Breech birth: Reviewing the evidence for external cephalic version and moxibustion

Abstract

Background: Breech presentation, where a baby is buttocks or feet rather than head occurs in about 3 to 4% of singleton pregnancies at term. Worldwide, the majority of babies identified as breech are now delivered by planned caesarean section. Aim: This paper is the second of two that reviews evidence concerning breech presentation and birth mode. This review focuses specifically on women's preferences for birth mode, experiences of breech presentation and the use of external cephalic version (ECV) and moxibustion, which may be used in the third trimester of pregnancy to turn a breech baby to a cephalic presentation. Method: A structured literature review was undertaken using the Cochrane Library, CINAHL, EMBASE, MEDLINE, and AMED. Different permutations of 'breech' ('frank' or 'complete' or 'extended' or 'flexed') and 'alternative' or 'complementary therapies' or 'external cephalic version' or 'ECV' or 'moxibustion' and 'before term' and 'term' and 'singleton' in the title, key words or abstracts were used. Results: There is evidence that the majority of women would prefer a vaginal birth. There is substantial evidence that ECV can reduce the caesarean section rate by turning breech presentation to cephalic. Further research is needed to confirm or refute the clinical effectiveness and women's views of moxibustion therapy. Conclusions: As rates of caesarean section for breech presentation continue to rise, it is important that midwives and women have up-to-date evidence-based information about the alternative to proceeding straight to planned caesarean section when a breech presentation is identified.