Acosta L. Complications of the third stage of labour, 14th edn. In: Macdonald S, Magill-Cuerden J. (eds). Edinburgh: Baillière Tindall Elsevier; 2012

Anderson A. Ten years of maternity claims: an analysis of the NHS Litigation Authority data – key findings. Clin Risk. 2013; 19:(1)24-31

Australia's mothers and babies 2014-In brief.Canberra: AIHW; 2016

Banks M. Breech birth woman-wise.Hamilton: Birthspirit Ltd; 1999

Berhan Y, Haileamlak A. The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies. BJOG. 2016; 123:(1)49-57

Bin YS, Roberts CL, Ford JB, Nicholl MC. Outcomes of breech birth by mode of delivery: a population linkage study. Aust N Z J Obstet Gynaecol.. 2016; 56:(5)453-9

Bin YS, Roberts CL, Nicholl MC, Ford JB. Uptake of external cephalic version for term breech presentation: an Australian population study, 2002–2012. BMC Pregnancy Childbirth. 2017; 17:(1)

Catling C, Petrovska K, Watts N, Bisits A, Homer CSE. Barriers and facilitators for vaginal breech births in Australia: clinician's experiences. Women Birth. 2016; 29:(2)138-43

Cho SH, Lee H, Ernst E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG. 2010; 117:(8)907-20

Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev.. 2012; (5)

Cui H, Chen Y, Li Q, Chen J, Liu C, Zhang W. Cesarean rate and risk factors for singleton breech presentation in China. J Reprod Med.. 2016; 61:(5-6)270-4

Do CK, Smith CA, Dahlen H, Bisits A, Schmied V. Moxibustion for cephalic version: a feasibility randomised controlled trial. BMC Complement Altern Med.. 2011; 11

Dresner-Barnes H, Bodle J. Vaginal breech birth - the phoenix arising from the ashes. Pract Midwife. 2014; 17:(8)30-3

Evans J. Breech birth: Abnormal or unusual?. Midwifery Today Int Midwife. 2013; 106:16-8

Forster DA, McLachlan HL, Davey MA Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth. 2016; 16:(1)

Goffinet F, Carayol M, Foidart JM Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol.. 2006; 194:(4)1002-11

Hannah ME, Hannah WJ, Hewson SA Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet. 2000; 356:(9239)1375-83

Hastings-Tolsma M, Goodman S. Midwives, laboour induction and the Wooden Spoon award: part two. Pract Midwife. 2012; 15:(4)26-9

Homer CSE. Models of maternity care: evidence for midwifery continuity of care. Med J Aust.. 2016; 205:(8)370-4

Homer CSE, Watts NP, Petrovska K, Sjostedt CM, Bisits A. Women's experiences of planning a vaginal breech birth in Australia. BMC Pregnancy Childbirth. 2015; 15:(1)

Hunter LA. Vaginal breech birth: can we move beyond the Term Breech Trial?. J Midwifery Womens Health. 2014; 59:(3)320-7

Hutton EK, Hofmeyr GJ, Dowswell T. External cephalic version for breech presentation before term. Cochrane Database Syst Rev.. 2015; (7)

Hyde MJ, Mostyn A, Modi N, Kemp PR. The health implications of birth by Caesarean section. Biol Rev Camb Philos Soc.. 2012; 87:(1)229-43

Impey LW, Murphy DJ, Griffiths M, Penna LK. External cephalic version and reducing the incidence of term breech presentation. BJOG. 2017; 124:(7)e178-92

Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev.. 2000; (2)

Kathpalia SK, Singh Y, Sharma R. Outcome of external cephalic version in breech presentation. Med J Armed Forces India. 2012; 68:(2)151-3

Kemfang Ngowa JD, Kasia JM, Ekotarh A, Nzedjom C. Neonatal outcome of term breech births: A 15-year review at the Yaoundé General Hospital, Cameroon. Clin Mother Child Health. 2012; 9:1-3

Kerridge I, Lowe M, Stewart C. Ethics and Law for the Health Professions.Leichhardt: The Federation Press; 2013

Kok M, Cnossen J, Gravendeel L, van der Post J, Opmeer B, Mol BW. Clinical factors to predict the outcome of external cephalic version: a metaanalysis. Am J Obstet Gynecol.. 2008; 199:(6)630.e1-7

