The statistics showing that 92% of babies in utero are head down at 34 weeks and 97% are head down at full term1 suggest that most babies present head first (cephalically) in preparation for labor and delivery. Complete or incomplete breech presentation, when the baby’s head is not down, occurs in 3-4% of all births, and most often leads to a caesarian section to avoid potential complications in labor and delivery.
Breech presentation may occur due to the shape of the mother’s pelvis, or uncommonly because of a shortened umbilical cord. Since gravity pulls the fetus’ head (the heaviest part of the baby) down, a mother who is immobilized may not have gravity working in her favor, and the baby’s head may not be drawn down. There have also been anecdotal reports of babies turning breech from excessive lower abdominal pressure created in such positions as deep forward folds in yoga and Pilates, or due to disorienting flip turns in swimming pools.
In 2001 the American College of Obstetricians and Gynecologists (ACOG) recommended that all breech babies be delivered by caesarian. In 2006 the ACOG amended the recommendation to state that a vaginal breech delivery may be attempted by an experienced obstetrician. External cephalic version (ECV), manually turning a fetus from a head up to a head down position (routinely done with ultrasound guidance at 37 weeks in a hospital), is the technique most commonly used to turn breech babies. It has been suggested that version by acupuncture be attempted between 32 and 34 weeks, so that should the intervention fail, mechanical external version can still remain a possibility before the breech descends into the pelvis in preparation for labor and delivery.2,3
Acupuncture treatment for turning breech babies is very simple. It involves stimulating one point on the 5th toe corresponding to BL-67 (BL=bladder point), and it is supported by the mother with self-treatments at home using moxibustion, powdered mugwort compressed into a cigar or cone shape. There have been encouraging studies reporting higher cephalic presentation in acupuncture and moxibustion treated groups compared to control groups.
Traditional acupuncture treatment involves ten sessions, spaced about a day apart. There have been no adverse side effects reported when using acupuncture and moxibustion to turn breech babies. This includes no increased risk of stimulating preterm labor.2
Acupuncture will not turn a breech-presenting baby if it will cause the baby harm. It is easier for a baby to turn cephalic if the baby isn’t too big, and if there is sufficient amniotic fluid.3
I had my own experience turning my breech-presenting baby. I was 35 weeks pregnant, had an ultrasound on a Wednesday, and the first thing the technician asked was if I knew I had an incomplete breech presenting baby. This was news to me since on the previous ultrasound he was cephalic. I asked my OB what his thoughts were on using acupuncture and moxibustion to attempt to turn the baby, and he encouraged the treatment.
I did a treatment on myself on Thursday night. I felt an immediate increase in fetal activity, as has been reported in the literature.3 On Friday morning when I went in for my routine OB visit, the baby was head down, and he was delivered full term with no complications.
From personal experience, I can report that the treatment was only mildly uncomfortable. And I was very happy to experience a natural version.
The postulated neurophysiology of how acupuncture and moxibustion works to turn a breech baby is that increases in placental estrogen and prostaglandin levels lead to increases in uterine contractility and fetal activity4, although fetal version may also occur passively.1 It has also been suggested that moxibustion of BL-67 for five days may allow for more successful ECV procedures.5
In Traditional Chinese Medicine, the cause of breech presentation is weakness in the Kidney meridian system, as the Kidney nourishes the uterus and fetus. Acupuncture and moxibustion to BL-67 nourishes the Kidney yang to prepare the uterus and fetus for birth, including positioning the fetus cephalically, properly head down.4,5
- Judy Slome Cohain. Turning Breech Babies after 34 weeks: The if, how, & when of turning breech babies. Midwifery Today, Autumn 2007.
- Sananes N., Vayssiere C., et al. Acupuncture for breech version: Principles, technique, mode of action and utility – A literature review. The Journal of Maternal-Fetal and Neonatal Medicine, May 2010; 23(5):455-458.
- Grabowska C. Turning the breech using moxibustion. Midwives. Volume 9, No. 12; December 2006.
- Maciocia G. Obstetrics & Gynecology in Chinese Medicine. p. 562. Churcill Livingstone, 1998.
- Betts D. The Essential Guide to Acupuncture in Pregnancy and Childbirth. p. 128. The Journal of Chinese Medicine, 2006.