References

Aveyard H, Sharp P. A beginner's guide to evidence-based practice in health and social care.London: McGraw-Hill; 2017

Aveyard H. Doing a literature review in health and social care: a practical guide.London: Open University Press; 2018

Bigby M. Understanding and evaluating systematic reviews and meta-analyses. Indian J Dermatol. 2014; 59:(2) https://doi.org/10.4103/0019-5154.127671

Carbillon L, Benbara A, Tigaizin A Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies. BMC Pregnancy Childbirth. 2020; 20:(1)1-8 https://doi.org/10.1186/s12884-020-2831-4

Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomised controlled trial. JAMA. 1998; 280:(18)1580-1584 https://doi.org/10.1001/jama.280.18.1580

Cheng CW, Fu SF, Zhou QH Extending the CONSORT statement to moxibustion. J Integr Med. 2013; 11:(1)54-63 https://doi.org/10.3736/jintegrmed2013009

Cluett ER. Experimental research. In: Cluett ER, Bluff R (eds). London: Churchill Livingstone; 2006

Coates T. Malpositions and malpresentations. In: Macdonald S, Johnson G (eds). Amsterdam: Elsevier; 2017

Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev. 2012; (5) https://doi.org/10.1002/14651858.cd003928.pub3

Critical Appraisal Skills Programme. CASP Randomised Controlled Trial Checklist. 2018a. https://casp-uk.net/wp-content/uploads/2018/01/CASP-Randomised-Controlled-Trial-Checklist-2018.pdf (accessed 14 September 2020)

Critical Appraisal Skills Programme. CASP Systematic review Checklist. 2018b. https://casp-uk.net/wp-content/uploads/2018/01/CASP-Systematic-Review-Checklist_2018.pdf (accessed 14 September 2020)

Dahl CM, Zhang Y, Ong JX Patient characteristics associated with complications of external cephalic version. Am J Obstet Gynecol. 2021; 3:(5) https://doi.org/10.1016/j.ajogmf.2021.100411

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:(1) https://doi.org/10.1186/1472-6882-11-81

Greenhalgh T. How to read a paper: the basis of evidence-based medicine.Chichester: Wiley-Blackwell; 2019

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)1375-1383 https://doi.org/10.1016/s0140-6736(00)02840-3

Impey LWM, Murphy DJ, Griffiths M, Penna LK. Management of breech presentation. BJOG. 2017; 124:e151-e177 https://doi.org/10.1111/1471-0528.14465

Lei H, Lina W, Jianzi W, Grygorczyk R, Xueyong S, Schwarz W. Heat induces adenosine triphosphate release from mast cells in vitro: a putative mechanism for moxibustion. Journal of Traditional Chinese Medicine. 2015; 35:(3)323-328

LoBiondo-Wood G. Introduction to quantitative research. In: LoBiondo-Wood G, Haber J (eds). St. Louis: Mosby; 2017

Miranda-Garcia M, Domingo Gómez C, Molinet-Coll C Effectiveness and safety of acupuncture and moxibustion in pregnant women with noncephalic presentation: an overview of systematic reviews. Evid Based Complement Altern Med. 2019; 2019:1-8 https://doi.org/10.1136/bmjopen-2019-032256

Morris S, Geraghty S, Sundin D. Moxibustion: An alternative option for breech presentation. Br J Midwifery. 2018; 26:(7)440-445 https://doi.org/10.12968/bjom.2018.26.7.440

NHS Improvement. Proposed national tariff prices: planning for 2017/18 and 2018/19. 2016. https://improvement.nhs.uk/resources/proposed-national-tariff-prices-1718-1819/ (accessed 17 September 2020)

National Institute for Health Research. Justify sample size for a feasability study. 2019. https://www.rds-london.nihr.ac.uk/resources/justify-sample-size-for-a-feasibility-study/ (accessed 24 September 2020)

Ortega M, Barker J. Systematic Reviews and Evidence-based Practice. In: Linsley P, Kane R, Barker J (eds). London: Sage; 2019

