Podalic child? Spin it with the Moxa or the turning maneuver

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Philippe Gloaguen
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Maneuver of turning and moxa 

We are approaching the term of pregnancy, at one of the last ultrasound checks the gynecologist tells us: "the baby is still breech, if he does not turn around we must do a caesarean". For some mothers this leads to a collapse in expectations about their delivery. There are some methods some more invasive others less, which can somehow try (and I repeat try) to help the child to turn around: the turning maneuver and moxa.

What is moxa

Between the two methods I mentioned moxa is the least invasive. The term Moxa is a Japanese term which means "to burn a ball of herbs". Not actually a ball of herbs is burned, it is a term that has been extended to a technique that uses a particular acupuncture point. It is therefore a method deriving from the traditional oriental medicine which consists in bringing a burning mug of pressed Artemisia close to a specific point on the side of the little finger of each foot, 5-10 minutes on each side. The positive aspects of this technique are the fact that it has no side effects for either the mother or the baby, it can be repeated (indeed it should be repeated several times between the 30th and 38th week of pregnancy if no changes are seen) and if it doesn't work, it leaves no effect.

As you can guess it is not that the burning cigar is put in contact with the skin, it is simply brought closer, letting it emanate the heat in that specific point. The negative aspect of this method is the fact that if it is not performed by expert people, who have studied it perhaps in association with other principles of traditional oriental medicine, it can be performed in the wrong place and therefore not have the effect. desired. In 70-80% of the cases I have treated and seen treated with moxa, the baby turned around and a caesarean section was avoided.

Read also: Caesarean section

When it is necessary to carry out the reversal maneuver

In the event that the moxa technique did not work or if you have decided not to approach it, you can switch to this method. It is an obstetric technique in all respects that can be performed both in the last weeks of pregnancy and at the beginning of labor, in the latter case, however, the amniotic sac must not be broken (i.e. you must not have lost water) otherwise you can proceed with cesarean. Generally this technique is performed around the 36th -37th week.

There are other conditions that must be present for the turning for external maneuvers (or breech turning):

  • the baby must not already be channeled with the podium (the bottom) or with the legs inside the mother's pelvis, because in this case it would not have the possibility to move.
  • There must be enough amniotic fluid to allow for the maneuver and there must be no contractions.
  • Finally, the placenta must be positioned in such a way as not to obstruct the cervical canal, that is, it must not be previously, otherwise it would not make sense to perform this maneuver since the cesarean is already certain in itself.

How to carry out the turning maneuver

  • The first and most important factor is that this maneuver it is strictly performed in the hospital, under ultrasound guidance. That is, while one operator performs the maneuver, the other allows him to see through the ultrasound of the abdomen what is happening and how the baby is moving.
  • Also during the maneuver tocolytic drugs are administered, which serve to eliminate possible uterine contractions. This is because the uterus at term of pregnancy is very reactive and any manipulation risks triggering contractions that would reduce the supply of oxygen to the baby.
  • But what happens operationally? The purpose of the maneuver is have the child perform a forward flip. Then the operator carrying out the maneuver grasps the baby's podium on one side and the head on the other (all through the maternal abdomen of course), and invites the baby with a certain vigor to do this upside-down. You make a couple of attempts forward and, if it fails, you also try the flip back.

Risks of the reversal maneuver

  • The turning maneuver it is basically safe, if done correctly and in suitable facilities.
  • The mothers who have undergone it, however, often report to me how it is annoying, sometimes even painful. This is because the doctor also puts a lot of force through the abdomen, and therefore the discomfort for the mother is considerable.
  • In some cases, but rather rare because as mentioned above, the maneuver is performed under ultrasound guidance, it may happen that the child twists the umbilical cord around a leg, arm or neck. This can happen naturally, but if we try to force a movement we risk pulling the cord and therefore not getting enough blood to the affected part.

As I said, it is a rare risk because the ultrasound shows exactly how the umbilical cord is positioned and if it is already in a position where kinking is likely or if it is particularly short, the maneuver is not even started.

  • Another inconvenience that can occur, especially if the maneuver is performed very close to the term of pregnancy or in labor, is that the amniotic sac ruptures. And therefore either the maneuver takes effect and one can spontaneously wait for labor and delivery, or it has no effect and in that case a caesarean must be done.

Maneuver of upheaval, opinions

If we read on the forums, on the various dedicated sites we will often find conflicting opinions on the breech turn maneuver. The main reason is the fact that it is performed in a hospital setting and that it is not without risks that are also quite important. From the point of view of statistical data derived from important scientific studies, I can tell you that this maneuver is able to significantly reduce the rate of caesarean sections, and by significant I mean a percentage of around 60%. This means favoring a natural birth and moving from a population with a high risk of performing a caesarean section to a low-risk one. So this is certainly a point in favor of the maneuver.

Those who are opposed to the reversal maneuver bring the negative points on two levels: one maternal and the other concerning professionals. Mothers often experience this experience as invasive and with a success rate not so certain as to tolerate the pain and discomfort it causes. As for the professionals, on the other hand, execution must be ensured by an expert doctor, who knows exactly what to do whether the maneuver is successful or in the case of urgent intervention and unfortunately not all facilities are equipped with these professionals.

Maneuver of turning, advice

  • The first piece of advice I give is to choose well the structure where to perform the inversion. This is because if complications arise, it is important that there is an operating room in the hospital equipped to perform an urgent cesarean section.
  • From my point of view I think that one method does not exclude the other, that is the moxa does not exclude the upheaval and vice versa. In my experience, both attempts can be made starting from the moxa, a little less invasive, and arriving at the turning maneuver.
  • As I have already said, they are not necessarily successful, and I definitely want to strongly emphasize that giving birth with a caesarean section does not mean being less of a mother. Perhaps it is not exactly as you dreamed of it, but a caesarean is better than a very risky breech birth that can leave important outcomes at the level of the baby's neurological functioning.
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