breech baby
making sense

Fetal flip: Can burning herbs rotate a baby in the womb?
When it comes to being born, plunging head-first through the birth canal is the method of choice. Babies trying any other tack -- called breech presentation -- can be harmed during delivery. Up to half of moms with a breech-position baby undergo cesarean surgery.breech

A few weeks before birth, about 3 percent of babies are in breech position, with the head up instead of down.

Doctors can try to rotate babies by hand before delivery, but that carries risks. For centuries, Chinese doctors have tried to accomplish that trick by holding burning herbs near the skin. The procedure, called moxibustion, is cheap, not painful, and apparently harmless to the babies.

A new test (see "Moxibustion... " in the bibliography) proves the Chinese doctors right. Holding burning herbs close to the mother's toenail caused a significant number of babies to spontaneously shift to the healthier, "cephalic" position.

We hear you. This is strange. But it's worth taking seriously because it survived the peer review at JAMA, the American Medical Association's journal.

How do they know?
The researchers located 260 first-time gonna-be mothers in China who were carrying a breech-presentation baby. When the mothers were at the 33rd week of pregnancy, they were randomly divided into treatment and control groups.

The treatment group received moxibustion once or twice a day. Moxibustion (burning the herb Artemisia vulgaris) is an ancient practice that strikes Westerners as bizarre, but is common in China. A dried roll of the herb is ignited, then placed close enough to heat -- but not burn -- an acupuncture point on the skin. Acupuncture points are chosen for their supposed ability to affect organ systems -- there are, for example, points associated with liver, gall bladder and spleen.

When the women were checked two weeks later with ultrasound, 75 percent of the babies in the moxibustion-treated group had shifted to the more desirable cephalic position, compared to 48 percent in the control group. The researchers calculated that the effect was more than 99.9 percent likely due to the burning herbs.

Apgar scores, used to assess the health of newborns, were higher in the moxibustion group, possibly because the delivery was less stressful.

Got an inkling how this thing might work?
We're mystified. Were the effects due to placebo -- to the mother's belief in a traditional treatment? In an e-mail interview, lead researcher Francesco Cardini, who is in private practice in Verona, Italy, explained that this was unlikely. The difference between the two groups, he wrote, "is more than that expectable with a placebo." The fetuses moved in mothers who did not seem to believe in the treatment. And the effect was dose-dependent -- more babies shifted among mothers who received two daily treatments rather than one. Furthermore, Cardini says women in Italy, where acupuncture is not traditional, show similar benefits.

If not the placebo effect, Western medicine cannot explain the phenomenon. The effect could have resulted from the mother breathing fumes from the burning herb, but that's considered unlikely.

There is a clue in the fact that babies in the moxibustion group were more active. Cardini says the acupuncture point in question receives its nerve supply from a nerve that also branches to the uterus. "Is it possible," he asks, "that this stimulation causes micro-changes in the uterine muscular tone, which could enhance the fetal activity? Moxibustion on the same point is traditionally used to strengthen uterine contractions during labor. Is it possible that the same therapy has a stronger effect during labor, and a mild one during pregnancy?"

Don't look to us for answers, although we'll be happy to advocate more research. But Cardini points to another explanation. "The ancient Chinese tradition says that both uterine inertia during labor and breech presentation are due to the deficiency of yang energy in the kidney-bladder system." That's why acupuncturists give energy, or heat, to an acupuncture point related to the bladder.

Much better.

Is there rhyme or reason to this mess? Some work, some don't. Tell us what to think...

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