During the last trimester, it is possible for your baby to turn (or not turn) in such a way as to be considered a breech position, i.e. not in the accepted cephalic or head down position.  If this happens and you want to avoid a C-section, Traditional Chinese Medicine may offer help in turning the baby. 

Treatment

Treatment is generally given between weeks 30 through 38, with week 34 being the optimal time. If treatment is applied after week 38, it is not as effective.  Treatment involves the burning of an herb called mugwort (moxa) over a point on the fifth toe.

 

 

How it works

Applying heat to this point appears to stimulate production of placental estrogens and prostaglandin, both of which are maternal hormones.  This hormonal increase encourages uterine contractions, which in turn stimulates fetal activity. 

Research

In a 1998 study in The Journal of the American Medical Association, 75.4% breeches successfully turned in the moxibustion intervention group compared to 47.7% in the control group.  260 pregnant women diagnosed with breech positioning, who were otherwise healthy, were randomized into two groups: the intervention group received moxa treatment; the control group received no treatment other than routine care.  All were at 33 weeks gestation.   This study has been replicated several times with as high as a 90% success rate.

 

 

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Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial

Francesco Cardini, MD; Huang Weixin, MD JAMA. 1998;280:1580-1584.

Context— Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomized controlled trial has evaluated the efficacy of this therapy.

Objective— To evaluate the efficacy and safety of moxibustion on acupoint BL 67 to increase fetal activity and correct breech presentation.

Design— Randomized, controlled, open clinical trial.

Setting— Outpatient departments of the Women’s Hospital of Jiangxi Province, Nanchang, and Jiujiang Women’s and Children’s Hospital in the People’s Republic of China.

Patients— Primigravidas in the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of breech presentation.

Interventions.— The 130 subjects randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks’ gestation and delivery.

Main Outcome Measures— Fetal movements counted by the mother during 1 hour each day for 1 week; number of cephalic presentations during the 35th week and at delivery.

Results— The intervention group experienced a mean of 48.45 fetal movements vs 35.35 in the control group (P<.001; 95% confidence interval [CI] for difference, 10.56-15.60). During the 35th week of gestation, 98 (75.4%) of 130 fetuses in the intervention group were cephalic vs 62 (47.7%) of 130 fetuses in the control group (P<.001; relative risk [RR], 1.58; 95% CI, 1.29-1.94). Despite the fact that 24 subjects in the control group and 1 subject in the intervention group underwent external cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs 81 (62.3%) of the 130 fetuses in the control group (P=.02; RR, 1.21; 95% CI, 1.02-1.43).

Conclusion— Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.

From the Jiangxi Women’s Hospital, Nanchang, People’s Republic of China (Dr Weixin). Dr Cardini is in private practice in Verona, Italy.