Is Acupuncture Safe for Turning Breach Presentation without OBGYN Follow-Up

Hi Ray--

Nightmare.

In her Obstetics & TCM courses, Raven Lang (who is a midwife & L.Ac.) drilled home that any practitioner doing this treatment should always check fetal heart tones before and after and CHART them.

She taught us how to do this with a feto-scope. However, we are not primary birth attendants and there can be a learning curve to locating FHT accurately, especially depending on baby's position.

I agree with the difficulty of the situation. I personally still do them, feeling relatively safe if I've verified the health of the baby. I think that improving assessment skills helps, but given the room for error, maybe having a primary birth attendant present or evaluate before and after is the best solution.

Jeannie

Hi Ray
Thanks for raising this – it is an important discussion to have.
First it must be remembered that the still birth rate in western countries is 5 – 6 babies for every 1000 births (usually counted as a still birth from 20 weeks)
The UK has keep the best statistics over the years and it shows that since the early 1990’s singleton still birth rates have not improved
Confidential Enquiry into Maternal and Child Health 2005 (CEMACH)

So unfortunately babies do die and usually the reasons remain unknown
Although obviously in such devastating circumstances the mother is desperate for a reason
While in this case the cord was found to be around the neck – this is a common occurrence – it is known that one third to one fourth of all deliveries will have the cord around the neck – and even when this is seen on ultrasound – no action is taken

From the WiSSP site - http://www.wisc.edu/wissp
(Which investigates of the causes of stillbirth)
Wrappage of the cord around the neck (nuchal cord) is common. Population studies do not demonstrate any general increase in mortality associated with such wrappage.
Stillbirth can only be attributed to a nuchal cord if the entanglement is so tight that there is obstruction of flow through the cord. Associated findings which support the notion that an entanglement is the cause of intrauterine fetal death include deep grooving of the skin plus evidence for premortem obstruction of blood flow in the cord. Only when such pathologic changes are present should this be considered causal.

Pressed to find some explanation for a baby's death, medical personnel often are tempted to attribute death to the most obvious feature at hand -- a twisted, knotted, short, long, or constricted umbilical cord. In fact, about 30% of fetal death reports submitted to the State list placental and cord processes as etiologic in stillbirths. We have previously shown that this is a profound overestimate.

So just because the baby when born was found to have a nuchal cord – does not mean this was a cause and effect for the still birth.

The other aspect is our care –
Could the moxa treatment have led to the cord becoming so tightly wrapped that it led to the still birth?
Should we be ensuring foetal heart monitoring post treatment?

First would need to know that there was detailed pathology to demonstrate the cord was responsible (as above)
Can only then look to the studies done on the safety of using moxa for breech – Latest one looked at 8 studies which involved 411 women receiving moxa (control group 347) and concluded
“No significant harmful effects of moxibustion on women or their infants were reported during or immediately after performing the treatment”
Van den Berg I, et al., Effectiveness of acupuncture-type interventions versus
expectant management to correct breech presentation: A systematic review, Complement Ther Med (2008),doi:10.1016/j.ctim.2008.01.001

Also a New Zealand committee looking at evidence based care for breech babies has concluded that moxa may be offered to women with breech babies at 33 weeks
These are guidelines that go out to all the midwives and specialists here in New Zealand
www.nzgg.org.nz/guidelines/0074/caesarean
(p 28-29)

I’m not sure what the advantage would be in listening to the foetal heart beat – unlike ECV the babies who have moxa do not (usually) turn at the time of treatment – here after an ECV women wait an hour while they have monitoring
Moxa babies are more likely to turn 4 – 6 days after treatment (with the mother doing the treatment every day herself)

Another consideration is to be aware that between 34 weeks and 36 weeks approximately 50 % of the breech babies will turn spontaneously (with no treatment).

While you can understand the mother wanting to believe if only…..
I’m not convinced a case could be made or that there is anything we could be doing (such as foetal monitoring) that would prevent stillbirth.

A long rave I know but I want practitioners to be aware that unexplained stillbirth is a reality and there is no evidence linking it to moxa for breech …..
so no I don't think we are putting our patients at risk

d betts
http://acupuncture.rhizome.net.nz

Debra -

Thanks for the very detailed post above. That answer is exactly why I wanted to raise this issue/situation that came across my desk. As I said, I don't work with these types of patients, but I know many Acupuncturists do - and as you pointed out, for good reason. It works, and it's generally safe as demonstrated by the Van den Berg study you cite above.

