Complementary therapy for induction of labour.

Midwives at West Middlesex hospital (WMUH) offer complementary therapies as part of antenatal care. Aromatherapy and reflex zone therapy (also known as 'reflexology', a system of using touch on areas of the feet that stimulate parts of the body) are offered to induce spontaneous labour for women with low risk pregnancies once post dates, reducing the need for medical induction of labour (IOL) and intervention and reducing the cost to the NHS. This paper discusses how this service was implemented and developed, and the audit results and feedback from women and midwives.

Moxibustion to turn the breech.

Midwives at West Middlesex NHS Trust (WMUH) have been trained in the use of moxibustion to turn a breech presentation. This paper informs the reader of this service, how it was implemented, the audit and importance of maintaining accurate data as well as the resulting changes to the service. Moxibustion appears to be a safe, easy and cost effective way to promote cephalic presentation and is offered prior to external cephalic version (ECV).

Factors affecting the success of moxibustion in the management of a breech presentation as a preliminary treatment to external cephalic version.

OBJECTIVES: to explore the effects of moxibustion treatment, to examine the predictors of its use in causing a breech presentation to spontaneously turn to a cephalic presentation which will result in a vaginal birth (the paper will refer to this as 'successful') and offer external cephalic version (ECV) subsequently after moxibustion treatment when the fetus remains in a breech presentation. DESIGN: a prospective study over a two-year time period from February 2004 until January 2006. PARTICIPANTS: 76 pregnant women from various acupuncture practices in the UK, with a third trimester breech presentation. INTERVENTIONS: the acupuncturist taught the women how to apply moxibustion (sticks of compressed dried herbs-Artemisia vulgaris) treatment at home by stimulating the acupoint on the outer edge at the base of the little toe nail for seven days twice a day (morning and afternoon). If the breech presentation persisted after treatment, ECV was carried out towards the end of the pregnancy. The obstetricians offered this during the routine antenatal hospital visits. FINDINGS: the results show that following treatment with moxibustion, 31 (40.8%) of the breech presentations spontaneously turned to cephalic presentations, and a further 33 (43.4%) breech presentations were turned by ECV. Women who involved other people in the administration of moxibustion were twice as likely to be successful. Multiparous women were also 16% more likely than primiparous women to succeed in achieving a spontaneous version with the use of moxibustion. Fewer side effects reported when using moxibustion were the strongest predictor of successful spontaneous cephalic version with an odds ratio of 12% (p = 0.02). KEY CONCLUSIONS: moxibustion creates a better chance of vaginal birth for expectant mothers. Of the women who were successful in turning their babies using moxibustion, 88% went on to have a normal birth and 12% had a caesarean section. Moxibustion treatment also significantly increases version from a breech presentation to a cephalic presentation where there are fewer side effects reported, if the woman is multiparous and has support during the administration of moxibustion treatment. IMPLICATIONS FOR PRACTICE: moxibustion treatment should be offered to all women with a breech presentation because it is non-invasive and can be self-administered by the woman. It is therefore a simple, cost-effective technique that requires no medical intervention.