A very interesting paper has been written in the Journal of Chinese Medicine, entitled, ‘Should Acupuncture and Moxibustion Be Routinely Recommended for the Treatment of Breech Presentation? (February 2012)’. This paper represents a thorough examination of research articles published through databases such as; the Cochrane Library, Medline, MIDIRS, and PubMed. Only English-language randomised controlled trials, and controlled clinical trials comparing moxibustion or acupuncture with a control group were included.

The aim of the study was to determine if there is a case for moxibustion/ acupuncture to be offered routinely for the treatment of breech presentation.

Introduction

There are limited options for treating breech presentation. Women are often told to ‘wait and see’, and if the baby does not turn then a caesarean section is recommended. The other alternative is ECV (External Cephalic Version), where the baby is manually turned into the correct position for birth. However, this procedure presents a high risk to both mother and baby, and must be performed by a trained gynaecologist in a hospital theatre.

In contrast, moxibustion is cheap, safe, pain-free, and easy to administer as home-based treatment. Moxibustion involves the burning of a Chinese herb ‘moxa’ on a particular acupuncture point on the foot. Although ‘direct’ moxa can be used (i.e. direct contact with the skin), it is more normal practice to use ‘indirect’ moxa, which does not touch the skin, and allows a gradual build up of heat. It is important to be properly shown this technique as the acupuncture point is very small, and requires good stimulation to be effective.

Results and Discussion

There were some inconsistencies in the treatment approaches, which raised further questions that needed clarification. For example, some trials started treatment at 28 weeks gestation, and another study started at 38 weeks. However, the general consensus was 34 weeks being the optimum week to start treatment.

There is little written about using acupuncture instead of moxibustion. In theory acupuncture should give a stronger stimulation, however the point indicated for breech presentation is very sensitive, and women would not be able to treat themselves at home. It would be interesting to compare acupuncture versus moxibustion.

A particularly interesting study was performed by Dr Francesco Cardini who is an Italian obstetrician and acupuncturist. He published a pioneering and highly influential trial. His European non-governmental non-profit organisation funded trial took place in China, and saw a 75% positive outcome with moxibustion, compared to 48% with no moxibustion.

During treatments, women often reported an increase in foetal movement. In addition, many women felt more relaxed, and described the experience as ‘relaxing’, ‘pleasant’, ‘safe’, and ‘enjoyable’.

Conclusion

In the UK, the National Institute for Health and Clinical Excellence merely acknowledge the use of moxibustion to treat breech presentation, and the procedure is not available in most hospitals (NICE, 2008). However, despite some inconsistencies in the treatment approaches studied, there is evidence that acupuncture and moxibustion are effective treatments for beech presentation.

The paper concludes that acupuncture and moxibustion should be offered routinely for the treatment of breech presentation.

Ref: Should Acupuncture and Moxibustion Be Routinely Recommended for the Treatment of Breech Presentation? Author Andrea Aiello Steinlechner, JCM, No. 98, Feb 2012

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