I also know remember my wife Tatiana explaining to me exactly what you describe above - namely, that moxa babies typically take a few days to turn, and the fact that 50% of breech babies will turn spontaneously without any intervention. This would definitely cloud the picture in trying to determine fault on the part of the Acupuncturist who treated this patient. Even the lack of direct evidence associated with nuchal cord as you mention above seems to exonerate the moxa treatment as the cause of the fetal demise. Everything you mention makes perfect sense.

The larger reason I wanted to initiate this conversation amongst our community - especially those of you who do treat breech - is because the legal system in the United States, and the Acupuncture malpractice coverage associated with treating pregnancy-related conditions past the first trimester, is fraught with uncertainty, and weighted heavily against the Acupuncturist. The sense is that the insurance carriers will not cover this intervention, and no matter what the preponderance of evidence is, as enumerated above, you are "SOL" if something like the above occurs.

It's obvious from several studies that moxa is effective and safe for turning breech, but the onus on proving this appears to be sitting squarely in our laps - at least as far as the Medical Malpractice Insurance Industry is concerned.

Would Debra and the rest of the CMT Community care to comment on this issue?

Ray Rubio, D.A.O.M., L. Ac. FABORM
President ABORM
www.westlakecomplementarymedicine.com

Debra, Ray, and others. Perhaps it would be prudent, particularly for those practicing in more 'litigious' parts of the world, to put together some sort of waiver complete with the detailed information listed above by Debra that any patient considering the use of acupuncture for breech presentation be required to read and sign. I have no doubt it would mean nothing to the most aggressive lawyer, but for the courts, it might demonstrate a significant level of due diligence and place more onus back on the patient in terms of understanding risks and unknowables with or without acupuncture. Daniel Schulman
Charlottetown, PEI, Canada

Hi
Yes it does seem strange – as I understand it – and this is coming in as an outsider, your major insurance provider for acupuncturists does not cover you treating women in pregnancy for western medical conditions – so as long as you are treating liver qi stagnation you are covered and if the high blood pressure reduces than that’s just a side effect.
It doesn’t then cover you for breech as this is termed a western medical diagnosis
Apart from the research showing effectiveness there is also the fact that
1) Information is readily available on the internet – so women will be accessing this information for themselves. There are sites with pictures and Lorne even has a Youtube video.
www.acubalance.ca/moxa-moxibustion-breech-baby

2) When I was in Canada I went into one of the bookshops - of the 26 pregnancy books - 12 books (mostly American publications from memory) recommended seeking a qualified acupuncturist to use moxa for breech due to the research that it is safe and effective.
So - if I was practicing there I would be concerned about public perception - a patient comes in for this treatment that is being recommended and I have to say that I was not covered to do this ….. does not say much for my qualifications !

The informed consent form may be an idea if you can somehow include the research information and that they have chosen to seek treatment from a qualified acupuncturist rather than the internet. So that it is clear, if ever used, that you are offering something that women can choose to access themselves

Would also be a great idea if some dedicated person could challenge your insurance to give you appropriate cover – obstetrics has the potential to be a growth area of practice and as I am sure I have posted elsewhere 50 % of my patients come in for preventive treatment to help them prepare for birth.
Also we have just started a clinic in a public hospital – we were invited in, they make the appointments for us, provide the hospital notes etc – ten years ago midwives using acupuncture were being told they could not practice within the hospital buildings
So huge change – just because they have seen how effective treatment can be …….

d betts
http://acupuncture.rhizome.net.nz

Ray, That is a horrible situation, and some of our worst nightmares. Thank you for bringing it up for discussion.
Debra, Thank you so very much for the wonderful detailed response.

I do treat patient's that present with a breech baby. The patients I work with make regular visits to their OB's, and OB's refer them for Ac. before they try a version. I believe you can see the location of the cord under US. Maybe that should be a standard question that is used during the initial intake of treatment, and maybe we should make direct contact with the OB to make sure there is not any unusual risks to the pt. and her baby before the treatment.
This should help us with information and spread the liability, if god forbid, this should happen.
Thank you for the heads up on the malpractice, I will be looking into that on Monday.
Warm regards,
Denise Noyer

Hi Debra,

Thanks for your advice. We finally have all of your seminars, including the acupressure course with video on line at Pro D

I sit on a committee for our regulatory body in BC and we have been working on informed consent. I will bring up the issue of informed consent for breech at our next meeting.

