Moxibustion for Turning a Breech Baby

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Turning a breech baby into the correct position for delivery is a concern for many expectant parents. Several methods have been proposed to help in this process, including exercise, chiropractic adjustments, external cephalic version, yoga poses, and using a birthing ball. Among these methods, moxibustion, a traditional Chinese medicine technique, has gained attention for its potential in turning breech babies. The exact mechanism of action for moxibustion is unclear, but it is believed to stimulate adrenocortical function, increase placental estrogen levels, and alter prostaglandin levels. [5] This leads to increased myometrial sensitivity and contractility, which in turn stimulates fetal movement and makes version more likely. The therapy's effectiveness relies on active fetal participation, and any explanation based purely on segmental reflex action is considered less likely. 


Homemade moxa stick holder, EvidenceBasedBirth.com

One famous RCT published in JAMA in 1998 [1] aimed to evaluate the efficacy and safety of moxibustion on acupoint BL 67 in increasing fetal activity and correcting breech presentation. The randomized, controlled, open clinical trial involved 260 primigravidas with normal pregnancies and breech presentation at the 33rd week of gestation. The intervention group (130 subjects) received moxibustion for 7 days, with an additional 7 days of treatment if the fetus remained in breech presentation. The control group (130 subjects) received routine care without interventions for breech presentation. Results showed that the intervention group experienced a higher mean number of fetal movements (48.45 vs. 35.35). By the 35th week of gestation, 75.4% of fetuses in the intervention group were in cephalic presentation compared to 47.7% in the control group. At delivery, 75.4% of fetuses in the intervention group were in cephalic presentation, while 62.3% were in the control group. In conclusion, moxibustion for 1-2 weeks increased fetal activity and cephalic presentation after treatment and at delivery among primigravidas with breech presentation during the 33rd week of gestation.

One recent systematic review and meta-analysis aimed to evaluate the effectiveness and safety of moxibustion and acupuncture in correcting breech presentation. [2] The study included sixteen randomized controlled trials (RCTs) with 2555 participants. The results showed that moxibustion significantly increased cephalic presentation at birth (RR = 1.39; 95% CI = 1.21–1.58). Moxibustion appeared to have better clinical outcomes in the Asian population (RR = 1.42; 95% CI = 1.21–1.67) compared to the non-Asian population (RR = 1.20; 95% CI = 1.01–1.43). The effects of acupuncture were inconsistent after sensitivity analysis. However, the combination of moxibustion and acupuncture showed synergistic effects in correcting breech presentation (RR = 1.53; 95% CI = 1.26–1.86) in one RCT. The findings suggest that moxibustion therapy has positive effects on correcting breech presentation, especially in the Asian population.

Walkthrough [3]

  1.  Ensure the patient is comfortably seated with legs raised and wearing loose clothes, particularly around the abdomen.
  2. Light two moxa sticks (1.5 cm diameter, 20 cm length) and hold them over the Zhiyin points (BL67) of both feet. These points are near the outer proximal corner of the toenail of the fifth toe.
  3. Hold the sticks still, maintaining a distance of 1.5 to 2.5 cm from the skin, so the patient feels warmth without discomfort.
  4. Perform treatment sessions for 15-20 minutes, ideally twice daily, for a total of 10 sessions.
  5. Monitor the patient for noticeable baby movement once the moxa sticks are applied. If significant movement is felt, stop the treatment and check the baby's position.
  6. Ensure safety by properly extinguishing the moxa sticks after use and not allowing them to get wet.
  7. Instruct the patient on how to perform moxibustion therapy at home.

Neri, I., de Pace, V., Venturini, P., & Facchinetti, F. (2007). Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL.67 acupoint at small toe on fetal behavior of breech presentation. The American journal of Chinese medicine, 35 1, 27-33 .

During the procedure Uterine contraction and Fetal movements were recored.



Side effects [5]

Some reported side effects of moxibustion treatment include unpleasant odor, throat problems, respiratory issues due to moxa smoke, and potential nausea and abdominal pain from contractions. However, no changes were detected in heart rate and blood pressure of pregnant women or fetal heart rate immediately after the intervention. Preterm uterine contractions were also not detected. Although some studies reported a few cases of premature labor and premature membrane rupture, there were no statistically significant differences between the moxibustion group and the non-moxibustion group in terms of Apgar scores, premature delivery, membrane rupture, and placental detachment. Overall, there is a trend toward fewer complications in the treatment group.


References

1. Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial. JAMA. 1998 Nov 11;280(18):1580-4. doi: 10.1001/jama.280.18.1580. 

2. Liao J-A, Shao S-C, Chang C-T, Chai PY-C, Owang K-L, Huang T-H, Yang C-H, Lee T-J, Chen Y-C. Correction of Breech Presentation with Moxibustion and Acupuncture: A Systematic Review and Meta-Analysis. Healthcare. 2021; 9(6):619. https://doi.org/10.3390/healthcare9060619

download; https://www.mdpi.com/2227-9032/9/6/619

3. Ewies A, Olah K. Moxibustion in Breech Version – a Descriptive Review. Acupuncture in Medicine. 2002;20(1):26-29. doi:https://doi.org/10.1136/aim.20.1.26

‌4. Smith CA. Moxibustion for Breech Presentation: Significant New Evidence. Acupuncture in Medicine. 2013;31(1):5-6. doi:https://doi.org/10.1136/acupmed-2012-010288

download; https://journals.sagepub.com/doi/epdf/10.1136/acupmed-2012-010288

5. Miranda-Garcia M, Domingo Gómez C, Molinet-Coll C, Nishishinya B, Allaoui I, Gómez Roig MD, Goberna-Tricas J. Effectiveness and Safety of Acupuncture and Moxibustion in Pregnant Women with Noncephalic Presentation: An Overview of Systematic Reviews. Evid Based Complement Alternat Med. 2019 Dec 3;2019:7036914. doi: 10.1155/2019/7036914. PMID: 31885661; PMCID: PMC6914967.‌

download; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6914967/pdf/ECAM2019-7036914.pdf