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Breech Presentation Before Birth

Babies shift around the mother’s belly during pregnancy up until about 36 weeks. Around this time baby turns head down in preparation for birth. Breech presentation is when baby is positioned buttocks or legs down and without intervention will likely need to be delivered via Caesarean section for the safety of the mother and child. There are both Western and TCM treatment options to try to flip baby into place, with different risks associated with each method.

Signs and symptoms of breech presentation are subjectively feeling baby’s head higher in the abdomen after week 36 and feeling kicking in the low abdomen. Most of the time mothers are unaware of this issue and it is found during a routine prenatal visit towards the end of the pregnancy. Differential diagnosis is made by the obstetrician or midwife who will check the cervix, palpate the abdomen, and may take a fetal ultrasound to confirm the baby’s position.

Western medical treatment for breech presentation is External Cephalic Version or ECV. ECV is only an option if the mother is healthy and there are no further risk factors. In ECV the mother and baby are monitored via fetal ultrasound and electronic fetal heart monitoring to make sure baby does not go into cardiac distress and see where baby is positioned during the process. Before ECV the mother is usually given tocolytic medication which relaxes the uterus and prevents uterine contractions or early labor. The doctor or midwife will then push on the mother’s abdomen and try to manually reposition the baby. This can be uncomfortable and painful and may cause early labor or fetal cardiac distress. If the version is unsuccessful they may attempt another ECV using epidural anesthesia to relax the uterus, stop pain, and ease the process.

Once ECV is successful there can still be complications. Mothers should not expect a normal cephalic birth outcome. Risks include pregnancies beyond 40 weeks requiring labor induction, increased rate of Caesarean section, increased blood loss during delivery, higher chances of the umbilical cord wrapping around the neck, and higher risk of obstetric complications.

In TCM we can safely and successfully turn a breech presentation baby by stimulating the point BL-67 with acupuncture, electrical stimulation, or moxibustion. BL-67 is located at the lateral corner of the pinky toenail and is classically indicated to turn breech babies. In one study, featured in the American Journal of Chinese Medicine, breech babies turned spontaneously in 73% of mothers while moxibustion treatment to BL-67 yielded a 92% rate of turn to cephalic presentation. Another study states, “In 56% of cases, fetal position was converted from breech position to cephalic one; the success share was 80% for moxibustion, 28% for acupuncture, 57% for acupuncture plus moxibustion; the conversion, on average, was achieved after 3 sessions.” There is no documented safety risk to the mother and moxibustion may have the added benefit of calming the baby’s heart and baby’s movements to yield healthier birth outcomes. Moxa and acupuncture are usually not contraindicated even with other risk factors and can be done safely and effectively.

If you are a pregnant mother with a breech presentation baby after 36 weeks, we can safely help this you achieve a positive birth outcome in a non-invasive way. A lot of the risks associated with ECV are due to the traumatic and invasive nature used to move the baby. By using moxa and/or acupuncture we can encourage baby to move naturally and improve you and baby’s chance of having a healthy vaginal birth.

Sources:

Lim, Pei Shan, Beng Kwang Ng, Anizah Ali, Mohamad Nasir Shafiee, Nirmala Chandralega Kampan, Nor Azlin Mohamed Ismail, Mohd Hashim Omar, and Zaleha Abdullah Mahdy. "Successful External Cephalic Version: Factors Predicting Vaginal Birth." The Scientific World Journal 2014 (2014): 1-8. Web.

Kanajura, Yoichi, Kunio Kometani, Tetsurou Nagata, Kuniaki Niwa, Hiroshi Kamatsuki, Yasutaka Shinzato, and Yasumoto Tokunaga. "Moxibustion Treatment of Breech Presentation." The American Journal of Chinese Medicine 29.01 (2001): 37-45. Web.

Neri, Isabella, Viviana De Pace, Paolo Venturini, and Fabio Facchinetti. "Effects of Three Different Stimulations (Acupuncture, Moxibustion, Acupuncture Plus Moxibustion) of BL.67 Acupoint at Small Toe on Fetal Behavior of Breech Presentation." The American Journal of Chinese Medicine 35.01 (2007): 27-33. Web.


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