Lorne
www.acubalance.ca
www.prodseminars.com

Hi Denise
Yes good point - working with medical personal is always the best idea
I should have mentioned that there are situations when you would need to reconsider using moxa to turn a breech
Special considerations include situations where there are twins, too much or too little amniotic fluid, diabetes, hypertension, a growth retarded baby or abnormal shapes to the uterus such as a bicornuate uterus
(not that this means that moxa cannot be used in these circumstances - just that you would want medical input)
In my practice if the specialist is happy to perform an ECV then they are usually happy for moxa to be used prior.
Some feedback from a midwife on using moxa

Over the last 6 months I have had three women with Breech presentations confirmed on Scan at 35 weeks gestation. Good foetal growth in all cases. With no hypertension, increased liquor volume, diabetes or known foetal abnormality.
I taught all three clients how to apply Moxa (using smokeless sticks) to BL-67 showing them the illustration from the acupressure booklet, and giving them a copy of the instructions on the safe use of Moxa. I instructed all to continue Moxa for 10 days even if baby turned.
Amber was a primigravida who employed Moxa for 7 days prior to presenting for ECV at 37 weeks, On that day the baby was found to be in oblique position and was easily turned to cephalic presentation by the obstetrician and stayed cephalic until delivery.
Beth was a multigravid patient who had a previous Caesarean section and again I started Moxa at about 36 weeks. When presented fro ECV at 37 weeks baby was transverse and easily turned to Cephalic presentation. I was not present at ECV as busy elsewhere and unfortunately she was advised by my colleague to stop moxa at that point. I did not find out about this until several days later. Baby reverted to transverse and an emergency Caesarean ensued after rupture of membranes and a baby in transverse position.
Cathy was an interesting case. Early scan at 7 weeks showed a bicornuate uterus with baby in right horn. At 34+ weeks she complained of reduced movements and a scan showed a baby in the breech position. All other measurements normal. I decided to offer her Moxa despite Bicornuate uterus and arranged for an ECV at 37 weeks. I fully discussed with the obstetrician her scan reports and comments re bicornuacity of uterus and he opted for an attempt at 36 weeks.
On presenting for ECV baby was in oblique position and ECV was successful. Moxa continued for 5 more days. Spontaneous labour at term with normal delivery of 3.8kg baby.
Margaret Hadley – midwife

d betts
http://acupuncture.rhizome.net.nz

susan minich cnm msn msom lac
Nurse-Midwife
Hi Ray and Everyone,

Interesting discussion. Thanks for bringing this to our attention. Thanks to Debra for her detailed and quick response. I agree with everything that Debra presented. Most Breech babies turn by 34-36 wks. In the Western setting, the OB's/Midwives do not worry about this until 36 wks. I see my patients as well as the local OB's/Midwives pts for breech presentation and Moxa. I do not listen to fetal heart tones after treatment since my role in the office is as an Acupuncturist not a Nurse-Midwife. But, all the patients have an office visit within a few days of my appt. All the OB's/Midwives like their patients coming for treatments and feel comfortable referring the patients to Acupuncturists. The case you presented is very sad.

I work with the OB who does our external versions. We do an ultrasound before version to check presentation, then after. We do not check for a cord around the neck. It is too hard to see. The patients are then given a one hour non-stress test to evaluate fht's, then sent home and return in a few days for their routine ob appt. We have never had a cord accident. We do 3-5 versions/week starting at 36 wks.

This week we had a very sad case. A women presented at 40 wks to labor/delivery with no fetal movement and no fetal heart tones, first baby, vertex presentation. She was induced and we delivered her stillborn baby with a tight nuchal and body cord. The day before this occured, the pt had a routine ob visit, sono with+ fht's. (Many Ob's do routine sono's at the office visit. It is not "standard of care" to check for nuchal cord during the sono). This pt had no documentation of Breech presentation in her chart. There is nothing we could have done to foresee this tragic event.

