skills to assist women have been lost. Most doctors recommend a Caesarean birth for breech babies, largely due to this lack of skills, and general fear in the medical community around facilitating a breech birth. The remedy for this situation is to find a supportive, confident caregiver, or to find an effective way of turning the baby quickly and safely to the physiologically desirable head-down position.  If their baby remains in breech position their freedom of choice around birthing options is reduced and the time to turn the baby naturally is fast running out.

What is Moxibustion?
Moxibustion is an externally applied Traditional Chinese Medicine treatment using a Chinese herb called Moxa (Artemisia argyi), commonly known as ‘Mugwort’. For external use, Moxa is compressed and rolled into a cigar-shaped herbal stick. Moxa sticks are then lit and held over acupuncture points. The radiant heat produced has the effect of stimulating the point.

Some practitioners will use ‘smokeless Moxa’, an alternative, charcoaled preparation of the herb which as the name suggests produces much less smoke, making it more suitable for use in the clinic and at home.

How is moxa used to turn breech babies?
During a TCM consultation to turn a breech baby the practitioner will take a comprehensive case history, make a diagnosis and apply the appropriate acupuncture treatment. They will assess if moxibustion might be helpful.

Practitioners will then instruct women on how to locate the appropriate acupuncture points and demonstrate how to safely apply moxa at home. Alternatively, if you can’t find a practitioner in your local environment, you can order the moxa sticks through eBay and find videos on YouTube as to the correct application of the treatment.

The acupuncture point UB 67 is the primary point selected for use because it is the most dynamic point to activate the uterus. Its forte is in turning malpositioned babies. It is located on the outer, lower edge of both little toenails.

According to TCM theory, moxa has a tonifying and warming effect which promotes movement and activity. The nature of heat is also rising. This warming and raising effect is utilised to encourage the baby to become more active and lift its bottom up in order to gain adequate momentum to somersault into the head-down position.

This technique can also be used to reposition transverse presentation, a situation where the baby has its shoulder or back pointing down, or is lying sideways across the abdomen.

How effective is it?
A 3 year study published in AJCM (2001) based in a facility where 1437 births were reported examined how effective moxibustion and acupuncture were in turning breech presentation.

Only women who were 28 weeks pregnant or later diagnosed with breech presentation were entered into the study.

The control group consisted of 224 women. This group was given exercise and external cephalic manipulation. They had a spontaneous correction rate of 73%.

The experimental group consisted of 133 women. They received 30 minutes of moxibustion to UB67 daily and acupuncture, but no exercise or external cephalic manipulation. They had a correction rate of 92%.
The study concluded that acupuncture and moxibustion is a safe and effective modality to correct breech presentation in a clinical setting.

Moxa-therapy in breech presentation: some facts from England and Wales

Three thousand years ago, Chinese acupuncturists started to treat pregnant women with moxa-therapy. Scientific research has increased the knowledge about and trust in acupuncture in our western society. In the Journal of the American Medical Association, a study was published in 1998 about moxa-therapy in pregnant western women.

In England and Wales, an estimated 710,000 babies are born every year. Just before birth, 23,450 of them, (3.5%), remain in breech position. Most of them will be delivered by Caesarean to avoid the risks of a natural breech birth.

The JAMA article has contributed to an increased interest in the UK for this treatment, as the study showed that with moxa-therapy, the chances of a spontaneous turning of the baby during the 33rd to the 36th week increased from 50% to 75%.

Fewer babies could be born in breech presentation if the mothers receive moxa-therapy between the 33rd and the 36th week. This can result in an additional 11,725 women yearly having a natural birth.

The safety of moxa-therapy

From the four research papers quoted on this site, no adverse effects have been experienced after moxa-therapy. The moxa-stick itself is of course hot. It should never touch the skin but kept at a distance of 1 cm (1/3 inch) as a minimum. If the treatment is performed carefully, it is without risks.

How does moxa-therapy work?
The way the moxa-therapy works can be explained using both the Western Physiology and the Traditional Chinese Medicine (TCM).

