CHAPTER 3

LECTURE EXTENSION

Ancient Chinese Medical Practice for Correcting Breech Presentation
Breech presentation during labor is associated with complications and risks including physical injury for both the infant and mother. Breech occurs when the fetus is in a position other than the head-first position, usually with the buttocks, feet, or legs emerging first for delivery. Breech position is common in the second trimester of pregnancy, and the likelihood decreases as birth nears because of spontaneous version. It is thought that fetal activity leads to the fetus spontaneously turning into a head-first position. Also, the incidence of breech presentation at delivery can be reduced by the use of external cephalic version (ECV), a procedure in which physicians attempt to change the baby's position by vigorously kneading the mother's abdomen to turn the fetus into a head-first position.

In a recent study by Cardini and Weixin (1998), a traditional Chinese medical practice involving the burning of herbs to stimulate acupuncture points (moxibustion) was found to be effective in stimulating fetal movement and correcting breech presentation. Moxibustion involves burning of the herb Artemisia vulgaris (mugwort) in a rolled-up tube placed directly next to the outside corner of the fifth toenail of each foot. The heat, rather than the smell of the burning herb, is thought to stimulate an acupuncture point on that toe that increases fetal movement, helping the baby move out of breech position. Moxibustion is a popular treatment for breech position in China. However, this experiment is the first randomized controlled clinical trial to evaluate the effects of this type of therapy on correcting breech presentation.

In this investigation, all 260 study participants were Chinese women in the 33rd week of pregnancy and were pregnant for the first time. All participants had fetuses in the breech position, determined by ultrasound. Half of the participants received moxibustion, and the remaining half received routine care but no moxibustion treatment. Moxibustion was performed once or twice on each foot for 15 minutes daily for one or two weeks. Participants whose fetuses continued to be in the breech position after two weeks could choose ECV. By the 35th week, 75% of fetuses in the moxibustion group changed to the correct head-first position compared with only 48% of the control group. There were no side effects or adverse events of the moxibustion treatment.

Further studies are needed to determine the effectiveness and safety of this therapy at advanced gestational ages, in higher-order pregnancies, and in populations other than Chinese. The researchers note that if the results of this trial are confirmed, moxibustion should be used extensively because of its noninvasiveness, low cost, and ease of implementation. Also, it is easy to train mothers to carry out the treatment at home.

Cardini, F., & Weixin, H. (1998). Moxibustion for correction of breech presentation: A randomized controlled trial. Journal of the American Medical Association, 280, 1580-1584.

LEARNING ACTIVITY

Examining Books Written for Children about Reproduction and Birth
Have students go to the public library or to a bookstore to examine books written for children about reproduction and birth. Students should examine books written for children of different ages-from early childhood through adolescence. The following questions can be used to guide students' examination of the developmental appropriateness of children's books: Are the books written in language that children of the targeted age can understand? Are the concepts explained such that they are understandable to children of the targeted age? Does simplifying the language and the presentation of the content still allow for clear understanding of scientific concepts? What styles of illustrations are used-for example, realistic photographs and drawings or impressionistic watercolors? What are the advantages and disadvantages of these different styles of illustrations? How are plants and animals used as models to explain reproduction and birth? Are thoughts and feelings discussed as well as scientific concepts? How do the books change as the age of the targeted audience increases? How would your rate the accuracy of the information in the books that you have examined? Would the presentation of the information in specific books seem acceptable to a wide audience of parents and educators? Do any of the books contain information that you feel is controversial or inappropriate for the targeted age level? Do the authors include notes or suggestions for parents? How should parents and educators share the information in these books with children?

The following is a list of children's books that includes a variety of presentation styles and targeted ages:

Cole, J. (1993). How you were born. New York: Morrow Junior Books.

Dorling Kindersley, Inc. (1992). What's inside? Baby. New York: Author.

Harris, R. H., & Emberley, M. (1996). Happy birth day. Cambridge, MA: Candlewick Press.

Kitzinger, S., & Nilsson, L. (1986). Being born. New York: Grosset & Dunlap.

Parraman, M. (1994). The miracle of life. New York: Chelsea House.

Royston, A. (1996). Where do babies come from? New York: DK Publishing.