At some point during the pregnancy all babies are breech, transverse, vtx. It is rare for a cord accident to occur with all the fetal movement, but it does happen. I will continue to see the patients for treatment and stay positive. Maybe we should have a consent form. I look forward to hearing more comments.
Best,
Susan Minich CNM MSN MSOM LAc
Nurse-Midwife
Los Angeles

Dear All,
It seems to me that there is no evidence that 'turning a breech' with moxa or acupuncture (or indeed homoeopathic remedies) creates adverse effects. In which case, why would anyone wish to create consent forms or statements of liability? Compared to ECV, turning a breech with moxa is mild and, in my opinion, cannot produce adverse effects since the whole point here is to work with the body to produce harmony. This is clearly a philosophical position however this seems to be backed up by the dearth of adverse events. In an increasing litigious world, particularly where holistic medicine is under attack from strongly positioned lobby groups, it would seem to be causing ourselves more difficulties if we go down the road of warnings and caveats.
I agree with you Susan when you say, keep seeing patients and remain positive.

Regards,
Stephen Gascoigne
Medical doctor, acupuncturist, herbalist
UK and Ireland

Debra, Lorne, Denise, Steven, Susan, and everyone else contributing to or reading this post:

I think we can all agree that - at least according to the data available, and apparently what most of you who work with breech somewhat frequently report - turning breech with moxa is 1. generally safe and without adverse effects; and, 2. the incidence of breech correcting itself without any intervention is fairly common anyway.

A couple have recommended having an informed consent for patients to sign as a way around the malpractice coverage issue. Stephen feels that this might provoke the litigation we seek protection from. Also, Debra pointed out the caveat that the largest insurer of Acupuncturist in the US (Allied Professionals Insurance Company - a division of American Acupuncture Council) uses to describe it's coverage rules: if you list a TCM Pattern diagnosis, and treat that pattern - i.e. liver qi stagnation - then you are covered for some gynecological treatments. However, my understanding is that they do not cover Obstetric treatments at all - whether using TCM diagnoses or not.

The reason for this, at least as I understand it, is Malpractice Insurance rates for Obstetrics in the United States are astronomically high (in some states $50,000-$100,000 dollars per year), and that most lawsuits resulting from fetal death begin at one million US dollars and go up from there. Also, from my understanding, most of these cases settle out of court - again, usually starting at a million. So, the explanation given from companies like the one above is that they can not offer coverage for Obstetrics for two reasons: 1. Acupuncturists can't afford Malpractice rates even close to what OB's are required to have, and 2. Because of this, companies like the one above can not get coverage for themselves from the larger Insurers.

So my question to all of you practicing in the US: Denise, Susan, and others: Are you performing these Obstetrics treatments without coverage, or have you looked into this issue? Is there a way to contact someone from American Acupuncture Council - maybe Marilyn Allen - to add her two cents worth to this thread? Would they even approve an informed consent form as a way to get around this problem/issue? Do Acupuncturists performing treatment for breech need to work under an OB and be covered under the OB's insurance?

What do you guys think...?

Ray Rubio, D.A.O.M., L. Ac. FABORM
President ABORM
www.westlakecomplementarymedicine.com

David Bock
I live in Wisconsin, have treated breech presentation among other things, I have AAC insurance, I am well aware of the exclusion clause. I was also taught to be bold in medicine, that if you constantly thought about the risk, to the point where it impairs your ability to help a patient, then you should be in another line of work. With that said, the clause is vague and if read literally most of us would see very few patients. " exclude.... obstetrics or gynecology, including delivery of babies, or care of newborns...." I assume any contract can be twisted with enough well paid insurance company lawyers. AAC however requires that claims go to arbitration. If you are not a "preferred" policy holder you are required to have your patients sign a arbitration agreement which states " I have been informed that acupuncture is generally a safe method of treatment but may have some side effects including......(many) Unusual risks of acupuncture include spontaneous miscarriage....." It may be interesting to know how arbitration affects our ultimate liability.
As a side note, in Wisconsin we have a nurse midwife, working for a hospital, and using acupuncture based on her quick 100 hour medical acupuncture certification. I would think that that situation sets an interesting precedent for any legal action.

David Bock

David -

Thanks for the thoughtful comments above. I hope my comments, and this issue in general, are not being taken as some sort of obsession with medical malpractice risk, or surrender to the "man" regarding patient care and my hippocratic oath.

First of all, as I have noted, I don't work with breech presentation or other 2nd/3rd trimester issues - not out of fear for lack of malpractice coverage, but simply because I prefer to refer to Acupuncturists who specialize in Obstetrics and are more skilled with these patients than I.

