Conclusion
Women show an interest in using moxibustion to assist breech babies turn cephalic.
When considering the evidence for the use of moxibustion, dosage may be an important consideration.
To date very few studies have used the moxibustion for the time and frequency recommended in acupuncture texts. This may impact on the inconclusive research findings reported to date.

This pamphlet prepared by :
Debra Betts (PhD)
Http://acupuncture.rhizome.net.nz
For further information about an
acupuncturist near you please contact:

Breech Presentation: Moxibustion

The evidence base for Moxibustion

The Evidence Base
The incidence of breech is reported as 3-4% at birth.1 While external cephalic version has been shown to be more successful than no treatment, the success rate remains relatively low.2 It is known that there is an interest from women in seeking interventions such as moxibustion in order to achieve cephalic version.3
A Cochrane review found limited evidence to support the use of moxibustion for correcting breech presentation. 4 However within these studies the length of time that moxibustion was applied and the frequency of treatment varied considerably. It may be that these ‘dosage’ differences impacted on the findings.

Only two trials examined the use of moxibustion daily for 15 minutes bilaterally for up to 14 days, as recommended in acupuncture texts.5,6 Trials that do not reflect a therapeutic dose may well limit the confidence of research findings.
An interesting finding from two trials reporting no statistical significance between moxibustion and control groups was the number of women failing to fully comply with the research protocols. With 20—30 % of women in these studies failing to complete treatment,7,8 this may have impacted on their findings.
Further studies to this Cochrane review include a comparison of moxibustion on the acupuncture point BL 67, an inactive laser on BL 67 and moxibustion on a Sham point. This study found that the moxibustion treatment was statically significant to the sham and control.9 In comparison a study using an inactive laser and a treatment of moxibustion plus acupuncture did not find any statically significant differences.10 However it should be noted that the use of acupuncture on BL 67 for breech is not recommended in acupuncture texts 5,6 and therefore this intervention may not reflect recommended clinical practice.
Finally a third study compared usual care to the use of moxibustion. While reporting no statically significant differences between groups,8 the intervention used moxibustion for less than 15 minutes bilaterally, and reported over 20 % of women did not complete the full treatment protocol, both factors which may have impacted on their findings.

Referances
1. Hickok DE, Gordon DC, Milberg JA, Williams MA, Daling JR. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol. 1992;166(3):851-2.
2. Hutton EK., Hofmeyr GJ, Dowswell T. External cephalic version for breech presentation before term. Cochrane Database Syst Rev 2105: doi: 10.1002/14651858.CD000084.pub3.
3. Coyle ME, Smith CA, Peat B.Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev 2012: doi: 10.1002/14651858.CD003928.pub3.
4. Smith, CA, Betts, D. The practice of acupuncture and moxibustion to promote cephalic version for women with a breech presentation: Implications for clinical practice and research. Complementary Therapies in Medicine .2014;22:75—80
5. Betts D. The Essential Guide to Acupuncture in Pregnancy & Childbirth. Hove: Journal of Chinese Medicine Publications. 2006
6. Deadman P, Al-Khafaji M, Baker K. A Manual of Acupuncture. London: Journal of Chinese Medicine Publications. 2001
7. Cardini F, Lombardo P, Regalia AL, Regaldo G, Zanini A, Negri MG, et al. A randomised controlled trial of moxibustion for breech presentation. BJOG: an international journal of obstetrics and gynaecology. 2005;112:743-7
8. Bue L, Lauszus F. Moxibustion did not have an effect in a randomised clinical trial for version of breech position Dan Med J. 2016;63(2):A5199.
9. Vas J, Aranda-Regules JM, Modesto M, Ramos-Monserrat M, Barón M, Aguilar I, Benítez-Parejo N et al. Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial. Acupunct Med. 2013 Mar;31(1):31-8. doi: 10.1136/acupmed-2012-010261
10. Coulon C, Poleszczuk M, Paty-Montaigne MH, Gascard C, Gay C, Houfflin-Debarge V et al. Version of breech fetuses by moxibustion with acupuncture: a randomized controlled trial. Obstet Gynecol. 2014 Jul;124(1):32-9.