Moxibustion is a well-known treatment among the Chinese for correcting a breech presentation.
Taut and twisted muscles will pull on the joints and hence create obstacles for the baby to turn. Therefore, these techniques will relax the body and the muscles, decrease any pain present and optimise the space in the pelvis and abdomen to give the baby maximum room to move.
"Your baby is in breech." These few words can arouse fear and anxiety in pregnant women as breech presentation increases the chances of having a caesarean. Approximately four per cent of babies will present breech at term and many obstetricians have a strict rule that if a baby is breech the pregnant woman must have a caesarean. Fortunately, several complementary therapies are proving successful in safely turning babies before term.
Hospital-based and independent midwives, including Jan Robinson, constantly challenge the high rate of caesarean births. Statistics indicate almost a quarter of the state’s expectant mothers undergo caesareans. Statistics also support midwifery hearsay that private patients are more likely to have surgical intervention (forceps, vacuum extractions and caesareans) than public patients. "The unnecessary rate of caesarean deliveries is largely due to the financial incentives on the part of the obstetrician as well as the ability to program their workload more effectively," says Jan.
In some cases, if the pregnancy has reached term and the baby is still breech a caesarean is advisable. These cases include placenta praevia, when there are fibroids or ovarian cysts present or when the uterus is divided. When there are signs of foetal anomalies a caesarean is also recommended.
Jan says normal breech presentation can make a woman feel vulnerable and helpless, viewing her predicament as beyond her control. "Some women will accept that nothing can be done and prepare themselves for an elective caesarean; others will go searching elsewhere and come across the alternative practitioners — osteopaths, traditional Chinese medicine practitioners, naturopaths and midwives."
Alternative practitioners view a breech presentation differently from obstetricians: "To midwives it’s just an upside-down version of normality and not something to be feared," says Jan. "Women with a breech baby after 34 weeks should first try different (non-invasive) ways to get the baby to turn and, if that doesn’t happen, prepare for a vaginal birth. Unless the breech baby has an abnormality that would make it hazardous to be born naturally, competent carers will ensure the woman learns how to work with her labour and birthing process to achieve the safe arrival of her breech baby."
Osteopathy and pregnancy
Jo Wilson was 30 weeks pregnant when she was told the new baby thriving inside her womb was in breech position. With almost a third of breech babies resulting in elective caesareans (National Perenatal Statistics Unit, 1995), Jo knew her delivery options were limited if she didn’t act immediately. She had been seeing an osteoopath for lower back pain before her pregnancy and was pleased with the results. After just one osteopathic treatment and four days of light exercise, Jo’s baby turned and was engaged at 34 weeks.
Ostoeopathy uses soft tissue stretching and joint manipulation, as well as dietary advice and exercise, to treat a wide range of health problems, including the common complaints associated with pregnancy, such as lower back pain, sciatica (leg pain) and neck, shoulder and middle back pain.
Osteopath Peter Green has been encouraging babies to turn for well over 10 years, with a great success rate for women 32 to 36 weeks into their pregnancy. Peter says osteopathy works to help the body regain its own rhythm. He says pregnancy can cause the body to miss a few beats because of the weight-bearing changes and hence the body may need re-tuning. In breech pregnancies, this re-tuning involves creating an ideal environment for the baby to move out of the breech position.
What is involved in turning a baby?
First, Peter smooths out all the "lumps and bumps" in the lower back, abdomen and rib area. This involves various massage techniques to decrease the muscle tightness and muscle spasms. This is followed by some gentle mobilisation and stretching techniques to restore movement to the spine and hip joints. Taut and twisted muscles will pull on the joints and hence create obstacles for the baby to turn. Therefore, these techniques will relax the body and the muscles, decrease any pain present and optimise the space in the pelvis and abdomen to give the baby maximum room to move.
Second, osteopaths will work on positional exercises to help dislodge the baby out of the pelvis. One exercise involves lying on the floor for two minutes with legs up on a chair and pillows supporting the lower back and buttocks. The pregnant woman then spends another few minutes on all fours with her forehead resting on the floor. These exercises create a wave-like motion in the womb and essentially get the baby up and out of the pelvis.
Depending on the breech presented (frank, buttocks first with legs extending straight up the front of the baby’s body; complete, buttocks first with legs crossed underneath; and footling, one or two feet first), the osteopath will help encourage the baby to move the short way out. Still on all fours, the pregnant woman engages in pelvis rocking. Peter says the partner or support person can assist by gently massaging the stomach at the same time. He says this gives the baby a sense of where it needs to move. Finally, the pregnant woman spends 20 minutes lying down because a baby is more likely to turn when the mother is still and resting.
