Future research on acupuncture and moxibustion for correction of breech presentation would benefit from more reporting on safety and adverse events in order to increase confidence in this technique by patients and prenatal providers. Additionally, comparative effectiveness research studies which aim to determine the best timing, “dosage” and type of moxibustion are needed as there is no consensus as of yet on the best regimen (7). Comparative effectiveness research looking at topics such as moxibustion’s effects at varying gestational ages and parities (1st baby, 2nd or subsequent) as well research that compares varying “dosages” (how many minutes per day, how often and for how many days) would greatly improve confidence in clinical recommendations.  

While many trials examine moxibustion alone, few investigate the outcomes when moxibustion for breech presentation is combined with acupuncture.  The small number of trials that have been done find that moxibustion treatment may be more effective when combined with acupuncture.  The RCOG Green Top Guidelines (10) reflect this finding with their guideline that moxibustion treatment for breech may further reduce the need for cesarean section when combined with acupuncture.  In the Delphi study conducted by Smith and Betts (5) 50% of acupuncturists reported use of acupuncture alongside moxibustion as an important part of treatment for breech presentation, suggesting that the inclusion of acupuncture in future trials would better reflect what is actually occurring in the clinical setting among acupuncturists.

Additionally, comparing the type of moxibustion used would help determine if different forms of moxa make a difference either in effectiveness or compliance. Higashihara et al. (14) compared smokeless moxa, smoke moxa and control groups. They found higher rates of cephalic presentation at the end of the intervention in the smokeless moxibustion group but no differences at birth.  Although this was a small, non-randomized pilot study it is a starting point for further research.

There is growing consensus in the research community that pragmatic and comparative effectiveness research is more applicable to real-life settings. This is in part because over and over, “sham” or “placebo” acupuncture (of all sorts) has not been found to be truly inert, therefore acupuncture research that aims to demonstrate efficacy (versus effectiveness) is generally not possible. According to Langevin et al., “Sham acupuncture treatments have consistently been shown to have greater therapeutic effects than conventional placebos (15). For more information on this topic, please see the “Special Acupuncture Research Considerations” page on this site.