According to the TCM, warming the Bladder 67 (or Zhi Yin) point in the small toe will create warming energy (Yang) in the pelvic floor. This warming energy will cause movement. The uterus is also situated in the pelvic floor, and the movement will cause the baby to move which can result in the turning of the baby.

According to western medical science, the moxa-therapy improves the blood circulation of the womb. This enhances the maturing process and increases the chance of the baby turning spontaneously. Furthermore, moxa probably stimulates the adrenal gland and the hormones the adrenal gland produces, and positively affects the muscular tissue of the womb. Owing to this, the baby would become more active and ultimately, could turn.

How to Administer Moxa at Home
Prior to commencing moxibustion, ensure the room is adequately ventilated as moxa can produce profuse, smelly smoke similar to cigarette smoke which can linger in a closed room.  OR buy a smokeless version.

To burn moxa at home, you will need:
2 Moxa Sticks
Lighter
Candle
Shot Glass or small glass

Administer treatment two times each day, 15 minutes per toe for two weeks, starting at 34 – 36 weeks. Repeat each day until baby’s head-down position is confirmed either by midwife, doctor or mother, or unless otherwise directed by acupuncturist.

The mother should position herself in a comfortable semi-reclined position so that her uterus is as open, relaxed, and as unobstructed as possible.  Both pinky toes should be readily accessible.  Moxibustion is best performed in the evening to take full advantage of the horizontal resting position of sleep. With less gravitational pressure bearing down into the woman’s pelvis conditions are more conducive to the baby turning.   It takes several hours for the baby to turn and this will be easier if lying down, because the baby will not be sitting as firmly into the pelvis.  It is not uncommon for women to experience increased fetal movement once the moxa is applied and for the hours following.

  1. Light candle.

  2. Light moxa by slowly rotating moxa stick in the candle flame until tip glows red. This may take up to a couple minutes. You may gently blow air on the tip of the moxa stick to see if it is lit.

  3. Once lit, hold the each moxa stick about 1 inch above BL67, the acupuncture point on the lower, outer corner of each pinky toe nail.

  4. Gently move the moxa sticks above each BL67 in a circular motion, clockwise or counterclockwise. As you rotate, visualize the moxa opening and widening the mother’s uterus to make more space for the baby.

  5. When the mother reports that either toe is too hot, remove the moxa from her toe for a few seconds to cool down. Then resume above the toe again.

  6. As the moxa stick burns, ash will collect on the tip, blocking the heat. Knock or scrape the ash off the stick into the shot glass and resume above the toe.

  7. At the end of the 15 minutes, extinguish the moxa in the ash that has collected in the shot glass.

An obstetrician or midwife will confirm if the baby has turned, however most women report having a strong body sensation of the baby moving and somersaulting at the time it occurs. Moxa should be ceased as soon as the woman knows for sure that her baby has turned.

Adjunctive treatment
Breech tilt is a positioning technique aimed at discouraging the baby’s bottom from settling into the pelvis. Women can begin this technique from 32 to 35 week’s gestation.
Begin by propping one end of an ironing board securely on a sofa or chair slanted at 30 degrees incline. It might be necessary to bolster the sides to prevent the ironing board from slipping or tipping.

Lie face up on the ironing board with your feet pointing towards the elevated end. That is with your head positioned lower than your feet. Bend your knees, keeping your feet flat on the board.

Begin by taking deep, relaxing breaths in this position, and try to avoid tensing your body. You might like to use your breath to help deepen your relaxation by focusing your mind on counting your breath. Inhale for the count of 4 and exhale for the count of 4, so the length of inhalation roughly matches the length of exhalation.

Alternatively use the ‘I let go’ breath. The inhalation will just happen and on the exhalation repeating to yourself ‘I let go’. As you exhale feel the tension of the day and the week passing, inviting the body to enter into deeper rest and relaxation.