Peter says that after about two treatments and continuing the exercises two to three times a day, the baby will turn within two weeks. Peter recommends further exercises such as walking and pelvic rocking (in the standing position) to prevent the baby from reverting to the breech position, and encouraging the head to engage. He says the odds for turning breech presentations after 38 weeks are much less because the baby may be too large or too stubborn to turn.
Traditional Chinese medicine
Another therapy providing alternatives for women with breech presentation is traditional Chinese medicine (TCM). TCM is best known for Chinese herbal medicine and acupuncture, but also includes Chinese exercises, massage and moxibustion. TCM practitioner Margaret Bruce says women have shared the same problems in pregnancy for thousands of years, and moxibustion, China’s most ancient form of therapy, has been just as effective in treating these problems as it was centuries before.
After a breech delivery the first time around, Jodie was determined to have a natural delivery at home for her second baby — providing hers and the baby’s health were not compromised. At 28 weeks, baby number two was again breech. Jodie consulted her midwife to discuss her options. "I was prepared to do anything to turn her [Kyra, now 12 months]," Jodie reveals. "This was going to be our last child so I really wanted to have her at home and it was really getting me down thinking I couldn’t because of her position. I wasn’t prepared to have a breech at home."
Jodie and her midwife discussed acupuncture and moxibustion, kinesiology and an external cephalic version (manually turning a baby using massage and ultrasound). In addition to the acupuncture and moxibustion, Jodie was put on a diet of raw vegetables and limited to two pieces of fruit a day. She says that at first she wasn’t convinced the treatments were going to work. But her scepticism was quashed when an ultrasound at 36 weeks revealed a vertex presenting baby.
Moxibustion and pregnancy
TCM practitioners regard pregnancy as a natural process and something to be interfered with as little as possible. Moxibustion is a well-known treatment among the Chinese for correcting a breech presentation. The Chinese word for moxa is jiu, which means burning. It’s a burning herb taken from the veins of the artemisia vulgaris leaf. The herb is rolled into a cigar-shaped stick and burnt to stimulate acupoint BL 67, located beside the outer corner of the little toenail.
The moxa stick is lit and placed about an inch above the acupoint until it becomes hot. When the woman feels it "hot", the stick is pulled away for a few seconds, then immediately placed over the point until she says "hot" again. This process is repeated for about 20 minutes. The combination of the herb and the heat will stimulate energy in the body and stimulate movement of the amniotic fluid and blood, encouraging the baby to raise out of the breech position. TCM practitioners recommend using the moxa stick for 20 minutes everyday for 10 days. Moxibustion is most effective before week 34 but has even been able to help turn babies past their due date.
Margaret says pregnancy problems must not be treated unless the partitioner has holistic knowledge of the patient. "I will work on the problems I see associated with the woman’s health and what I feel on the pulse and what I see on the tongue. This will ensure the best results possible. In the case of a baby presenting in the breech position, I would be using other acupuncture points that would augment BL67 (Zhiyin) by strengthening both mother and baby."
There are 28 different pulse qualities in traditional Chinese medicine. "For instance, the pulse can feel thin, wiry or thready; it may be very slippery, too fast or too slow," says Margaret. "If the quality of the pulse is a little bit wiry, the woman’s stomach may be weak; or she may be lacking in blood if it’s too thin." She says the kidney is the basic energy for fertility, so if the kidney pulse is strong the woman is likely to experience a positive birth. Tongue examinations are equally important; the shape, colour and texture of the tongue can tell a lot about the health of the woman as well as the baby. "For example, a tongue that is red with a white/yellow coating indicates there’s too much heat in the stomach," Margaret says. "The baby may move around a lot because it’s too hot and can’t find a place to relax. This may make the woman feel nauseous, so I will choose an acupuncture point to remove the heat."
A woman’s physiological state will also influence baby’s energy. Margaret says if a woman is carrying a hectic workload, her body is not going to be able to relax and allow the change to happen. She says that if the woman is strong and relaxed, the baby should turn. A study published in the Journal of the American Medical Association (Nov 11, 1998) found moxibustion to be safe and effective for stimulating foetal activity in the wombs of pregnant women to turn from a breech position to a head-first position. While this treatment may seem quite strange for many people, it’s a safer and less radical course of action than a caesarean delivery, says Margaret.