Padulo J, Oliva F, Frizziero A, Maffulli N. Basic principles and recommendations in clinical and field science research: 2018 update. Muscles Ligaments Tendons J. 2018; 305-3-7 https://doi.org/10.32098/mltj.03.2018.01

Evaluating Research Credibility: 3 Misconceptions. 2020. https://www.aje.com/en/arc/evaluating-research-credibility-3-misconceptions/ (accessed 20 September 2020)

Rees C. An introduction to research for midwives.Edinburgh: Elsevier; 2012

Schlaeger JM, Stoff el CL, Bussell JL Moxibustion for cephalic version of breech presentation. Journal of Midwifery & Women's Health. 2018; 63:(3)309-322

Sedgwick P. What is an open label trial?. BMJ. 2014; 348 https://doi.org/10.1136/bmj.g3434

Tiran D. Complementary therapies in maternity care: an evidence-based approach.London: Singing Dragon; 2018

Toijonen AE, Heinonen ST, Gissler MV, Macharey G. A comparison of risk factors for breech presentation in preterm and term labor: A nationwide, population-based case–control study. Arch Gynecol Obstet. 2020; 301:(2)393-403 https://doi.org/10.1007/s00404-019-05385-5

van den Berg I, Kaandorp GC, Bosch JL, Duvekot JJ, Arends LR, Hunink MM. 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. Complement Ther Med. 2010; 18:(2)67-77 https://doi.org/10.1016/j.ctim.2010.01.003

Vas J, Aranda-Regules JM, Modesto M Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial. Acupunct Medicine. 2013; 31:(1)31-38 https://doi.org/10.1136/acupmed-2012-010261

Breech presentation and moxibustion: should it be offered to improve maternal outcomes?

02 December 2021
12 min read
Volume 29 · Issue 12

Abstract

Background

It is known that moxibustion promotes cephalic version, thereby increasing the likelihood of vaginal birth, reducing the chances of a caesarean section and augmentation in labour. This study aimed to review and critically appraise research articles on the benefits of moxibustion use for low-risk women with breech presentation.

Methods

This study reviewed research articles published in English between July 2010 and July 2020. A computerised search using Maternity and Infant Care, CINAHL Complete, Cochrane Database of Systematic Reviews and Medline databases was undertaken, using a combination of terms such as ‘moxibustion’, ‘childbirth’, ‘birth’, ‘labour’ and ‘labor’. One article was chosen after reading the references of the articles selected. Overall five research articles were analysed using specific critique guidelines.

Results

The studies confirmed the use of moxibustion to turn a breech fetus, and found that in combination with acupuncture, moxibustion decreases the rate of caesarean section syntocinon use before and during labour for women who had a vaginal birth, as well as slightly decreasing instrumental use at birth. Moxibustion was safe and well accepted by women. However, studies need to be interpreted with caution because of clinical and statistical heterogeneity, and further quality evidence is required.

Conclusions

Moxibustion use for women with uncomplicated pregnancies may reduce the number of breech presentations at birth, caesarean section rates, syntocinon use and instrumental births.

Between weeks 24–27 of pregnancy, 23.5% of fetuses are in a breech presentation, reducing to 2.5% in term pregnancies (Toijonen et al, 2020). A breech is considered a malpresentation that is associated with stillbirth and adverse perinatal outcomes (Carbillon et al, 2020). However, some clinicians consider it a variation from normal (Morris et al, 2018). In breech, the fetal buttocks lie lowermost in the maternal uterus and the fetal head is at the fundus, classified as frank, complete and incomplete (footling), its diagnosis is made by ultrasound. Management of breech birth is controversial and since the publication of the Term Breech Trial (Hannah et al, 2000), planned caesarean section has become the recommended mode of birth for breech birth. External cephalic version, manual manipulation of the fetus from breech to cephalic position, is also routinely offered to women (Impey et al, 2017). However, these practices carry significant risks, including placental abruption and cord prolapse (Dahl et al, 2021).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month