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April is Cesarean Awareness Month – Resources and a Test Your Knowledge Quiz

April 10th, 2014 by avatar

fb profile cam 2014April is Cesarean Awareness Month, an event meant to direct the American public’s attention to the United States’ high cesarean rate. 32.8% of all birthing women gave birth by cesarean in 2012. A cesarean delivery can be a life-saving procedure when used appropriately, but it takes one’s breath away when you consider that one third of all women birthing underwent major abdominal surgery in order to birth their babies.

Professionals that work with women during the childbearing year can be a great resource for women, pointing them to evidence based information, support groups and organizations that offer non-biased information to help women lower their risk of cesarean surgery, receive support after a cesarean and work towards a trial of labor after a cesarean (TOLAC) and achieve a vaginal birth after a cesarean (VBAC) for subsequent births if appropriate.

Here are my top suggestions for websites and resources every birth professional should have on their short list to share with students and clients when it comes to cesarean awareness.

1. International Cesarean Awareness Network – an international organization with almost 200 volunteer led chapters, (most in the USA) offering peer to peer support for cesarean recovery and VBAC information by way of a website, e-newsletters, webinars, online forums, Facebook groups and monthly meetings in the community.

2. VBACFacts.com – Led by birth advocate Jen Kamel, this website is big on research and helps consumers and professionals alike understand the evidence and risks and benefits of both repeat cesareans and vaginal birth after cesarean, including vaginal birth after multiple cesareans.

3. Lamaze International’s “Push for Your Baby” – is a great resource for families to learn about the Six Healthy Care Practices, what evidence based care looks like and how to work with your health care provider to advocate for a safe and healthy birth. Also Lamaze has an wonderful infographic that can be shared online or printed.

4. Spinning Babies – Midwife Gail Tully really knows her stuff when it comes to helping babies navigate the pelvis during labor and birth. Many cesareans are conducted for “failure to progress” or “cephalopelvic disproportion” when really it is a case of a malpositioned baby who needed to be in a different position. This website is a wealth of information on what women can do to help their babies into the ideal position to be born, prenatally and during labor. It includes valuable information about helping a breech baby turn vertex. This is important, because finding a health care provider who will support vaginal breech birth is like finding a needle in a haystack.

© Patti Ramos Photography

© Patti Ramos Photography

5. Childbirth Connection – This website is a virtual goldmine of evidence based information about cesareans and VBACs including a valuable guide “What Every Pregnant Woman Needs to Know about Cesareans.” There are questions to ask a care provider and includes information on informed consent and informed refusal.

6. Cesareanrates.com is a great website run by Jill Arnold for those who love the numbers. Find out the cesarean rates of hospitals in your area. All the states are represented and families can use the information when searching out a provider and choosing a facility. Jill’s resource page on this site is full of useful information as well.

7. Safe Prevention of the Primary Cesarean –  The American Congress of Obstetricians and Gynecologists along with the Society for Maternal Fetal Medicine recently published a groundbreaking document aimed at reducing the first cesarean. While fairly heavy reading, there is so much good information in this committee opinion that I believe every birth professional should at least take a peek. You may be pleasantly surprised.

Test your knowledge of the facts around cesareans and VBACs with this informative quiz:

As a birth professional, you can be a great resource for all your clients, helping them to prevent their first cesarean, providing support if they do birth by cesarean and assisting them on the journey to VBAC by pointing them to these valuable resources. You can make every day “Cesarean Awareness Day” for the families you work with, doing your part to help the pendulum to swing in the other direction, resulting in a reduction in our national cesarean rates and improving outcomes for mothers and babies. What are your favorite resources on the topic of cesareans and VBACs? Share with us in the comments section.
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Home Birth In a Risk Society: A Commentary by Sociologist Barbara Katz Rothman

February 4th, 2014 by avatar

By Barbara Katz Rothman, PhD

Today, I am delighted to share with you an essay on risk written by sociologist and author Barbara Katz Rothman, PhD.  There has been much discussion and debate on two papers just published in the Journal of Midwifery and Women’s Health, using the MANA Stats V2.0 data from the Midwives Alliance of North American. You can find these two papers and a research review by Judith Lothian published on January 30th on Science & Sensibility. – Sharon Muza, Community Manager, Science & Sensibility.

