Can Moxibustion Help Turn a Breech Baby?

Finding out that your baby is in a breech position with their feet or bottom facing down can be stressful. A baby that is still breech at term often requires a C-section delivery. However, there is some evidence moxibustion, a noninvasive traditional Chinese medicine practice, may help encourage breech babies to turn into a head-down position in time for delivery.

Read on to learn more about moxibustion, including what it is, how it works, and why some prenatal care providers recommend it in the third trimester for breech babies.

Moxibustion for a Breech Baby

Many medical providers routinely refer their pregnant patients for moxibustion to treat breech presentation. "If I were to diagnose a breech presentation early in the third trimester, I would recommend acupuncture and the use of mugwort," says Marsha Granese, MD, an OB-GYN with Mission Hospital in Mission Viejo, California. "I would refer the patient to a Chinese medicine provider who knows the acupuncture points and herbs used to relax the uterus," Dr. Granese adds, noting that mugwort is a natural muscle relaxant.

In the US, moxibustion is taught as part of the typical curriculum for a degree in acupuncture and only licensed acupuncturists can perform it. Moxibustion can be combined with acupuncture treatment or done on its own with moxa sticks.

There are several theories as to how moxibustion works for breech presentation. "It is thought that stimulating the last point on the bladder meridian brings movement to the kidney channel and helps the baby to turn," says Tom Ingegno, a licensed acupuncturist and doctor of acupuncture and Chinese medicine (DACM) with a master's in Oriental medicine (MSOM) who practices with Charm City Integrative Health in Baltimore.

"One theory, from a Western medical perspective, is that the heat encourages the release of two specific hormones in pregnancy: placental estrogen and prostaglandins," says Kristen Burris, a licensed acupuncturist with a master's in traditional oriental medicine (MSTOM) who practices with Eagle Acupuncture in Idaho. These hormones can lead to mild uterine contractions, helping the baby to move into an optimal, head-down position for a vaginal birth.

Trying Moxibustion Before ECV

Many babies are in the breech (feet-down) position through early pregnancy and even up until 33 weeks. However, most babies turn into a head-down position (cephalic presentation) somewhere around 36 weeks gestation. But in about 3% to 4% of pregnancies, the baby remains breech even at full-term.

When a baby is still in the breech position at 36 weeks, a trained prenatal health care provider may use a technique called external cephalic version (ECV), which is also referred to as a "version," to "turn" the baby by manipulating the pregnant person's abdomen externally with their hands. According to the American College of Obstetricians and Gynecologists (ACOG), ECV is successful just over 50% of the time.

Before then (usually between 33 to 35 weeks), health care providers may recommend trying moxibustion to encourage a breech baby to flip around on their own. Research has been mixed, but a 2023 Cochrane review concluded that moxibustion can reduce the risk of the baby staying breech.

Trying moxibustion for breech presentation has some advantages over waiting for an ECV as it is less painful and may increase your chances of getting your baby into an optimal position for birth.

Is Moxibustion Safe?

According to a review published in Evidence-Based Complementary and Alternative Medicine in 2019, most of the evidence suggests that there are "no adverse effects directly related to acupuncture and moxibustion" in the treatment of breech presentation. That is to say that moxibustion is generally regarded as safe for use in pregnant people with breech babies.

When moxibustion is performed in a clinical setting, the risks are minimal. "They're hardly worth mentioning," says Burris. Those risks include coughing and nausea from the scent of burning mugwort and burns and blisters if the ignited herb comes in contact with the skin. "However, in 20 years of practice, none of my patients has ever experienced an inappropriate burn from moxibustion," Burris notes.

How Moxibustion Is Performed

When moxibustion is combined with acupuncture, the practitioner wraps a small amount of dried mugwort atop a needle that is already in the acupuncture point and lights it. This creates a warming sensation in the skin.

A cone of moxa may also be placed directly on the acupuncture point and lit, with the practitioner taking care to extinguish it before it touches the skin. Another form of moxibustion, known as indirect moxibustion, involves lighting cigar-sized moxibustion sticks near the points and holding them close until their heat warms the skin.

At Integrative Acupuncture in Vermont, Kerry Boyle, a licensed acupuncturist and doctor of acupuncture (DAc), holds a moxibustion stick above the pregnant person's pinky toe when performing moxibustion for a breech baby. "Connective tissue and nerve channels link this area to the uterus and cause it to relax," says Boyle. "We add acupuncture needles to the ears and feet to further the relaxation."

Moxibustion for a breech baby is usually performed between weeks 33 and 36 of pregnancy and may be prescribed as an alternative or precursor to an ECV.

Can Moxibustion Be Done at Home?

Whether or not it's safe to practice moxibustion at home depends on who you ask. The guidelines from reputable sources like the British Journal of Obstetrics and Gynaecology recommend moxibustion only be performed by a trained professional.

Burris says that although she's aware other practitioners give their patients moxibustion sticks to use at home, her practice advises against it. "Moxibustion only takes a few treatments in the office, and success rates are much higher and safer when performed by a professional," she claims.

But Ingegno says moxibustion that doesn't involve direct contact with the skin can be performed at home using sticks under the training and supervision of a licensed acupuncturist. "The moxa sticks need to be held at a comfortable distance to warm the area and not burn," says Ingegno. However, burning moxa directly on the point is not an at-home technique and should only be performed in a clinical setting, Ingegno warns.

Success Rate of Moxibustion for Breech Babies

Moxibustion doesn't always result in a breech baby turning head down but it's thought to increase the odds. When combined with in-office treatments and daily moxibustion at home, Ingegno says his practice has seen a 70% success rate with moxibustion for breech babies. "Modern studies confirm that moxibustion does increase the success of the fetus repositioning, but most of these studies are small," he says.

"Factors like how far along the pregnancy is can affect the outcome. The best success seems to occur when we intervene at 34 weeks. However, this leaves about a month and a half before the expected delivery date in which a decent percentage of babies would turn on their own [anyway]," explains Ingegno.

In other words, the farther out from their due date a baby is, the greater the chance that they will turn on their own without intervention. This is why treatment at 33 to 34 weeks will show a greater success rate than treatment after 35 weeks. The closer you get to 36 weeks and beyond, the less likely it is that a baby will be able to move to a head-down position as there is less space in the uterus to allow them to turn.

While research on the efficacy of moxibustion for breech babies is slim, there is some promising data. One 2013 study of 406 pregnant people with confirmed breech presentation showed that the moxibustion group had a significantly higher rate of success than those that had "sham moxibustion" or usual care. In fact, nearly 60% of the pregnant people in the moxibustion group had their babies turn while only about 45% of the people in the other groups experienced their breech babies turning head down.

At the end of the day, with both moxibustion or a version, the goal is to encourage the baby's movement to a head-first or "vertex" position so that a safe vaginal birth is possible. If both moxibustion and version are unsuccessful, a scheduled C-section delivery will likely be recommended.