Sound vibration also seems to help activate the baby in this position. The buzzing sensation and noise of an electric toothbrush on the lower abdomen or i-pod speakers placed over the pubic bone with classical music playing might also be combined when in this position.

Use this technique for 10-15 minutes 2 to 3 times per day until the baby flips.

England & Horowitz (1998) suggests that breech tilting 80% effective to turn breech between 32-35 weeks.

Breech tilt is best practised on an empty stomach, and at times when the baby is most active. The gravity of the incline pushes the pelvic contents up and helps the baby to fall back from the pelvic brim. The theory is that on standing the baby will have more space and momentum to somersault and greater opportunity for the heavier head to sink downwards.

Another treatment that could be utilised to turn a breech baby is chiropractic. Sometimes the baby cannot get into the head-down position, because the pelvis is not in the correct position itself to allow this. Visiting a chiropractor can help rebalance the pelvis and correct any dysfunctions caused by looser joints.

Conclusion
There is no fool proof technique that guarantees a late-term baby will turn from a breech position. Moxibustion is a surprisingly effective, safe, non-invasive treatment worth women considering should they wish to attempt to turn their baby naturally and avoid restricting their birthing options.

Unfortunately, however a percentage of babies will invariably stay in the breech position until birth, making their grand entry into the world bottom first. If this is the case for you, and you really would prefer a vaginal birth, rather than a Caesarean, discuss this with your care providers and ask around as much as possible to find one who is confident in facilitating breech births.

Please note that this information is for general advice only and women should check with their health care provider before attempting to use moxibustion treatment to turn their baby, to ensure that no contraindications apply.

References
England, P. & Horowitz, R (1998) Birthing From Within: An extraordinary guide to childbirth preparation (p286), Patera Press: USA
Kanakura, Kometani, Nagata et. al. (2001) Moxibustion treatment of Breech presentation, AJCM
Cardini, F & Weixin, H (1998) Moxibustion for Correction of Breech Presentation A Randomized Controlled Trial, JAMA: 280(18):1580-1584.

From a qualitatively point of view, this study is the best article of the four. Partly due to this, the renowned and western, regular medical science focused journal JAMA (Journal of the American Medical Association), accepted the study for publication.

A total of 260 women were screened on the effect of the moxa-therapy. Half of the women were given moxa-therapy, the other half were not. After two weeks of moxa-therapy, 98 children (74.8%) had turned to the right position compared to 62 children (47.7%) in the group without moxa-therapy.

This paper has also shown an increase in foetal movement. During the moxa-therapy, the babies were more active than the babies were whose mothers did not receive the therapy. Scientifically, it can be assumed that one of the factors playing a role in the turning of the baby is the increase in movements of the baby.

Neri I, Airola G,Contu G, Allais G, Facchinetti F, Benedetto C. (2004) Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study. J Matern Fetal Neonatal Med. 2004 Apr;15(4):247-52.

This was a large study, including 240 women whose situation was not measured after the moxa-therapy, but just before labour started. The results were very promising: from the women who received moxa-therapy, 53.6% of the babies had turned compared to 36.7% in the control group.

Habek D1, Cerkez Habek J, Jagust M. (2003) Acupuncture conversion of fetal breech presentation. Fetal Diagn Ther. 2003 Nov-Dec;18(6):418-21.

This study has the same set up as the JAMA study mentioned above but less women took part. The results however were similar: moxa-therapy seems successful during and after the 34th week in 76.4% of the cases. The chances of a baby turning spontaneously without moxa-therapy was shown as 45.4%.

Kanakura Y1, Kometani K, Nagata T, Niwa K, Kamatsuki H, Shinzato Y, Tokunaga Y. (2001) Moxibustion treatment of breech presentation. American Journal of Chinese Medicine. 2001;29(1):37-45.

In this study, the women received moxa-therapy after the 28th week of their pregnancy. This gave a higher success rate: 73.66% of all children turned spontaneously without the moxa-therapy, 92.48% of the children turned after the mother was given moxa-therapy.

 

Further Reading

Spinning Babies

 

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