Mechanism of Action

The mechanism by which moxibustion and acupuncture may act to correct fetal malposition is unknown at this time.  It is understood that acupuncture affects a diverse array of biochemical processes within the body and also has direct effects on the central nervous system (16).  However, how acupuncture point Urinary Bladder 67 can change fetal presentation has not been determined. According to the 2012 Cochrane Review, one theory is that it may stimulate the production of maternal hormones (placental estrogens and prostaglandin), and encourages the lining of the uterus to contract which in turn stimulates fetal activity. A 1998 study by Cardini (11) found a statistically significant increase in number of fetal movements per hour (as counted by the pregnant person) in patients undergoing moxibustion therapy. The number of movements per hour was still within normal range. Much more research into the mechanism of action of acupuncture and moxibustion that could affect this specific condition of pregnancy is needed.  Understanding mechanisms may also assist with study design to help determine the best dosage and timing for treatment.  

Safety

Combined, the 2012 Cochrane Review and the 2021 Liao et al Systematic Review pooled data on adverse events reported in 4 trials.  No adverse events were reported in 3 trials, however in 1 trial (Cardini 2005) (12) participants undergoing moxibustion treatment reported unpleasant odor, nausea and abdominal pain. This trial seems to be an outlier in terms of poor compliance, high rate of participant dropout and adverse events.  

Generally accepted best practice guidelines for using moxibustion include performing it in a well-ventilated room (or outdoors) and using “smokeless” moxa sticks which have been carbonized to produce far less smoke than pure moxibustion sticks.  If these guidelines are not followed, there is the potential for irritation to the respiratory tract from the smoke. In addition, the person performing the moxibustion treatment must be attentive to avoid accidental moxa stick contact with the skin, which can result in blistering or burning.  The pregnant person as well as any partners who may be performing the treatment at home should undergo detailed instruction and a demonstration of safely performing moxibustion and extinguishing the stick afterwards. 

Acupuncture and moxibustion for breech presentation appears to be a safe and well tolerated option for pregnant people when they are treated and adequately instructed in appropriate usage by a trained provider.

Risk Factors and Contraindications

There are some instances where acupuncture and moxibustion are contraindicated or present increased risk when assisting babies to turn. These are similar to contraindications for ECV and may include Olgiohydraminos (too much amniotic fluid); Polyhydramnios (too little amniotic fluid); a history of vaginal bleeding in pregnancy, known fetal abnormalities or growth issues; history of PROM or premature labor; gestational diabetes, hypertension; placenta previa; bicornuate uterus; twins or other non-singleton pregnancy and any concern in which ECV is contraindicated by the primary care provider.  Decisions about whether or not to attempt this type of treatment with the above mentioned conditions should be made between the pregnant person, the acupuncturist and the primary prenatal care provider.