Moxibustion for breech babies explained

Babies lying bottom first or feet first in the uterus instead of in the usual head-down position are called breech babies. Breech is common in early pregnancy, and by 36-37 weeks of pregnancy, most babies turn naturally into the head-down position. If your baby remains breech, it does not usually mean that you or your baby have any problems and if attempts to turn your baby into the head down position have not succeeded, your birth options are either an elective caesarian or a planned vaginal breech birth.

In the UK, if your baby is in the breech position you will be offered an External Cephalic Version (ECV), a procedure to turn your baby to a head-down position. It involves an experienced obstetrician placing their hands on your abdomen to manually move the baby up and out of the pelvis. They will attempt to turn the baby through a forward or backward somersault to a head-down position. Attempting ECV is performed to increase your chances of having a vaginal birth (80% chance) and lower the chances of a caesarean section. Up to half of all attempts are successful, but ECV success rates differ in each hospital. Women who have this done describe it as being uncomfortable.

Another technique called ‘moxibustion’ is used in traditional Chinese medicine to encourage version of the foetus in breech presentation. It is a method that is suggested as an alternative to ECV by the Royal College of Obstetricians and Gynecologists (RCOG) and an increasing number of maternity units across the UK refer patients for moxibustion. So what exactly is moxibustion and how can you seek treatment?

What is Moxibustion?

Moxibustion is a traditional Chinese method of acupuncture treatment, which consists of burning the dried leaves of a plant called Moxa (also known as Mugwort) and use the heat generated to stimulate specific acupuncture points on the body.

The method

There are various forms in which moxibustion can be applied. One form used to correct the baby’s position in case of breech position during pregnancy is called indirect moxa – with this method the moxa leaf is pressed into a stick, which can resemble a cigar or small rolls.

The technique consists of lighting a moxa stick and bringing it close to the skin close to the acupuncture point located at the tip of your fifth toe, until it produces hyperaemia (increase of blood flow) due to local vasodilatation. The heat felt should be warm but not uncomfortable.

Women with a breech presentation may seek treatment with moxibustion from 32–38 weeks but it is preferably performed around 34 weeks of pregnancy. The baby at this stage is small enough to turn and big enough to remain in the head-down position.

Moxibustion may be administered for 15–20 minutes each time. Ten treatments comprise a course, and can be carried out once or twice a day.

There are usually increased foetal movements during the treatment and for a while afterwards. A possible mechanism is the influence of moxibustion on maternal cortisol levels leading to increase in foetal movements.

The benefits

Generally, moxibustion is used to warm areas of the body with the intention of stimulating circulation and lymphatic flow. It also helps to smooth the flow of Qi and blood and expel pathogenic influences. The scent of moxa is very distinct and many people find it to have a therapeutic and relaxing aroma.

Published evidence suggests that moxibustion has a positive effect and play a part in reducing the number of breech presentations at term. Therefore, it is effective in reducing the need for an external cephalic version (ECV) and contributes to a reduction in the number of caesarean sections which are so often advocated in breech presentation. There have been no reported side-effects for mothers or babies.

Contra-indication:

The exclusion criteria apply for those women with the following conditions:

1. Placenta previa.

2. History of ante-partum haemorrhage.

3. Multiple pregnancy.

4. Known abnormality of the uterus or pelvis.

5. History of premature labour or premature ruptured membranes.

6. Previous Caesarean section if more recent than 2 years.

7. Oligohydramnios.

8. Rhesus antibodies.

9. Known hydrocephalic fetus.

Those in whom none of the above conditions apply can attend online consultations (preferably with a partner) and learn how to apply moxa in the comfort of their home.

Consultations:

In a face-to-face consultations, I give a treatment and demonstrate to my patients how to self-administer moxibustion at home. Applying moxa is simple to do and it does not involve any needles. I give clear verbal and written guidelines covering method and safety to enable mothers to continue the course of treatment in the comfort of their home for up to 10 days.

After your treatment you go home with

o 2 Moxa sticks

o Instruction sheets (incl. list of equipment needed and method, and safety guidelines)

If you would like to know more and learn how to use this simple technique, please contact me via email at sophies@silverwoodacupuncture.co.uk

References:

Moxibustion for breech presentation – Sarah Budd SRN, SCM, Dip Ac, B Phil (Comple.Health Studies), Midwifery Sister / Acupuncturist

https://www.rcog.org.uk/en/patients/patient-leaflets/breech-baby-at-the-end-of-pregnancy/

https://www.stgeorges.nhs.uk/wp-content/uploads/2013/05/SGH-Breech-Leaflet-PING-approved.pdf

Sophie Silverwood-Cope BSc(Hons) Chinese Medicine Acupuncture, Member of the BAcC

Tel: 07809 828 402

sophies@silverwoodacupuncture.co.uk

Consultations at Make Me Feel Pharmacy in Clapham (SW4 London), 2Me Clinic in Marylebone (W1 London 2meclinic.com)

Acupuncture for morning sickness

C9 Chinese obstetrics text, C19 re-edition, Woodblock print

Nausea and vomiting in pregnancy – the facts

Nausea and vomiting in pregnancy is believed to occur in about half of all pregnancies, usually between the sixth and the sixteenth weeks and is at its most intense at eight to twelve weeks.