Second, I don't really think it's being weak, or not bold, to be aware of what our malpractice insurance covers and doesn't cover. This is simply being informed, and then making personal choices based upon that information - apparently as you have done there in Wisconsin. These choices can include, " damn the torpedos (or lack of coverage in this case), full speed ahead!" It can also include choosing not to work with breech unless there is a change in the current coverage under AAC (if they are your carrier) for these treatments. If a practitioner chooses to not put their practice/livelihood at risk, by choosing to not treat something that isn't covered, I don't think they are breaking faith with their patients. In fact, by not putting themselves and their practice at risk for something that is explicitly not covered, it could be argued that they are being responsible to their patients that come for other diagnoses and treatments.

Obviously, there is no guarantee in practice, or life for that matter, that something won't go wrong, and litigation might ensue. To be preoccupied with this type of amorphous risk would, as you point out, cripple a practitioner. Taking steps to minimize explicit risks - like the OB exclusion under AAC - is probably a different matter, and partially why I started this thread. I wanted to open up this discussion so that those treating breech are aware of the data to support it, the facts surrounding it, and the insurance coverage issue.

Ray Rubio, D.A.O.M., L. Ac. FABORM
President ABORM
www.westlakecomplementarymedicine.com

Thanks Ray, I agree, and hope that no one feels that my comments about boldness implies, fool hardy or that not doing these types of procedures makes you weak. Medicine is a situation where it is very important to evaluate and be aware of risk. We all individually need to be comfortable with the level of risk we take on. That level should not be a matter of weakness but rather informed choice. I have my lines that I do not cross, based on my evaluation of the situation and I am sure they are different from the lines drawn by others.

I believe this comes back to the fact that we need a clarification from AAC (et.al) since at least in the AAC coverage they do not specifically define "Obstetrics and Gynecology" and spell out what they mean. Under the holistic nature of our medicine we could be left hanging for just about anything that goes wrong in regards to a female patient where treatment impacts the menstrual system.
David Bock

Thank you, everyone, for posting on this important issue. I did check with ACC on this issue some time last year and they stated that as long as we treat the mother (and not the child) during pregnancy and treat a Chinese TCM diagnostic
pattern we're fine. The minute we claim to practice obstetrics we're not in compliance. So, we're clearly in the gray area in regards to turning breech babies. We use V 22.2 for the ICD-9 code which is the code for prenatal care patients, and we list the TCM diagnosis in our records. So when you keep your records and superbill to V 22.2 rather than state "breech presentation" or "labor induction" you're likely better off.

As far as putting your livelihood/family at risk: it's worth considering placing your practice into an S-corporation or LLC as those provide additional protection from lawsuits. It simply isn't a good idea to be a sole proprietor in our suit happy culture and your accountant will be able to assist you in this process.

Hope this helps...

Dagmar Ehling

I also checked with AAC for clarification on the vague OB/GYN coverage area several years ago & was told in regards to gynecology, basically we are not allowed to do internal examinations (ie PAP smears or the like) to aid our diagnosis or treatment (I, personally, am quite ok with following this rule & leaving the speculum handling to the trained professionals!)

As for OB, they told me we are not covered for any treatments directly related to labor & delivery, so breech (which they consider related to this part of pregnancy), labor induction, pain control in labor, etc. are exclusions in our coverage. Otherwise, any other condition during pregnancy, as long as we are practicing according to the standard of practice of course, would be covered by AAC's plan.

It has been awhile since I spoke with anyone there, so this may be outdated, but just thought I would pass it on.

The baby turns voluntarily in response to the acupuncture. It would be difficult to prove malpractice or culpability in such a case. Listening to the fetal heart rate for a few minutes is useless. Medically managed breech versions force the fetus to turn. The fetal heart is then watched for an hour on a monitor. In my experience as a midwife and labor nurse once and luckily only once a baby died a week after a forced version from a similar cord strangulation. The fetal heart tracing had been perfect. Warning the client to call her midwife if the baby decreases movement is the most effective advice. This does bring up the bigger issue especially in regard to prescribing herbs in pregnancy and that is the occurrence of spontaneous events and the appearance of causation. Birth defects from unknown causes occur in 2-4% of live births. Even though we know that some herbs are safe in pregnancy that doesn't mean that the herbs will not be blamed when such birth defects occur coincidentally. This will affect all of TCM not just the unlucky practitioner who is involved. It is so important to know your patient, your herbs and therapies well because this is the best way to avoid litigation.

