Breech Presentation

In the realm of Western medicine, breech presentation refers to the position of a baby in the womb where the buttocks or feet are positioned to be delivered first instead of the head. It occurs in about 4% of full-term pregnancies and is classified into three types: frank breech (legs straight up and buttocks presenting), complete breech (legs crossed and buttocks presenting), and footling breech (one or both feet presenting). The underlying causes of breech presentation in Western medicine are not yet fully understood. However, certain factors increase the likelihood of a breech position, such as premature birth, multiple pregnancies, placental abnormalities, polyhydramnios (excess amniotic fluid), and certain uterine abnormalities. Additionally, advanced maternal age and previous pregnancies with breech presentation also raise the risk. Detecting breech presentation usually occurs during routine prenatal visits, where doctors palpate the abdomen to determine the position of the baby. To confirm the breech presentation, physicians may recommend an ultrasound or other imaging techniques.

Depending on various factors such as the gestational age, the overall health of the mother and baby, and the preference of the obstetrician, different management options are available for breech presentation. In Western medicine, external cephalic version (ECV) is often offered around 36-38 weeks of gestation. ECV is a procedure where the obstetrician manually attempts to turn the baby into a head-down position through gentle pressure on the mother's abdomen.
If ECV is not successful, or if it is contraindicated due to certain maternal or fetal conditions, cesarean delivery is typically recommended. This is because vaginal delivery in breech presentation carries a higher risk of complications, such as cord prolapse, head entrapment, or birth injuries. Cesarean delivery provides a safer alternative, ensuring the well-being of both the mother and baby.

The prevailing approach to delivering breech babies is through cesarean section, a significant surgery fraught with risks that can affect the mother's healing process, overall results, and healthcare costs. Having access to alternative techniques for flipping breech babies can bring advantages to both the healthcare system and expecting parents, easing potential burdens along the way.

Moxibustion Treatment

Moxibustion Treatment for breech presentation involves the use of a moxa stick made from dried Chinese mugwort to warm and stimulate a specific acupuncture point, UB67, located on the outer edge of the 5th toe. This treatment is typically administered once or twice daily for 15-30 minutes over a period of 5-14 consecutive days. While the optimal timing for moxibustion and acupuncture in treating breech presentation hasn't been definitively established, it is generally believed within the acupuncture community that treatment is most effective at 33-35 weeks gestation. Offering moxibustion as an option to expectant parents may help reduce rates of breech presentation, ultimately lowering cesarean section rates and improving maternal satisfaction with the birth experience.

Current Standard of Care:

The most common medical intervention for correcting breech presentation is External Cephalic Version (ECV), which involves manually attempting to turn the baby from the outside of the abdomen. However, ECV is not always offered by prenatal care providers, and some parents may choose not to undergo this procedure due to its potential risks and discomfort.

Summary of Research:

A 2023 Cochrane Systematic Review examined various methods, including moxibustion and acupuncture, for breech presentation in uncomplicated pregnancies. Moxibustion treatment, when administered before 37 weeks of pregnancy, was found to probably reduce the chance of breech presentation at birth and the need for oxytocin during birth. However, it did not consistently decrease the overall rate of cesarean section, and the reasons for cesarean sections were not reported. Combining moxibustion with acupuncture, a common practice, has shown promising results in increasing the rate of cephalic presentation at birth compared to usual care, but more research is needed to understand the specific effects of this combination treatment.

A study focused on the UB67 acupuncture point suggested that it might be particularly useful in turning breech babies. The rates of cesarean section were not significantly different between the groups, and more research is needed to confirm these findings.

In 2017, the Royal College of Obstetricians and Gynecologists (RCOG) included moxibustion and acupuncture in their guidelines for managing breech presentation, recommending moxibustion at 33-35 weeks gestation and emphasizing the importance of choosing trained practitioners.

Mechanism of Action:

One theory is that treatment at the UB67 acupuncture point may stimulate maternal hormones (placental estrogens and prostaglandins), leading to uterine contractions and increased fetal activity. A study measuring fetal movement found a statistically significant increase in movement in the moxibustion group compared to the usual care group.

Safety:

Using acupuncture and moxibustion for correcting breech presentation in uncomplicated pregnancies is generally considered low risk. Common adverse events include potential burns, increased fetal movements, uterine contractions, nausea, and headaches. Adequate reporting of adverse events in trials is essential to determine safety conclusively. These treatments should be performed in well-ventilated spaces to prevent respiratory irritation and should be administered by trained practitioners who are aware of potential risks and contraindications.

Conclusion:

Acupuncture and moxibustion have the potential to be effective, safe, and well-tolerated options for correcting breech presentation, especially since they can be attempted several weeks prior to ECV. However, individual results may vary, and expectant parents should consult with healthcare providers before pursuing these treatments. Further research is needed to better understand their mechanisms of action and optimise their use in clinical practice.

Chinese Medicine & Breech Presentation