Joy you raised some very interesting questions. Firstly the numbers of women included in the trial were actually quite small (130 in each arm), so the percentages translate to even smaller numbers (the 75% of moxa treated women with cepalic fetuses at term reprsents 98 women and the 62.3% of women in the control group with option of ECV represented 81 women with fetuses in cephalic presentation. The stats given for these numbers were P=.02;RR 1.21; 95% CI, 1.02-1.43.
Second was the timing of the moxa. My comment here is I think we are all reluctant to change our traditions. According to this paper, the standard of care for breech babies in China (or at least the hospitals were the trial took place) is moxa early in the 3rd trimester followed by ECV around 36-37 weeks. In the introduction the authors present research on the probability of breech fetuses of primips, multips with prior breech, and multips with no prior breech turning spontaneously before 33 weeks, 35 weeks, etc.. They then decide to do the moxa treatment trial in the 33-35 week window ( which is not surprising to me because this is when it is done anyway). They appear to believe that spontaneous turning of a primip breech after 35 weeks in unlikely and so they want to use the moxa to enhance the likelihood of spontaneous turning (they give a figure of 15.5% for spontaneous correction of breech in primiparous women based on and article by Gottlicher and Madjaric, which is in a German publication (if anyone wants the name of it I will copy it later). Since moxa is traditionally done relatively early in the 3rd trimester, there is actually nothing in the literature to suggest that it is better than doing nothing at all later in the third trimester. Even though it is a procedure that the woman can do at home, it takes a lot of time and preparation to do right (or at least in the way it is done in the trial: 2 half hour stimulation per day for one to two weeks or until the baby is confirmed cephalic presentation). I realise that women who are making there own herbal preparations etc. may have no trouble with this but, I have worked with women who found it difficult to tolerate the smoke etc., not to mention the considerable irritation on their toes, and one client whose husband did not realise he had to extinguish the moxa stick and created a small fire in the kitchen. I don't know (because I have never offered it before 36 weeks) but I tend to think the discomforts would be more tolerable at 33 weeks than 37 weeks. Then ECV is your back up. I have only worked with 4 clients who had breech presentations. 2 turned with ECV and were born vaginally and 2 were born vaginally in breech presentation. Of the 2 breeches at birth, one was undetected until labor and was born at home, the other refused to turn with 2 attempted ECV's [plus moxa daily from 37 weeks and was born in the hospital with a necessary forceps lift out. The home birth was a multip, the hospital birth was a primip. My second daughter was breech (24 yrs ago and the dx was not made until 37 weeks, after which I had to change care providers (since my GP was recommending a c/s), get u/s, educate myself, and run around in a flap without appearing to be in a flap). I would have preferred to know earlier I think with full disclosure of all options, I don't know. I think it should be the woman's choice ultimately. But how can she choose if she doesn't have all of the information. Oh! The awareness of increased fetal movement: the paper admits it doesn't know how it (moxa) works, but they assume since increased awareness of fetal movement occured in the moxa subjects then that is related to how it works. They call for further investigation. The paper states: "since moxabustion and ECV must be performed at different gestational ages, we may regard them as completmentary therapies to be used in succession". Interestingly enough both of the groups in the trial had a high c/s rate even amongst babies cephalic at term. In the treatment group the c/s rate was 35.4% (26 for breech at term) and in the control group 36.2% were c/s, again 26 for breech at term. And this was apparently at hospitals wher the routine for breech birth was vaginal delivery. Sorry this is so long. Marilyn -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