We live in what Social Scientists called a ‘Risk Society.”[i] If you simply google “risk and birth,” you get over 402 million ‘hits.’  So no question, birth is understood as  having risks, creating risks, being risky business indeed.  But not the riskiest of businesses – Google “risk and food,” and you get almost twice as many hits – over 746 million. That doesn’t feel right somehow – pregnancy and birth are always and everywhere in our world understood as risky; food not so much.  I nibble some snacks as I write, sip some tea – are you worrying for me? Wishing me luck with that?  Thinking about the odds of food poisoning? Insecticide exposure?  the long term risks of diabetes, joint pain, heart troubles, cancers that might be flowing forth from the snack choices I am making?

image: www.thinknpc.org

image: www.thinknpc.org

 

And what about those snack choices?  Do they not carry much of the same moral weight that pregnancy choices make — if I tell you it’s green tea and carrots, or if I tell you it’s a honey chai latte and multigrain crackers with organic almond butter, or if I tell you it’s a Nestle Iced Tea and Oreo cookies – do I not create different images of myself as a risk-taking or risk-sparing person, even as a more or less ‘good’ and responsible person?  These are of course the arguments that Risk-society thinkers have been addressing: the risks we perceive and the risks we take are judged, by ourselves and by others.

In birth, few choices have been as freighted with the language of risk and responsibility as that of home birth.

The irony here is that birth moved into the hospital with all of the data showing us that move increased risk; and all of the research we have now still shows us that hospitals present unique and particular risks for birth. Birth moved into the hospital long before the era of Risk – that move was done in the era of Science.  The same science that covered our kitchens in white laboratory-style paint and tiles, that replaced local baking with packaged white bread made out of mass-milled white flour, that created industrialized systems to raise cheap meat at whatever costs to health of humans or animals, that moved fruits and vegetables from fresh to canned – that same science that created the industrial diet of the turn of the century, created the industrial birth.

image: sharon muza

image: sharon muza

When I wanted a home birth almost forty years ago, I knew nothing of midwifery. I just assumed that obstetricians had the necessary knowledge and skills to deliver babies (and yes, I called it ‘deliver’) and that those skills could be used in my bedroom as well as in a ‘delivery room.’  Over the course of my scholarly work in the years following, I learned how wrong that was.  Home birth involves a set of skills, practices and competencies that people trained in hospital birth most often never have learned.  Thus the MANA data is not merely a comparison of place: What we are seeing in this data set is a study of midwifery-led care, or as Ronnie Lichtman has called it[ii], midwifery-guided birth, birth in settings where midwives and the women they are guiding have control over practice.

MANA’s data and these articles are showing us that the United States, for all of its problems, is not exceptional:  Fully autonomous, informed midwifery care provides better birth outcomes than does care under Obstetrical management.  Obstetrics and Gynecology is a surgical specialty, magnificently equipped to manage particular illnesses and crises, but neither the discipline nor the hospital settings it has developed for its practice are appropriate for normal, physiologic birth.

Research on women who choose home birth, as well as midwives who provide it, show that their concerns go beyond the risks of what is often called the ‘cascade of interventions’ that follows medical management, leading as it so often does to cesarean section.  In addition to the well-documented iatrogenic risks, they address risks of the hospital itself, what are called when looking at infections, ‘nosocomial’ risks. They were concerned with errors that are made when people are managed in what is essentially a factory-like setting: risks of overcrowding; risks of exposure to others and exposure of self.[iii]

Hospital-industrialized births demand standardized care. Consider something as mundane and yet intrusive as the vaginal exam.  Medical guidelines, the medical story, is that such exams are necessary to determine labor and its stages.  That of course is absurd.  Do you really think that an experienced midwife, someone who has attended hundreds or thousands of births cannot tell if a labor is established without a vaginal exam? What a midwife needs that exam for is to document, not to establish the labor.  Those exams are not only intimate and intrusive, but for women with histories of sexual abuse especially, can be experienced as traumatic.[iv] For all women, raised with ideas of bodily privacy, integrity and what used to be called ‘modesty,’ such exams at a moment of vulnerable transition are problematic. Done for reasons of institutional management and control, they are one more interruption and create risks of their own. Particularly in hospital settings, vaginal exams are one more occasion for the introduction of nosocomial infection.

