Chinese medicine tactic doesn't turn breech babies
Thu Oct 29, 2009 1:13pm EDT
By Amy Norton
NEW YORK (Reuters Health) - A traditional Chinese therapy used for turning babies out of the breech position before birth may not be effective, a new study finds.
The study, reported in the journal Obstetrics & Gynecology, tested a tactic known as moxibustion, which uses heat to stimulate a particular acupuncture point in an effort to turn a breech fetus to the head-down position before birth.
Researchers found that the method appeared no more effective than Mother Nature among the 212 women they studied.
In about 3 percent to 5 percent of pregnancies, the fetus is in the breech position near the time of delivery -- meaning the feet or buttocks are closest to the birth canal. Because delivering a baby in this position presents risks, doctors typically perform a cesarean section.
In the weeks before the due date, women can also choose to try an external cephalic version (ECV), where a doctor or midwife uses their hands on the woman's abdomen to encourage the fetus to turn to the head-down position. The method, performed in the 37th week of pregnancy or later, is successful in 30 percent to 80 percent of cases, depending on the center.
Moxibustion has emerged as an alternative. Long used in Chinese medicine, the method involves burning a stick with the herb mugwort and placing it near the little toe to stimulate a particular acupuncture point there.
Some research has suggested moxibustion might be effective; a trial in China, for example, found that the method increased the chances of the fetus turning to the head-down position.
However, some other studies have been unable to replicate that success, and moxibustion remains "controversial" outside of Chinese medicine, according to the researchers on the new study, led by Marie-Julia Guittier of the Geneva University Hospitals in Switzerland.
For their study, the researchers followed 212 women who had a fetus in the breech position between the 34th and 36th week of pregnancy.
Half of the women were randomly assigned to have moxibustion therapy; a midwife trained in acupuncture performed it three times weekly in the hospital, and the women were encouraged to do it at home on all other days. The rest of the women received no therapy and served as control group.
All study participants, however, had the option of undergoing an ECV at the 37th week of pregnancy.
In the end, Guittier's team found, 18 percent of fetuses in the moxibustion group had turned to the head-down position by the time of delivery or a scheduled ECV. In the control group, 16 percent of fetuses had spontaneously turned -- a difference that was not statistically significant.
"To say the least, moxibustion was not as effective as suggested in (the) earlier trial that was conducted in China," co-researcher Dr. Michel Boulvain, also with the Geneva University Hospitals, told Reuters Health in an email. The reasons for the differences in the trials, he added, are unclear.
It's also unclear whether moxibustion has any physiological effects that would help turn a breech fetus.
Boulvain said that some researchers have reported increases in fetal movement during moxibustion sessions, which in theory could be beneficial. But he added that there are no known reasons, based on "traditional physiology," for why moxibustion would work in this context.
Based on the existing evidence, Boulvain said, "the decision in our hospital is to not implement or recommend moxibustion for these women."
SOURCE: Obstetrics & Gynecology, November 2009.
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