Wednesday, January 13, 2010

Moxibustion for Bringing Babies Around to the Head-First Position

From Childbirth Connection's E-newsletter came an interesting piece that was published in the American Journal of Obstetrics and Gynecology 2009;201(3), 241-59 talking about using an ancient Chinese tradition to turn breech babies by means of moxibustion

What is Moxibustion? Moxibustion is a traditional Chinese medicine technique that involves the burning of mugwort, a small, spongy herb, to facilitate healing(or in this case, turning a breech baby) Moxibustion has been used throughout Asia for thousands of years; in fact, the actual Chinese character for acupuncture, translated literally, means "acupuncture-moxibustion."

Moxibustion to turn a breech baby? Really? Andrea Robertson sheds some light on this ancient Chinese tradition

Using moxibustion to encourage the baby to turn by itself
A very successful "do it yourself" technique with a proven high success rate is to use locally applied heat treatment.
The heat from burning moxa sticks can also be used to stimulate the baby's movements and encourage it to turn. These sticks, shaped like cigars, are available from herbalists, Chinese medicine stockists and some acupuncturists (who use moxa sticks for other purposes) and they contain tightly rolled dried leaves of the mugwort plant. They are very inexpensive and two sticks will be needed - they can be used several times.

[Box of Moxibustion Sticks]
Sit on a chair and place each foot on a book with your little toes hanging over the edge. Place each stick on another book with the tip in the gap.

[Place each foot on a book with your little toes hanging over the edge]
Light the sticks (they burn with no flame but an intense heat and pungent smell) and position the hot tip as close as possible to the outside of each little toe, with the heat directed at the point just above the toe nail. Leave in place for 20 minutes. Be careful not to touch the skin as you will burn yourself. The heat should be as strong as you can tolerate, for the best effect.

[Directed the heat at the point just above the toe nail]
After a few minutes, you will notice the baby begin to kick and move. The primary aim of the moxibustion treatment is to encourage the baby to move around and thus increase the effect of gravity which will help the heaviest part of the baby (its head) to turn over and enter into the pelvis.
This simple treatment is best done just before bed, starting at 34 - 36 weeks. It takes several hours for the baby to turn, and this will be easier if you are lying down, because the baby will not be sitting as firmly into the pelvis. Continue over several nights, or until the baby has turned itself.
A randomised controlled trial indicates that at approximately 70% of breech babies will turn using this method. If the baby does not turn from its breech position, external cephalic version should be attempted just before labour begins.

A video on Moxibustion

Here is the actual article in the E-newsletter from Childbirth Connection

Moxibustion for Bringing Babies Around to the Head-First Position
Vas J, Aranda JM, Nishishinya B, et al. Correction of nonvertex presentation with moxibustion: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology 2009;201(3), 241-59.
This review pooled the results from studies published between 1980 and 2007 that looked at ways to turn fetuses that were not well-positioned for head-first birth into that position. The studies compared moxibustion to other ways to encourage the fetus to turn (hands-to-belly maneuvers, having the mother lie with her head lower than her feet, acupuncture). Moxibustion involves burning the herb mugwort (Artemisia vulgaris) over an acupuncture point found on the outer corner of the smallest toenail. Seven studies presenting data from 1087 women were included in the analysis. All the women in the studies in this review were randomly picked to receive either moxibustion or one of the other methods, to strengthen confidence that any differences in experiences of study groups were due to the moxibustion.
Combined results from the studies showed that the fetuses of women receiving moxibustion were 36% more likely to turn to a head-first position than those who got other treatments or no treatment, and this result was statistically significant. To check this result, the study authors looked separately at four trials that used similar starting points for moxibustion, all after the 32nd week of pregnancy. Here too, the likelihood of the fetus turning to a head-first position was more than 30% greater for the women who got moxibustion than for those who got another treatment. The study found no differences in safety between moxibustion and the other methods. Surprisingly, there was also no difference in the rate of cesarean birth between the groups. Six of the seven studies were carried out in China or Italy. Practice patterns in those countries (e.g., greater acceptance of vaginal breech birth) may explain why the review did not show a higher risk of cesarean section in the group that did not get moxibustion; if done too early, babies could also flip back into breech position, which could impact this outcome.

The take-away: Vaginal breech birth is currently rare in the U.S., where cesarean delivery is routine when the fetus’s position is not head-first. With known risks associated with cesarean delivery for mothers and babies, and no known downside to moxibustion, all women with fetuses that are not head-first by the third trimester should receive information about the safety and effectiveness of this treatment. Most licensed acupuncturists can perform moxibustion. Further research should explore the best frequency and timing of the practice.

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