As a very experienced labor and delivery RN and instructor as well as an acupuncture student in the second year, I can affirm that attempting to induce version with acupuncture/moxa in gestational women with breach presentation must never be done without ultrasonography and the presence of fetal monitoring as well as the presence of a trained physician or certified midwife familiar with this procedure. There were too many occasions that as RNs (not with acupuncture modalities), we often delivered via vaginal births, infants with cord around the neck (sometimes X 2) when physicians were not able to attend a hospital birth. There is a prescribed gestational age for acupuncture version that must be accompanied by in-hospital setting, with a documented U/S, and an obstetrician who is capable of doing a crash caesarian section if necessary along with informed consent signed by the patient, the obstetrician and the licensed acupuncturist. No one needs legal exposure nor the tragedy of what you described in a preventable death.

Dear Alopeztcr,

You make some very strong statements here and I wonder what is their basis?

When you say, "There is a prescribed gestational age for acupuncture version", what is this? What is the source?

When you say 'preventable death', this is an assumption. We don't know whether the death was a result of the version.

When you discuss the problems of delivery, whilst these may occur, I think that Chinese medicine is inherently non invasive and safe. What is your basis for saying this is not so?

Of course, in today's legal climate, there may be legal or insurance reasons for being circumspect. That is not the same as Chinese medicine being contraindicated because it is hazardous.

I am wary of the medicalisation of any normal process and it is certainly true to say that medical management of pregnancy causes at least (if not more) problems than it solves.

Regards,

Stephen Gascoigne

Medical doctor, acupuncturist and herbalist

UK and Ireland

I will be seeing Marilyn Allen in the next couple of weeks and I will be happy to bring this up to her. Has anyone been able to speak to her or others from AAC? If so, what were their thoughts?

This topic is brought up at every conference I attend. This is something that is a concern for many practitioners and one that hopefully can get solved.

Marc Sklar, LAc, FABORM
www.ReproductiveWellness.com

Hi marc,

Maybe we can have you interview her at PCOM next week. CMT and Pro D will be there. Will Marilyn Allen be there. CMT would love to have you ask the important questions and then we can air it for all to view on CMT. I am sure she could shed some light on this topic for all to benefit.

Lorne
www.acubalance.ca
www.prodseminars.com

Having worked as a Childbirth Educator and as an Acupuncturist for the last 20 years both in Australia and here in New Zealand, I have probably by now had a hand in turning several hundred breech babies using acupuncture and moxa. The way I see it is that we use acupuncture to bring a body to the point of balance. If a baby is in the breech position then something somewhere is out of balance and we use the needles and moxa to correct that. Correct the imbalance and baby will turn.

Most commonly babies turn whilst mum is asleep - no point trying to organize foetal monitoring as it rarely happens during the procedure. Not surprising that baby chooses to turn when mum is most relaxed.

In NSW in Australia it is customary to administer IV ventolin and monitor via ultrasound to do the ECV - here in NZ no ventolin is used and only sometimes do they monitor using ultrasound. Women invariably describe the procedure along the scale of very uncomfortable to painful.

In contrast, having had acupuncture and moxa, frequently women simply get up in the morning and know immediately that the baby is in a different position. But sometimes they don't realize it until they go for their next scan - and are surprised to find that it has been successful as they had no awareness of the baby moving.

My observation of the success of ECV vs moxa (no data to back this up, only my own experience) is that those turned using ECV often turn back to breech a little further on, but those turned with moxa rarely do. Not surprising really - acupuncture and moxa work to correct the imbalance that caused the baby to go breech in the first place.

Asking for the acupuncture practitioner to be monitored by an obstetrician is not a path I would be keen to head down. Acupuncture and moxa have been used for thousands of years to turn breech babies - long before medical science even existed.
Paddy

Thanks Paddy –

I have never (in over 30 years of practice) had a baby turn with me in attendance – In fact I do not even do the moxa Bl 67 myself these days but send dad home with instructions- (and a large part of this is the sacral moxa to do what the medicos use the Ventolin for - and also him massage the rump first).

I do a prelude treatment - and often several - as it is usually a matter of changing what is happening in mum's world/thus body and THEN the baby does the change when it feels better (the new 'right' way up - in this case down) itself without recurse to us making it happen . . .. . Optimal Fetal Positioning seems to have been not mentioned in any discussion of turning babies - and we need, if we are going to be inducing, or doing anything in late pregnancy - be aware that most women need baby lying facing her right side, hence baby's back on mum's left side, to initiate labour and be birthed easily.