Although it is commonly called morning sickness, nausea and vomiting in pregnancy can happen at any time of the day or night. The degree to which women experience morning sickness hugely varies: a woman can have nausea only or accompanied by vomiting. The intensity or the time of the day it is felt can also vary. But it can also be constant, including on waking at night.

 Although women are often eating less and possibly lose weight while experiencing nausea and vomiting early in pregnancy, the real concern is the possibility that excessive vomiting (hyperemesis gravidarum in scientific terms) can lead to dehydration and the woman may then require hospitalisation to receive intravenous fluids. Doctors or midwives who suspect dehydration in pregnant women often give them blood tests to check their electrolyte levels or urine testing sticks to measure their ketone levesl.

 The Causes

There are many theories as to why nausea happens in pregnancy:

Hormonal reasons  - HCG the hormone used as an indicator in pregnancy test and rising oestrogen levels are cited as the main culprit

Brain stem – this part of the brain is believed to be the control centre of nausea and vomiting. The way it responds to the hormones produced in pregnancy might influence the level of nausea and vomiting a woman experiences

Stress levels and fatigue – they are believed to increase the risks of developing morning sickness

 Acupuncture to treat nausea and vomiting in early pregnancy

Women’s experiences of morning sickness varies as much as their experience of labour: some are bedridden and might need hospitalisation, some damage blood vessels in their throat from vomiting so often and violently, some are not vomiting but feel that if they could, it might help them. Finally some carry on with their normal daily routine whilst feeling absolutely awful.  There is no ‘normal’ and it certainly doesn’t support the myth that suggests that morning sickness is both mild and a normal part of pregnancy.

 Whatever the symptoms, acupuncture offers a real, safe, natural alternative to simply putting up with the nausea and vomiting in pregnancy.

 A traditional Chinese medicine viewpoint – Pattern differentiation and treatment

 From a traditional Chinese medicine perspective pregnancy brings up changes to the energetic balance of the body but these changes are not considered pathological developments.  It is therefore considered normal to see the following

 ·      Increase in blood

·      Increased heat

·      Increased dampness

·      Increased Liver energy

·      Decreased kidney energy

 (note that blood, heat, dampness, Liver and Kidney energy here are Chinese Medicine terms and concepts)

 However, because of constitution or lifestyle, the balance can be sometimes disrupted by one of the elements above. Too much heat or dampness, too much Liver energy or not enough Kidney energy for example can evolve in patterns of disharmony.

 In Chinese medicine each pattern of disharmony presents with specific symptoms. As mentioned before in the case of nausea and vomiting, a trained and skilled Chinese medicine acupuncture practitioner will see a different pattern in a patient who vomits her food soon after eating it, with a persistent thirst, a red tongue and a rapid pulse, and a patient who feels nauseous with no vomiting but with epigastric distension and fullness and who presents with extreme tiredness of the arms and legs, lethargy, weak voice, spontaneous seating, a pale tongue and a weak pulse.

 The acupuncturist is able to identify the causes of the imbalance and chooses the appropriate treatment (a combination of acupuncture points) tailored to address the particular symptoms of the patient but also the causes of her imbalance.

 The number of needles used in a single treatment is limited to 6 to 8 to prevent excessive stimulation and they are usually retained between 15 and 20 minutes

 Although not all women will flourish following treatment, the majority will see a dramatic improvement that put them back in control.  It is worth warning the patient that no matter how good she feels after the treatment, she needs to be aware of her body’s limit, stick to appropriate food, not skipping regular meals or snacks, or not staying up late for example.

 Patient advice

An acupuncture practitioner should also be able to help women incorporate life-style changes in their routine, rest and hydration being paramount. Again not everything will work on everyone but according to the specific symptoms each woman presents, a tailored list of food, snacks and beverages can be introduced in the diet to relieve the symptoms.

 Safety and effectiveness of acupuncture treatment in early pregnancy

Smith et al. (2002) published two articles from their research on nausea and vomiting during early pregnancy.  The study involving 596 women who were followed through their pregnancy until childbirth to record any adverse outcomes, confirmed the benefits of acupuncture and concluded that acupuncture was a safe and effective treatment for women who experience nausea and dry retching in early pregnancy.

 So if you’re pregnant and feel that your quality of life is impacted by morning sickness, it is worth considering acupuncture as a drug-free option to relieve your symptoms.

 For more information or to book an appointment, please contact sophie at sophie@silverwoodacupuncture.co.uk  

 References

Betts D (2006). The essential guide to Acupuncture in Pregnancy and Childbirth.

Smith C, Crwother C, Beilby J (2002). ‘Acupuncture to treat nausea and vomiting in early pregnancy: a randomised trial”. Birth. 29(1):1-9

 Smith C, Crwother C, Beilby J (2002).  ‘Pregnancy outcome following women’s participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy.” Complement Ther Med. 10(2):78-83