Research on Moxabustion and Breech Presentation

Notes on research from Debra Betts PhD on a Cochrane review:

The Evidence Base for moxibustion and moxibustion with Acupuncture

A Cochrane review found limited evidence to support the use of moxibustion for correcting breech presentation (Table 1).  However within these studies the length of time that the moxibustion was used and the frequency of treatment delivered varied considerably.  It may be that these ‘dosage’ differences impacted on the findings. Only two trials examined the use of moxibustion as recommended in acupuncture texts (7,8).This involves using moxibustion for 15 minutes bilaterally.  Trials that do not reflect the therapeutic dose delivered in clinical practice may well limit the confidence of research findings.

A finding from the research that has important considerations for clinical practice was that for women in western countries there were two trials where women failed to fully comply with the research protocols (9.10). Practitioners may need to consider how to support women compleate treatment if the concept of moxa is unfamiliar. Written information sheets and follow up may be required.  

Table 1. Trials in Cochrane review

Citation

Control 

Intervention 

Treatment details 

Findings 

Cardini

1998

N =260

Usual care 

Moxa only 

15 mins each toe   

Daily up to 14 days

Moxa       (+)

Cardini

2005

N=123

Usual care

Moxa only

15 mins each toe  

Daily up to 14 days  

Discontinued  due to noncompliance

Chen

2004

 N = 142

Usual care

Moxa + position 

10 – 15 minutes in total

Once a day for 3 days  

Moxa plus position (+)

Lin

2002 

N= 122

Position exercises

Moxa + position 

15 minutes in total  

Once a day for 2 days  

Moxa plus position (+)

Yang

2006

N=206

Position exercises

Moxa + position 

15 – 20 mins in total  

Twice a day up to one week

Moxa plus position (+)

Guittier

2009 

N=212

Usual care 

 Moxa 

10 minutes each toe 

Once up to 14 days

18 % turned  Moxa

16% usual care

Neri

2004 

N=226

Observation (no ECV) 

Moxa  + acupuncture

20 mins in total  

Twice a week up to 2 weeks 

Moxa + aupuncture    (+)

Neri

2007

N= 41

Moxa/ Acupuncture/ Moxa  + acupuncture

20 mins each toe  

Twice a week up to 2 weeks 

80% for moxibustion

28% for acupuncture

57% for acup + Moxa

(+) Statically significant.    N= number of women

 Although the studies using moxibustion plus positioning demonstrated positive befits it is worth noting that two of these studies ( Lin 2002; Yang 2006)  accepted women under 34 weeks gestation and as more babies are expected to tune spontaneously before 34 weeks these results may not be transferable.  

 Further studies to this review include a comparison of Moxa on BL 67 to Moxa on Sham point and an inactive laser on BL 67. This study found that the moxa treatment was statically significant to the sham and control.11 While a study that used an inactive laser as a control to a treatment of moxa plus acupuncture did not find any statically significant differences, 12  it should be noted that the use of acupuncture is not recommended in acupuncture texts 7.8 and may not reflect recommended clinical practice. Finally a study examined usual care to the use of moxibustion for a total time of 15- 20 minutes rather than 15 mins to both toes.10.  This does not necessarily reflect recommended clinical practice and may have impacted on their findings that there was no statically significant differences between groups.

Conclusion 

When considering the evidence for the use of moxibustion to turn breech babies cephalic it is worth considering dosage. To date very few studies have used the moxibustion as recommended in acupuncture texts. This may impact on the research findings reported.  

 

Cochrane Review 2012:

Cephalic Version by Moxibustion for Breech Presentation

There is some evidence to suggest that moxibustion may be useful for turning babies from breech presentation (bottom first) to cephalic presentation (head first) for labour when used with either acupuncture or postural techniques of knee to chest or lifting buttocks while lying on the side. 

Breech presentation of babies is common in the second trimester of pregnancy but most babies turn themselves before the onset of labour; some do not. A baby coming bottom first can have more difficulty being born, which causes trauma to the mother. A vaginal birth has to be planned or a caesarean section may be suggested. Moxibustion is a type of Chinese medicine that may be helpful in turning a breech baby. It involves burning a herb close to the skin at an acupuncture point on the little toe to produce a warming sensation. This review found eight randomised controlled trials involving 1346 women. Women randomly assigned to moxibustion had daily to twice weekly treatment at between 28 and 37 weeks. In one trial adverse events relating to treatment included an unpleasant odour (with or without throat irritation), nausea and abdominal pain from contractions. The included trials were of moderate methodological quality, sample sizes in some of the studies were small, how the treatment was applied differed and reporting was limited. While the results were combined they should be interpreted with caution due to the differences in the included studies. More evidence is needed concerning the benefits and safety of moxibustion.

Authors' conclusions: 

This review found limited evidence to support the use of moxibustion for correcting breech presentation. There is some evidence to suggest that the use of moxibustion may reduce the need for oxytocin. When combined with acupuncture, moxibustion may result in fewer births by caesarean section; and when combined with postural management techniques may reduce the number of non-cephalic presentations at birth, however, there is a need for well-designed randomised controlled trials to evaluate moxibustion for breech presentation which report on clinically relevant outcomes as well as the safety of the intervention.

To review this research in further detail click here

 

 

 
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