Correcting Breech Position During Pregnancy

 

Reversing breech position of a baby while in the uterus seems revolutionary, yet it is not new news. We reported the good news several years ago with the publication of Shizuko Yamamoto and Patrick McCarty's second book, The Shiatsu Handbook.


Breech position of the fetus can be reversed in a good number of cases. In China, studies have shown that by using moxibustion on one acupoint, the fetus can move to the correct delivery position. In the China study is occurs in 90% of woman treated. Moxibustion is applied to Bladder 67 (Zhiyin) on both feet. The heating is controlled so as not to produce burning pain. It is applied once a day for 15 minutes. Most can be corrected within one to four treatments. Some take up to 10 treatments. It is assumed that stimulation of Bladder 67 increases secretion of the adrenal cortex which enhances uterine activity. At the time of treatment, the movement of the fetus increases. This favors the automatic correction of the fetal position.

Zhiyin is located on the lateral side of the small toe, about 0.1 inch posterior to the corner of the nail.

Moxibustion is the application of heat, usually from the burning of the herb mugwort, to a specific acupoint.


Summary from the Journal of American Medical Association

Moxibustion for Correction of Breech Presentation-A Randomized Controlled Trial

conducted by Francesco Cardini, MD; Huang Weixin, MD.


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. Breech presentation means the baby is coming rear end first for delivery instead of head first. 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 JAMA. 1998; 280:1580-1584

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