Managing the management thus becomes necessary in hospital settings: – midwives use the vaginal exam to create the story that will be most in the woman’s best interests, and occasionally in the midwives’ own best interest.  Midwives are thoughtful about when they measure because, for example, they are hesitant to start the clock too early.  In such care, what midwives are trying to minimize is not the risks of a prolonged labor, but the risks of intervening in a labor medically defined as prolonged.

It is reasonable to talk about how recent this language of ‘risk’ is in pregnancy and in birth – but the language of danger, that which we are in risk of, has long been an accepted part of birth.  Calling it “Risk” is adding the numbers – sure there are dangers, but precisely what are the odds? That there are dangers in pregnancy and in birth, and that they can be avoided or overcome, this is not news.  Dangers, disasters even, could happen in the best and healthiest of pregnancies and births.  The difference perhaps is that now there is no such thing as a healthy pregnancy and birth.  There still is an understanding of such a thing as a ‘healthy meal” and even a “healthy diet,’ but no longer, it seems to me, a healthy pregnancy – the best you can hope for is a low risk pregnancy.

It is not that midwives do not have understandings of danger and knowledge about ways to avoid danger, including the dangers of prolonged labors.  That is precisely what midwifery has been throughout time and across place: the development of a body of knowledge and skilled craftsmanship to navigate the dangers of childbirth.  All of that knowledge was discounted with medicalization.

Scientific or ‘Medical’ knowledge is accepted as real and authoritative; other knowledge is reduced to ‘intuition’ or ‘spiritual knowing,’ made all but laughable.   But when a baker adds a bit more flour because the dough is sticky, is that ‘intuition’?  Or is that knowledge based on craft, skill, deep knowledge of the hands?  When a violin-maker rejects a piece of wood in favor of one lying next to it that looks just the same to me or to you, is that ‘intuition’?  Or experience, skill and craft?  And when a leading neurosurgeon examines a dozen stroke patients who all present pretty much the same way on all of their tests and feels hopeful about some and concerned for others, is that ‘intuition’?  Or knowledge based on experience, using a range of senses and information that may not be captured in the tests?

In hospital settings, midwives do not have the authority to use their knowledge fully in the woman’s best interests.  And therein lie the risks.

And finally, it would be helpful to put these risks in contextIf safety were our real concern, if saving the lives of babies and of mothers were the driving force, then there are a number of changes we would make immediately.  We would require helmets for people in cars, something we know would save lives each week.  We would lower the speed limit in urban areas, and end driveway parking in suburbs. To suggest such things makes one look crazy – crazier than suggesting home birth.  But it most assuredly would protect children. If saving babies were our concern, we would invest in public housing, and in the food system.  These are large scale changes that would save far more people than anything that happens in those few hours of late labor to early neonatal period, the 24 or so hours of hospitalization that is now being debated.

Clearly something more or other than saving babies is at stake.

References

[i] Beck, U. (1992). Risk society: Towards a new modernity (Vol. 17). Sage.

[ii] Lichtman, R. (2013). Midwives Don’t Deliver or Catch: A Humble Vocabulary Suggestion. Journal of Midwifery & Women’s Health.

[iii] Katz Rothman, B., (2014) Risk, Pregnancy and Childbirth, Risk, Health and Society, edited by Alaszewski, Intro by Barbara Katz Rothman. Volume 16.1, forthcoming.

[iv]  Adult manifestations of childhood sexual abuse. Committee Opinion No. 498, American College of Obstetricians and Gynecologists. Obstet Gynecol 2011: 118:392-5.

About Barbara Katz Rothman

image: Barbara Katz Rothman

image: Barbara Katz Rothman

Barbara Katz Rothman, PhD, is Professor of Sociology, Public Health, Disability Studies and Women’s Studies at the City University of New York, and on the faculty of the Masters in Health and Society at the Charite in Berlin, the University of Plymouth in the UK, and the International Midwifery Preparation Program at Ryerson University in Toronto Canada. Her books include In Labor: Women and Power in the Birthplace, The Tentative Pregnancy: How Amniocentesis Changes the Experience of Motherhood, Recreating Motherhood, The Book of Life: A Personal and Ethical Guide to Race, Normality and the Human Gene Study,  Weaving A Family: Untangling Race and Adoption and Laboring On: Birth in Transition in the United States.  Dr. Katz Rothman is the proud recipient of an award for “Midwifing the Movement” from the Midwives Alliance of North America.

