The research articles outlined below can be used to promote the use of acupuncture
in pregnancy. Some like the articles on pelvic pain, nausea and vomiting and breech
presentations have been selected for their publication in medical and midwifery
journals readily accessible to medical professionals. Others such as the prebirth
and cervical ripening articles are included as they represent the research available
While clinical practice does not always reflect the methods used in research and
questions remain over the use of methods such as a placebo in acupuncture, or the
use of prescribed points rather than an individual diagnosis, western medical research
does offer opportunities to discuss and promote acupuncture to medical professionals
and the community. This is especially relevant in the area of obstetrics were safety
and evidenced based practice are primary concerns.
Interventions on BL 67 for women with a breech foetus at 33 weeks
van den Berg I, Kaandorp G, Bosch J, Duvekot J, Arends L, Hununk M. Cost-effectiveness
of breech version by acupuncture-type interventions on BL 67, including moxibustion,
for women with a breech foetus at 33 weeks gestation: a modelling approach. Complementary
Therapies in Medicine 2010;18, 67—77.
A modelling approach to evaluate the effectiveness and costs of using acupuncture-type
interventions on BL67 (Zhiyin) compared to expectant management for women presenting
with a baby in a breech position at 33 weeks gestation.
A modelling approach was used to predict the number of
caesarean sections that could be prevented using moxibustion and or acupuncture
on BL 67 at 33 gestational weeks. There were two strategies for women presenting
with breech presentation at 33 weeks gestation:
- Expectant management - a wait and see approach with external cephalic version (ECV)
offered if required
- Acupuncture-type interventions on BL67
Ten thousand women were accounted for in this model. Also included were the medical
costs of two ultrasounds for every woman, ECV treatment if required and costs for
pre- and postnatal care until eight days post delivery.
The acupuncture treatment included extra costings for two visits with an acupuncturist
and the moxibustion sticks supplied for home treatment.
Both strategies of this modelling included an option for women to receive an ECV
at 36 gestational weeks and for all births to occur in hospital. Women refusing
the option of acupuncture-type interventions on BL67 or non compliance with using
the moxa treatment at home were also accounted for.
The probability that women would
accept treatment and that babies would remain in a persistent breech presentation
were retrieved from a systematic review and meta-analysis of six randomized controlled
trials (RCTs) reporting on the effectiveness of acupuncture-type interventions on
BL 67 versus expectant management. These trials comprised of three RCT’s using moxibustion.
The remaining three used acupuncture, electro- acupuncture and a mixture of moxibustion
Two data analysis were preformed for the women receiving
acupuncture type intervention: one with and one without ECV. Both resulted in a
decreased breech presentation at term.
To prevent one caesarean section, seven women with breech presentation at 33 weeks
gestation would need to be treated with acupuncture-type interventions on BL 67.
Sensitivity analysis showed that if 16% or more of the women offered moxibustion
treatment complied, it was more effective and less costly than expectant management.
The cost difference per woman with a baby in breech position at 33 weeks gestation
using the moxa around 33 weeks versus no additional treatment was € 451 (95% CI
€ 109, € 775; p = 0.005) eight days post delivery.
The authors concluded that offering acupuncture type interventions at BL 67 to women
with a breech foetus at 33 weeks gestation reduced the number of breech presentations
at term, the number of caesarean sections required, and was cost effective when
compared to expectant management.
The lead researcher of this study has published a
previous systematic review on the safety and effectiveness of using acupuncture
type interventions on BL 67 for women presenting with breech presentation. This
recent research approach is timely, enabling acupuncturists to now engage in discussions
with medical, midwifery and hospital clinic management staff about of the cost effectiveness
of implementing acupuncture type interventions for breech presentation. Being able
to enter into such discussions may well be an important factor for acupuncturists
to facilitate the integration of acupuncture services within main stream medical
Moxibustion use for Breech Presentation
Cardini et al in 1998  had the following
randomised controlled trial published in the Journal of American Association (JAMA)
The objective was to evaluate the efficacy and safety of moxibustion on Zhiyin BL-67
to correct breech presentation. 130 women having their first baby (primigravidas)
at 33 gestation received moxibustion to Zhiyin Bl 67 while 130 women, also primigravidas,
received no intervention.
The moxibustion was administered for 7 days .Women were then assessed and a further
7 days of moxibustion treatment given if the position had not changed.
Outcomes were measured in terms of fetal movements, as counted by the mother for
one hour each day for one week and the number of cephalic presentations both at
35 weeks gestation and at delivery
At 35 weeks gestation 75.4% in the intervention group were cephalic (47.7% in the
Women in both groups then had the option of undergoing external cephalic version
(ECV). One woman took this option from the intervention group and 24 from the control
At delivery the presentation of 75.4% of the intervention group were cephalic compared
to 62.3% in the control group.
The presentation did not change in any of the groups after 35 weeks except in those
undergoing ECV. In terms of fetal movement the moxibustion group experienced a greater
number of movements (a mean of 48.45 compared to the control group with a mean of
That in prigravidas at 33 weeks gestation with breech presentation moxibustion treatment
for 1 to 2 weeks at Zhiyin BL-67 increased fetal activity during the treatment period
and cephalic presentation at 35 weeks and at delivery.
The women and their partner (or a person to help with the treatment) were given
a treatment and taught how to use the moxibustion in a hospital appointment within
24 hours of the scan confirming the breech position. They then applied the treatment
to Zhiyin BL-67 daily at home. Moxa sticks were used with the women sitting or in
a semisupine position and the partner delivering the treatment.
As part of this study an attempt was made to assess if there was a difference in
delivering moxibustion sessions once or twice a day.
87 women used moxibustion for a total of 30 minutes (15 minutes to each point) while
43 women used moxibustion in the same way but received treatment twice a day.
At the end of the first week 79% of the cephalic versions were obtained in the women
using moxibustion twice a day compared to 55.2 % in the daily treatments. But by
the end of the second week 15 additional cephalic versions were obtained in the
group having moxibustion treatment once a day.
This meant that at 35 weeks the results were termed as a nonsignificant difference
(72.4% in the once a day moxibustion group compared to 81% for the women having
moxibustion treatment twice a day).
From a safety perspective it was reassuring that no adverse events (such as intrauterine
death or placental detachment) were noted in the treatment group. It was also interesting
that while the number of premature rupture of membranes was similar in both groups
the number of premature births was lower in the intervention group and that the
use of oxytocin, before or during labour, was also reduced in the moxibustion group
(8.6% compared to 31.3%).