Breech (bottom first) presentation occurs in around four out of every 100 babies; it can mean a longer and more difficult labour and is one of the main reasons for Caesarean deliveries, especially in first-time mothers. In the hope of avoiding a Caesarean, some consultants try to turn the baby by manipulating the mother's abdomen in the last few weeks of pregnancy, but this can be uncomfortable for the mother and does not always work. Many consultants will not even attempt it.
Moxibustion is an alternative that Sarah Budd, a midwife acupuncturist, has used on about 200 mothers-to-be at Freedom Fields Maternity Unit in Plymouth. She saw it used in China, where she went for practical experience after qualifying as an acupuncturist, and is about to carry out a scientific trial that she is confident will prove its effectiveness.
'Ideally you should start moxibustion at 34 weeks. Some people say the baby might turn by itself anyway, but in fact only 40 per cent turn between 34 weeks and the end of pregnancy. We have had 60-65 per cent success in turning babies, but many mums-to-be haven't been referred until 36 or 37 weeks - we could do better if we got to them sooner.' In China the technique is said to have a success rate of 85-90 per cent.
The Plymouth initiative is the latest sign that some aspects of complementary medicine are being taken more seriously by orthodox medicine. It follows Exeter University's announcement last month that it is to appoint the first professor in complementary medicine to bridge the gap between orthodox and alternative therapies - the university has been given pounds 1.5m to establish the chair.
The Plymouth trial will be in two phases. In the first, videos of ultrasound scans taken during moxibustion will be analysed by specialists in foetal behaviour to examine how it might be affecting the baby's movements. The second phase will be a large-scale trial, comparing the number of breech babies who turn after moxibustion at 34 weeks with the number who turn spontaneously.
The technique for turning a breech baby involves lighting a cigar-like stick of the dried herb moxa, or mugwort, and using this to heat the acupuncture points on the feet, just by the little toe. This is done for 15 minutes a day for up to 10 days. The treatment can be carried out at home by the woman's partner or a friend. But if it works, how does it work?
'The only research on this has been done in China,' says Ms Budd. 'It shows a change in the levels of certain hormones in the mother, but that doesn't go far towards explaining what happens. Not much is known about it. But babies do wriggle around a lot more when you do moxibustion.' She is optimistic that her research will result in moxibustion being adopted by the midwifery profession as part of breech management, with a consequent reduction in Caesarean sections.
'The way to get it accepted is to get some decent research results. We may not be able to show how it works, but I'm confident we'll show it's worthwhile.'
In her second pregnancy, Nicola Allen, of St Budeaux, Plymouth, was told her baby was in the breech position. 'I had a scan and they said that as I'd had a baby before, I could have a vaginal delivery rather than a Caesarean,' she says. 'But I had this awful fear of a breech birth. At 36 weeks the doctor tried turning the baby by external manipulation, but it didn't work and I didn't like it at all.
'Then I had one moxibustion session with Sarah and she showed my husband how to do it at home. We did it quite a few times and then I suddenly realised that my tummy felt different - the discomfort had gone. When the scan showed that the baby had turned, I was so elated. Emily was born head-first and perfect.'
In her outpatient clinics, Ms Budd offers acupuncture treatment for a wide range of antenatal and postnatal ailments such as backache and morning sickness. But patients who are in labour and want acupuncture to help them cope with the contractions take priority; acting as both midwife and acupuncturist, she will see them through labour and delivery.
Acupuncture is a popular form of pain relief at Freedom Fields. The needles are inserted into the cartilage at the top of the ear and, for extra stimulation, attached to a machine that passes a mild electrical current through them. This has been found to induce the release of endorphins - morphine-like substances that have pain-relieving properties.
However, some women still need additional pain relief. Mandy Rose, who lives in Plymouth, had her first baby with the help of both acupuncture and transcutaneous electrical nerve stimulation (Tens).
'I could move around as I wanted, and when the intensity of the contractions increased I could turn up the Tens and the acupuncture machine. Sarah was absolutely brilliant. I was pleased with how I coped. I feel lucky that I was able to have acupuncture - and if I have another baby, no matter where I am living, I would want it again.'
Midwives are becoming increasingly interested in acupuncture and other complementary techniques, such as aromatherapy and reflexology, as increasing numbers of women look for alternatives to drugs to bring them pain relief. Some midwives who are trained in these therapies are able to use them with the support of their managers - others, however, face hostility from senior midwives and consultants.
Melanie Every, professional officer of the Royal College of Midwives, says: 'The code of practice allows midwives to use these therapies provided their knowledge and training are adequate. They must also consult their supervisors - and the attitude of hospitals does vary tremendously.'
If complementary therapies such as acupuncture are not on offer at a maternity unit, some women arrange to take 'alternative' practitioners into hospital with them when they are in labour. But only a few private practitioners offer this level of commitment. It means being on call for up to five weeks, when labour could take place at any time of the day or night.
Kathleen Powderley is a former midwife who works privately as an acupuncturist in Aberdeen. 'This has been a wonderful way of combining the two roles - I know exactly what's going on in the pregnancy and labour, and can offer pain relief with none of the side- effects of drugs,' she says.
Ellen Hynes, director of maternity services at Aberdeen Maternity Hospital, where Ms Powderley has attended births, says: 'The management team was very receptive to the idea. We decided that if this is what women want, we would not stand in their way.'
Having an NHS midwife who is also qualified to do acupuncture has obvious advantages over relying on an independent practitioner - though there is no guarantee that she will be on duty when you need her.
The ideal would be for acupuncture to become a specialisation in midwifery training, so that it can be offered by teams of midwives, rather than one enthusiast having to meet the demand
Ms Budd is off to China for a second time this month, armed with cameras and video equipment, to watch Caesarean sections carried out using acupuncture as the anaesthetic.
Could this be an option for mothers in Britain in the future? Ms Budd is uncertain. 'People's first reaction will be: 'How can they do a Caesarean without anaesthetic?' But after all, someone had to do the first epidural Caesarean, with a patient who was awake.'
To find a registered private acupuncturist, send for the 'Directory of British Acupuncturists', from the Council for Acupuncture, 179 Gloucester Place, London NW1 6DX (071-724 5756). Send a cheque for pounds 2 plus a large SAE.
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