Cesarean Birth, Childbirth Education, Do No Harm, Evidence Based Medicine, Guest Posts, Home Birth, informed Consent, Maternal Quality Improvement, Maternity Care, Midwifery, New Research , , , , , , , , , ,

Test Your Knowledge of Just Released 2012 Birth Data – A Fun Pop Quiz

January 28th, 2014 by avatar
Image: blog.camera.org
Image: blog.camera.org

As childbirth educators and birth professionals who work with expectant families, it is critical that we remain up to date on the newest data and research available on a wide variety of topics.  When we have current information, we are then able to share this information with the families that we work with in relevant ways.  Today, I would like to bring to your attention to the most fundamental, yet comprehensive data available about birth in the United States.  2012 date was released last month by the Center for Health Statistics.  The National Vital Statistics Report “Births: Final Data for 2012” is a gold mine of information for those of you who are interested in the state of births in the USA.

I thought it would be fun to try and present some of the data in the form of a quiz, for Science & Sensibility readers to take just for kicks.  Take the quiz and see how many of the ten questions you get right?  Then follow the link above to the complete report to find out more details and other interesting facts about birth in the USA in 2012. I invite you to share your score in our comments section along with any surprises you discovered when quizzing yourself.  If you want to see how you did compared to all the other folks who took the test, you can register on the quiz site, but it is totally not necessary.  Take it more than once if you like!  You might even use this technique with your students for a fun class activity.

References:

Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J., & Mathews, T. J. (2013). Births: final data for 2011. National Vital Statistics Report62(1).

Disclaimer:

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Q1: Bonnie U. Gruenberg

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Babies, Cesarean Birth, Childbirth Education, Home Birth, Maternity Care, New Research, Newborns , , , , , , , , ,

Book Review: Cut It Out: The C-Section Epidemic in America

November 7th, 2013 by avatar

By Christine Morton, PhD

What accounts for the dramatic rise in cesarean delivery in the United States over the past two decades? In her new book, Cut it Out: The C-Section Epidemic in America, sociologist Theresa Morris addresses this question by going to the source: she interviewed maternity clinicians (obstetricians, midwives and labor and delivery nurses) as well as women who had recently given birth. She examines guidelines from the major professional group of obstetricians and gynecologists. Morris goes beyond simply documenting the rise in C-sections, the health risks they pose to women and their babies, although she does that very well. To explain how we got to an epidemic of c-sections in the U.S, she applies an organizational lens, making it clear how “organizational changes constrain the decisions and behaviors of maternity providers and women.”

This way of looking at c-sections will be useful for childbirth educators, doulas and childbearing women because it goes one step farther than most research on c-sections, which demonstrate trends and possible associations between clinical causal factors, or characteristics of women. It is also different from advocacy around c-sections that largely frames the issue as one of individual agency or rights (“women must advocate and prepare for vaginal birth,” or “women have right to informed choice”). And although we have some research on how organizational structure impacts c-section rates, such as teaching hospitals and health maintenance organizations (HMOS), absent from these studies are explanations as to why this is so. Morris argues that the research on c-section epidemic is missing an “understanding that is rooted in the experience of maternity care providers and pregnant women” (p. 21).

While most childbirth educators and doulas have a good understanding of pregnant women’s experience, Morris takes the reader into the perspectives of a range of maternity clinicians, arguing that organizational policies and procedures constrain their actions. We can’t blame individual clinicians for the high c-section rate, she argues, nor can we hold them responsible for reducing it. Social constraints on individual behavior are very powerful and need to be understood if they are to be changed. As many sociologists have observed, deviance from social norms has real consequences for individuals. Imagine yourself riding in an elevator filled with people you don’t know, with your back to the doors. It’s not easy to do. Morris notes, “Maternity providers may face professional consequences for deviance—for example, being informally scolded by colleagues, formally reprimanded by a supervisor, or having a malpractice insurer deny coverage in a case of a bad outcome” (p. 22). By talking to maternity clinicians about how they see the problems, and what they do about them, Morris is able to show how obstetricians are also caught in systems not of their own making.