Kotaska A. Commentary: routine cesarean section for breech: the unmeasured cost. Birth. 2011; 38:(2)162-4

Lawson GW. The term breech trial ten years on: primum non nocere?. Birth. 2012; 39:(1)3-9

Lewis P. Malpositions and malpresentations, 14th edn. In: Macdonald S, Magill-Cuerden J (eds). Edinburgh: Baillière Tindall Elsevier; 2012

Lothian JA. Risk, safety, and choice in childbirth. J Perinat Educ.. 2012; 21:(1)45-7

, 14th edn. In: Macdonald S, Magill-Cuerden J (eds). Edinburgh: Baillière Tindall Elsevier; 2012

Macfarlane AJ, Blondel B, Mohangoo AD Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG. 2016; 123:(4)559-68

Menakaya UA, Trivedi A. Qualitative assessment of women's experiences with ECV. Women Birth. 2013; 26:(1)e41-44

Caesarean section.London: RCOG Press; 2011

National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. 2017.

Odent M. Breech presentation at term: Beyond the dominant strategies. Midwifery Today Int Midwife. 2013; (106)12-3

Midwifery preparation for practice. In: Pairman S, Tracy S, Thorogood C, Pincombe J (eds). Sydney: Churchill Livingston Elsevier; 2014

Pennick VE, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev.. 2007; (2)

Sananès N, Vayssière C, Helmlinger C Acupuncture for breech version: Principles, technique, mode of action and utility – A literature review. J Matern Fetal Neonatal Med.. 2010; 23:(5)455-8

Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev.. 2016; 4

Sanders R, Steele D. Re-engaging with vaginal breech birth: A philosophical discussion. Br J Midwifery. 2014; 22:(5)326-31

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. Complement Ther Med.. 2014; 22:(1)75-80

van Roosmalen J, Meguid T. The dilemma of vaginal breech delivery worldwide. Lancet. 2014; 383:(9932)1863-4

Vlemmix F, Bergenhenegouwen L, Schaaf JM Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. Acta Obstet Gynecol Scand.. 2014; 93:(9)888-96

Walker S. Breech birth: An unusual normal. Pract Midwife. 2012; 15:(3)20-1

Walker S. Undiagnosed breech: towards a woman-centred approach. Br J Midwifery. 2013; 21:(5)316-22

Walker S. 2014. To ECV or not to ECV? The current evidence base concerning external cephalic version. Pract Midwife. 2014; 17:(9)30-3

Whyte H, Hannah ME, Saigal S Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial. Am J Obstet Gynecol.. 2004; 191:(3)864-71

Moxibustion: An alternative option for breech presentation

02 July 2018
9 min read
Volume 26 · Issue 7


In many countries, including the UK, Australia, China, and the USA, more than 80% of breech-presenting fetuses are born by caesarean section. However, it is important for midwives to note the options that are available to women desiring a vaginal birth. This article will investigate cephalic version methods available to women with a breech-presenting baby, including external cephalic version, moxibustion and acupuncture. The literature emphasises the need for further research into alternative methods of cephalic version, for clinicians to up-skill on vaginal breech birth techniques and, if not recommend, then advise women of alternative methods available if mainstream interventions are unacceptable or contraindicated.

The safest mode of birth for a breech-presenting fetus has been a topic for debate among researchers and clinicians for decades (Walker, 2012; Evans, 2013; Odent, 2013; Homer et al, 2015). Women with a cephalic fetus at term, in the absence of contraindications, are encouraged to have a vaginal birth, yet women with a breech-presenting fetus routinely undergo a caesarean section, even if their pregnancy has been otherwise uncomplicated (Banks, 1999).

The debate seemed to culminate with publication of the Term Breech Trial (Hannah et al, 2000), which concluded, after a randomised controlled trial, that caesarean section was the optimal mode of birth when compared to vaginal breech birth. This was suggested because of an increased risk of serious morbidity and mortality to infants born vaginally and, as a result, management of breech birth changed worldwide (Kotaska, 2011; Lawson, 2012; Odent, 2013; Sanders and Steele, 2014; Vlemmix et al, 2014).

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