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Turning a Breech Baby

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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Care that appears to influence babies in a breech presentation:  Webster, Bagnell

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