“Hospitals are organizations with fixed rules to guide individual behavior” (p. 22) and this applies to all individuals within organizations. Morris has provided a nuanced and rich picture of what she calls the “organizational paradox, in which the increasing rates of c-section do not protect the health of women or babies or make birth safer or good outcomes more likely,” and argues that if we look at the c-section rate as the result of how health care organizations respond to their legal, political and economic environments, we can understand, and hopefully change, the system.

I found one of the most compelling sections of her argument in her discussion of the patient safety movement and its emphasis on standardized protocols, language and peer review. Until very recently, c-section rates were not considered part of the patient safety movement in obstetrics. Morris shows that when a hospital embarks on patient safety initiatives, with the goal of malpractice claims due to a bad baby outcome, these initiatives often result in an increase, or at best, no change in c-section rates.

Morris also reviews how doctors frame risks of VBAC vs. repeat c-section in ways that foreground the statistically rare risk of uterine rupture (indeed, the more dangerous rupture vs. the more common, but still rare, occurrence of uterine dehiscence). The more common risk to women of repeat c-section is often not included. Here we see how possible risks for the baby (and to the physician in the event of a bad outcome) are prioritized over risks to women’s health. Organization pressures influence how these risks are defined and described to women, says Morris.

“Any effort to resolve the c-section epidemic requires organizational solutions” (p. 153).

The stakes are high, and unless there is concerted and coordinated effort to reduce the c-section rate through organizational and policy change, we are unlikely to see a downward trend. Morris concludes, however, by listing what individual women and maternity clinicians can do to help solve the c-section epidemic. For women, this includes learning about and advocating for evidence-based care, with the assistance of independent childbirth educators and birth doulas, and finding maternity physicians and hospitals with low rates of c-section. Maternity providers, she notes, may find it helpful to be up front with women about the risks of childbirth, and that even with best of care, sometimes things go wrong. The policy and social changes Morris recommends are quite sweeping and it’s not clear where political will for these will come, but happily, there are some efforts being made on the organizational solutions she proposes. In particular reporting of c-sections as a quality measure will be required by The Joint Commission as of January 2014 for hospitals with more than 1100 births/year. A recent publication on Preventing the first cesarean delivery summarized the evidence from a joint workshop held by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists.

In this YouTube video, author Theresa Morris shares why she wrote Cut It Out: The C-Section Epidemic in America. 

Here are several more videos in the video series, where Theresa talks about the cesarean epidemic

This book is highly recommended for all childbirth educators, doulas and other maternity care professionals who wish to help pregnant women understand how the organization in which they are giving birth will likely shape both they, and their maternity clinicians’ actions. Yet, it also holds out the promise of hopeful change, especially when it is clear that many of these efforts are underway. With states seeking ways to drive down costs and with support from national government action focusing on maternal health, more pressure from payers, women and maternity care advocates, we can look forward to reducing c-sections and turning the tide of this epidemic. Let’s discuss what we can do to bring down the c-section rate.

About Christine Morton

Christine Morton

Christine Morton

Regular contributor Christine H. Morton, PhD, is a sociologist whose research on doulas is the topic of her forthcoming book, with Elayne Clift, Birth Ambassadors: Doulas and the Re-emergence of Woman-Supported Birth, which will be published by Praeclarus Press in Fall 2013. Christine is also a new member of Lamaze International’s Board of Directors. For more on Christine, please see Science & Sensibility’s Contributor page.

Babies, Book Reviews, Cesarean Birth, Childbirth Education, Evidence Based Medicine, Guest Posts, Maternal Quality Improvement, Maternity Care , , , , , , ,

Can Moxibustion Help Turn Breech Babies?

