What Is Moxibustion and Can It Help Turn a Breech Baby?
The traditional Chinese practice of moxibustion is one of the world's oldest techniques for turning a breech baby—and OB-GYNs still prescribe it today. Here's why, when, and how this alternative therapy is done.
Moxibustion is an alternative therapy from traditional Chinese medicine that involves burning the herb mugwort (or moxa) near specific points along a set of invisible, vertical lines that cross the body, known as meridians. Practitioners believe these meridians correspond to specific organs and, when stimulated, can strengthen blood flow and prompt the release of certain hormones.
In the U.S., moxibustion is taught as part of the typical curriculum for a degree in acupuncture and only licensed acupuncturists can perform it. Moxibustion can be combined with acupuncture treatment or done on its own with moxa sticks.
Moxibustion for a Breech Baby
Among other things, moxibustion is used to treat breech presentation, when an unborn baby is positioned with her bottom or feet toward the cervix late in pregnancy. "If I were to diagnose a breech presentation early in the third trimester, I would recommend acupuncture and the use of mugwort," says Marsha Granese, an OB-GYN with Mission Hospital in California.
There are several theories as to how moxibustion works. "It is thought that stimulating the last point on the bladder meridian brings movement to the kidney channel and helps the baby to turn," says Tom Ingegno, a licensed acupuncturist and doctor of acupuncture and Chinese medicine (DACM) with a master's in Oriental medicine (MSOM) who practices with Charm City Integrative Health in Baltimore.
When moxibustion is combined with acupuncture, the practitioner wraps a small amount of dried mugwort atop a needle that is already in the acupuncture point and lights it. This creates a warming sensation in the skin. A cone of moxa may also be placed directly on the acupuncture point and lit, with the practitioner taking care to extinguish it before it touches skin. A third form of moxibustion—indirect—involves lighting cigar-sized moxibustion sticks near the points and holding them close until their heat reddens the skin.
"One theory, from a Western medical perspective, is that the heat encourages the release of two specific hormones in pregnancy, placental estrogen and prostaglandins," says Kristen Burris, MSTOM, a licensed acupuncturist with Eagle Acupuncture in Idaho. This can lead to mild uterine contractions, helping the baby to move into an optimal, head-down position for a vaginal birth.
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Is Moxibustion Safe?
OB-GYNs routinely prescribe moxibustion for breech babies when they're detected early enough in the third trimester. According to guidelines published in the BJOG: An International Journal of Obstetrics and Gynecology in 2017, "the use of moxibustion for breech presentation at 33-35 weeks of gestation, under the guidance of a trained practitioner" may promote spontaneous version.
Dr. Granese has prescribed moxibustion for breech presentation before 36 weeks. "I would refer the patient to a Chinese medicine provider who knows the acupuncture points and herbs used to relax the uterus," she says. "Mugwort is a natural muscle relaxant."
When moxibustion is performed in a clinical setting, the risks associated with it are so minimal "they're hardly worth mentioning," says Burris. Those risks include nausea from the scent of burning mugwort, and burns and blisters if the ignited herb comes in contact with the skin. "However, in 20 years of practice none of my patients has ever experienced an inappropriate burn from moxibustion," she adds.
Moxibustion at Home
Whether or not it's safe to practice moxibustion at home depends on who you ask. Burris, for example, says although she's aware other practitioners give their patients moxibustion sticks to use at home, her practice advises against it. "Moxibustion only takes a few treatments in the office, and success rates are much higher and safer when performed by a professional," she says.
But Ingegno says moxibustion can be performed at home using sticks, under the training and supervision of a licensed acupuncturist. "The moxa sticks need to be held at a comfortable distance to warm the area and not burn the mother-to-be," says Ingegno. However, burning moxa directly on the point is not an at-home technique and should only be performed in a clinical setting, Ingegno warns.
Moxibustion Benefits and Success Rate
While learning you have a breech baby is no doubt a stressful situation, moxibustion can be quite relaxing. At Integrative Acupuncture in Vermont, acupuncturist Kerry Boyle, M.S., L.AC., holds a moxibustion stick above the mother's pinky toe when performing moxibustion for a breech baby. "Connective tissue and nerve channels link this area to the uterus and cause it to relax," says Boyle. "We add acupuncture needles to the ears and feet to further the relaxation of mom."
Moxibustion for a breech baby is usually performed between weeks 34 and 36 of pregnancy, and may be prescribed as an alternative or precursor to an external cephalic version (ECV). With both moxibustion and a version, the goal is to encourage the baby's movement to a head-first or "vertex" position so that a vaginal birth is possible. If both moxibustion and version are unsuccessful, your doctor will likely recommend birth by scheduled C-section.
When combined with in-office treatments and daily moxibustion at home, Ingegno says his practice has seen a 70 percent success rate with moxibustion for breech babies. "Modern studies confirm that moxibustion does increase the success of the fetus repositioning, but most of these studies are small," he says. "Factors like how far along the pregnancy is can affect the outcome. The best success seems to occur when we intervene at 34 weeks, however, this leaves about a month and a half before the expected delivery date in which a decent percentage of babies would turn on their own."