A point to consider when feeling complacent as baby is now head down . . .

I have NEEDLED Bl 67 and had babies turn from OP (very hard to fit through pelvis comfortably like this – often a reason in itself for a C section here in Australia) to AO – so they no longer are stuck and can now be born, or have labour progress well- but the moxa Bl 67 trick seems to need help from mum’s body.

WARNING!!!
Going out of the mechanical/validatable/hinging on the biomedical model of a body and its workings here!!!!

This leads into the next issue – the physical is the eventual readout of the programmes that really run us or even being here. We may like to think that the personality and the mechanical are in control BUT the mammalian programmes – of pure survival (we as humans are ‘prey’ and are primed as deer in this regard) and spiritual (and we definitely have lost our roots there – karma anyone?) Anything tied to the spirit and possession and grace we have redefined life and hence medicine within a box that we may THINK we have all the parameters covered – and in pregnancy and birthing especially we obviously don’t.

The soul of the child may only have ’contracted’ to be here for a set time – the life experience of stillbirth may have been the turning point that the couple, or even someone hearing about the event needed to move through some stuck spot of their own.

The vehicle/physical body is just playing out instructions from elsewhere. Without getting too ‘flaky’/’out there’/’New Agey’ or whatever I am reporting in how it has seemed to me - when working within difficult and the apparently hopeless realms as I have chosen to for over 30 years, I see over and over that when we ‘get’ something – on a non logical level usually – instantly and apparently magically, the physical alters.

Ina May Gaskin in “Spiritual Midwifery” well over 35 years ago alerted those of us who were interested in causality as to how labour works really – and the “Sacred Birthing” book www.sacredbirthing.com takes up from here.

This seems similar to the kerfuffle in the medieval times leading onto witch burning – either the dominant (hence ‘real’) reality/discourse is adhered to, or we are ostracised.

Babies turn when the reasons they were as they had been, shift.
One way of shifting energy is through meditation, or visualisation, visiting a kinesiologist, talking to the kid, fixing the scars on abdomen so the meridian flow is as we pretend it must be as the texts never mention undoing what is obstructing/sticking up the normal flow . . .. (think, of all these navel rings and lap. scars – and also often working within her possibly extreme fear of birthing/or that medicalised intervention will not allow natural/ so she doesn’t have the perfect reason to ‘wimp’ out of birthing herself and the baby into a more connected relationship – as nature intended) – also www.spinningbabies.simplwebsite.com

When it comes down to it, it may be that the cord is too compromised to enable any other position – one of my patients had a baby who would NOT descend = and they couldn’t reach him too pull him out (13 years ago when C sections were not automatic) and once born through C section - his cord was so very thin after being wrapped around his neck FIVE TIMES that the clamps to tie it off, fell off. The ob. had never heard of a cord being around that many times – so sometimes there is great wisdom in letting, rather than forcing baby to be.

We all live as unique beings in an anecdotal world.
Going back to the comment re western diagnosis - babies turn spontaneously. The physical is just not set in concrete – it can change when we do – on any level. When I was running a midwives’ obstetric acupuncture seminar, one home birth midwife spoke of a baby turning when mum was fully dilated - she had colleagues waiting to watch as they were there to learn from her experience - and they were confronted (in the dark upside down, in dull torch light admittedly) with what they took to be a hairy bottom, as they were right regarding bub's breech position all through labour - but baby had other birthing ideas . . . . women's bodies are still mysterious.

As to the use of Ventolin – we can relax the uterus far more gently with whatever we see fit to use on treatment. I use moxa on the sacrum – covered extensively in the DVD and manual “What Dads Can Do”. This was discovered during my many pregnancies - these protocols are clinically tested and work remarkably. So also does a supportive and trusting appreciation of the naturalness and safety of allowing nature to work its magic. This may sound weird – but as mammals we and baby are wired for surviving birthing.

We cannot guarantee anything in life – there is risk in breathing - one woman tried to get a friend to see me when her baby as diagnosed to be breech, and she choose to go to the specialist ob. who had a wonderful rate of breech turning success. With all the medical bells and whistles, baby died as a direct result. No doubt it utterly shattered the chap - and being here in this country, the medical staff were completely exonerated as babies do not always make it - it is a case of us as modern day humans in a reality where self entitlement flows in abundance, thinking that we can count our chickens before hatching . . . .