November 5th, 2013 by avatar

By Rebecca Dekker, PhD, RN, APRN

Occasional Science & Sensibility contributor Rebecca Dekker of www.EvidenceBasedBirth.com examines the practice of Moxibustion to help turn breech babies head down.  Rebecca looks at what the current research shows on this ancient treatment for turning babies and shares the results with Science & Sensibility readers in an article that can be easily shared with students, clients and patients. – Sharon Muza, Science & Sensibility Community Manager.

A mother tries moxibustion to turn her breech baby. © EvidenceBased Birth.com

About 3-4% of pregnant women end up with a baby who is in breech (bottom first) position at term. The vast majority of these babies (90%) are born by planned cesarean section. In order to avoid a cesarean section, many women try various ways to turn their babies into a head-down position. I have written in the past about using external cephalic version (ECV), also called the hands-to-belly procedure, for turning breech babies. However, although ECV is safe and frequently effective, it can be uncomfortable and women may want to try different options for turning a breech baby. One potential option is moxibustion.

What is moxibustion?

Moxibustion is a type of Chinese medicine where you burn an herb (Artemesia vulgaria) close to the skin of the fifth toes of both feet. The fifth toe is a traditional acupuncture point called Bladder 67.

How do you use moxibustion?

There is no one recommended way to use moxibustion, but many women burn the moxa sticks close to their toes for about 15-20 minutes, from anywhere to 1-10 times per day, for up to two weeks. This treatment is usually started between 28 and 37 weeks of pregnancy.

How could moxibustion work?

The burning of the moxa stick stimulates heat receptors on the skin of the toe. It is thought that the heat encourages the release of two pregnancy hormones—placental estrogen and prostaglandins—which lead to uterine contractions. These contractions can then stimulate the baby to move (Cardini & Weixin, 1998).

So, does moxibustion work?

In 2012, researchers combined results from eight studies where 1,346 women with breech babies were randomly assigned to moxibustion, no treatment, or an alternative treatment (like acupuncture). The women in these studies lived in Italy, China, and Switzerland (Coyle et al., 2012).

For the women who were assigned to receive moxibustion, some used moxibustion alone, some had moxibustion plus acupuncture, and some used moxibustion plus posture techniques.

When moxibustion alone was compared to no treatment (3 studies, 594 women) there was:

• No difference in the percentage of babies who were breech at birth

• No difference in the need for external cephalic version

• No difference in cesarean section rates

• No difference in the risk of water breaking before labor began

• No difference in Apgar scores at birth

• A 72% decrease in the risk of using oxytocin for women in the moxibustion group who ended up with a vaginal birth

Side effects of the moxibustion included smelling an unpleasant odor, nausea, and abdominal pain from contractions.

When moxibustion alone was compared to acupuncture alone, fewer women in the moxibustion group had breech babies at birth compared to the acupuncture group. However, there were only 25 women in the single study that compared moxibustion alone to acupuncture alone, so this doesn’t really tell us that much.

When moxibustion plus acupuncture was compared to no treatment (1 study, 226 women), women who had moxibustion plus acupuncture had a:

• 27% decrease in the risk of having a breech baby at birth

• 21% decrease in the risk of having a cesarean section

When moxibustion plus acupuncture was compared to acupuncture alone, one study with only 24 women found no difference in the number of women who had breech babies at birth. Because this study was so small, it doesn’t really give us much meaningful information.

When moxibustion plus postural techniques was compared to postural techniques alone (3 studies, 470 women), women in the moxibustion plus postural group had:

• a 74% decrease in the risk of having a breech baby at birth

Are there any limitations to this evidence?

A homemade moxa stick holder helps a mother administer a moxibustion treatment. © EvidenceBasedBirth.com

Overall, the studies that were used in this review were good quality. However, some of the studies were very small, and sometimes researchers did not measure things that we would be interested in—for example, when moxibustion plus postural techniques was compared to postural techniques alone, we have no idea if it made a difference in cesarean section rates or any other health results. Also, all of the researchers used different methods of moxibustion. Some women may have had more frequent or longer sessions, and some women may have been more compliant with the therapy than others.

Is there any other good evidence on moxibustion?

After the review above was published, evidence from a new randomized controlled trial that took place in Spain came out in 2013. In this new study, 406 low-risk pregnant women who had a baby in breech position at 33-35 weeks were randomly assigned to true moxibustion, “fake” moxibustion, or regular care.

What kind of treatments did the women receive?

In the true moxibustion group, the women laid face up, and the hot moxa stick was held near the outside of the little toenail 20 minutes per day for two weeks, changing from one foot to the other when the heat became uncomfortable. The women did the moxibustion at home with the help of a family member. In the fake moxibustion group, the same treatment was carried out, except that the moxa stick was applied to the big toe, which is not a true acupuncture point. Women in all of the groups were educated on how to use a knee-chest posture to try and turn the baby.

Did the moxibustion work?

Women who did moxibustion plus postural techniques were 1.3 times more likely to have a baby in head-down position at birth when compared to both the fake moxibustion and the usual care groups. If you look at the exact numbers, 58% of the women who used moxibustion had a baby who was head-down at birth, compared to 43% of the fake moxibustion group and 45% of the usual care group. The number of women who would need to use moxibustion in order to successfully turn one baby is, on average, eight women.

There was no statistical difference in cesarean section rates among the three groups, but it looked like the numbers were trending in favor of true moxibustion: 51% of the women in the true moxibustion group had cesarean sections, compared to 62% of the fake moxibustion group and 59% of the usual care group.

Were there any safety concerns?

Overall, evidence showed that moxibustion treatment was safe. About 1 out of 3 women reported having contractions during the treatment, but there was no increase in the risk of preterm birth. Some women (14%) said they felt heart palpitations. One woman experienced a burn from the moxibustion. Other complaints from women in all three groups included heartburn, nausea and vomiting (2%), dizziness (1.7%), mild high blood pressure problems (1.7%), stomach pain (1.5%), and baby hiccups (1.2%). However, there were no differences among the three groups in the number of women who had these complaints. There were also no differences in newborn health issues or labor problems among the three groups. All of the babies had good Apgar scores five minutes after birth.

So what’s the bottom line?

• Evidence suggests that moxibustion—when combined with either acupuncture or postural techniques—is safe and increases your chances of turning a breech baby

• We still don’t know for sure which kind of moxibustion method (timing during pregnancy, number of sessions, length of sessions, etc.) works best for turning breech babies. However it appears that using moxibustion twice per day for two weeks (during 33-35 weeks of pregnancy) will work for 1 out of every 8 women.

• If women are interested in using Chinese medicine (moxibustion and acupuncture) to help turn a breech baby, they may want to consult a licensed acupuncturist who specializes in treatment of pregnant women.

Here is a video where an acupuncture physician shows how to use moxibustion to turn a breech baby:

Thank you to Kiné Fischler L.Ac. of Willow Tree Wellness Clinic, who provided feedback on this article.

As a childbirth educator or other birth professional, do you share information on moxibustion as a method that mothers might use to turn a breech baby?  How do you present this information?  How do the families you work with feel after learning about this option? If you did not cover this before, do you feel like you might start to include this information in your classes after reading Rebecca’s information here and on her blog? Are you aware of physicians who also encourage patients to try this treatment?  Please share your experiences in our comments section. I welcome your discussions. – SM

References

Cardini F. & Weixin H. (1998). Moxibustion for correction of breech presentation: A randomized controlled trial. JAMA 280(18), 1580-1584. Free full text: http://jama.jamanetwork.com/article.aspx?articleid=188144

Coyle ME, Smith CA, & Peat B. 2012. Cephalic version by moxibustion for breech presentation. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No: CD003928. http://www.ncbi.nlm.nih.gov/pubmed/22592693

Vas J, Aranda-Regules JM, Modesto M, et al. (2013). Acupuncture Medicine 31: 31-38. http://www.ncbi.nlm.nih.gov/pubmed/23249535

About Rebecca Dekker

Rebecca Dekker, PhD, RN, APRN, is an Assistant Professor of Nursing at a research-intensive university and the founder and author of EvidenceBasedBirth.com.  Rebecca’s vision is to promote evidence-based birth practices among consumers and clinicians worldwide. She publishes summaries of birth evidence using a Question and Answer style. The mission of Evidence Based Birth is to get birth evidence out of medical journals and into the hands of the public. You can follow Rebecca on Facebook, Twitter or follow the Evidence Based Birth newsletter to get free printable handouts and other news.

 

 

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