Moxibustion for Breech Baby

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

About 3-4% of babies remain in the breech position at term, and the news at the 36-week scan can be unsettling — most NHS units only allow vaginal birth in carefully selected breech presentations, so a baby that hasn't turned by 37 weeks usually means an offer of external cephalic version (ECV) and, if that fails, a planned caesarean section. The good news is that there is a simple, well-evidenced traditional Chinese medicine technique — moxibustion at the acupuncture point BL 67 — that you can learn to do at home, that takes about 30 minutes a day, and that gives the baby the best possible chance of turning before the clinical decisions need to be made. This page is a practical, home-use focused guide; for the full clinical detail see my main page on moxibustion for breech presentation.

On this page

1. What is moxibustion?
2. The evidence
3. When to start (and stop)
4. How to do it at home — step by step
5. BL 67 — finding the point
6. How it works
7. Combining with ECV
8. Postures that help
9. Cautions and contraindications
10. What to expect
11. FAQs

What is moxibustion?

Moxibustion (or "moxa") is the burning of dried mugwort (Artemisia vulgaris, called Ai Ye in Chinese) over an acupuncture point. It is one of the oldest and most widely used techniques in Chinese medicine — the warmth penetrates deep into the tissues, stimulates the point, improves blood flow, and shifts qi and yang. For breech presentation, moxa is applied to the point BL 67 (Zhi Yin) at the outer corner of the little toe.

The evidence

Moxibustion at BL 67 for breech is one of the most-studied applications of TCM in obstetrics. Headline findings:

• Cardini and Weixin, JAMA 1998 — landmark RCT of 260 women in China; cephalic version rate of 75% in the moxibustion group versus 47% in the control group at 35 weeks.
• Cochrane systematic review — concluded moxibustion at BL 67 reduces the rate of breech presentation at term and the rate of caesarean section, particularly when combined with knee-chest postural exercises.
• Coyle 2012, BMC Pregnancy & Childbirth meta-analysis — confirmed significant benefit, with an odds ratio for cephalic version of around 2.0.
• UK NHS commissioning data — moxibustion is now offered or recommended in many midwifery-led services for breech presentation between 33-37 weeks.

The technique is well tolerated, low cost, can be done at home, and has very few side effects.

When to start (and stop)

• Best window: 33-35 weeks — the baby still has plenty of room and amniotic fluid to turn. Earlier than this is unnecessary (most babies turn naturally before 33 weeks).
• Acceptable up to 37 weeks — and sometimes used between attempted ECV and a scheduled caesarean.
• Stop when the baby turns — confirmed by midwife palpation or scan.
• Stop at 37 weeks — moxibustion's effectiveness diminishes once the baby is engaged.

How to do it at home — step by step

1. Sit or lie comfortably with both feet bare and accessible. A reclining position with your feet supported is ideal.
2. Have someone help you (partner, friend, mother) — it is awkward to reach your own little toe at 35 weeks pregnant.
3. Light the moxa stick at one end (use a candle or a gas hob), let it glow until it produces a steady column of warmth and a small amount of smoke.
4. Hold the lit end about 2-3 cm above the BL 67 point on the outside corner of one little toe, just behind the corner of the toenail.
5. Maintain a comfortably hot but not painful sensation — if it feels too hot, lift the stick further away. The skin should turn pink, not red or burned.
6. Do this for 15-20 minutes on one little toe, then 15-20 minutes on the other. Total session: 30-40 minutes.
7. Do this once or twice a day for 10 consecutive days, ideally at the same time each day.
8. Note any increase in fetal movement during or after sessions — this is a positive sign.
9. If you suspect the baby has turned, contact your midwife to confirm before stopping.
10. Tap the burning end into a glass of water or extinguish in a sand-filled tray; never let it burn unattended.

Use a smokeless or low-smoke moxa stick if smoke bothers you or your household. Open a window for ventilation. Avoid moxa in poorly ventilated rooms or near smoke detectors.

BL 67 — finding the point

BL 67 (Zhi Yin, "Reaching Yin") is at the lateral corner of the nail bed of the fifth (little) toe — about 1-2 mm from the corner of the toenail on the outer side of the foot. It's small but easy to find. There is no need to press hard or massage the point — the warmth of the moxa is what does the work.

How it works

The exact mechanism is not fully established, but the leading explanations are:

• Increased fetal movement — direct stimulation of BL 67 increases fetal kicking and turning, giving the baby the opportunity to find a head-down position.
• Placental and adrenal stimulation — moxa at BL 67 produces a small rise in placental oestrogen and cortisol, which may stimulate uterine activity in a way that favours cephalic version.
• Uterine smooth muscle effects — modest, well-tolerated changes in uterine tone.
• TCM perspective — BL 67 is the jing-well point of the Bladder channel, with a strongly mobilising and "raising" quality. The TCM concept is that moxa at BL 67 mobilises Kidney qi and raises the baby out of the deep pelvis.

Combining with ECV

External cephalic version (ECV) — the obstetric technique of manually turning the baby — is offered by most NHS units at 36-37 weeks for persistent breech, with a success rate around 50%. Moxibustion can be used:

• Before ECV — to give the baby the best chance of turning naturally so ECV is not needed; or to "prepare" the baby and uterus, improving ECV success rates in some published series.
• After failed ECV — sometimes helpful, though success diminishes as gestation advances.
• With acupuncture — adding acupuncture at BL 67 (and sometimes other points like KI 1 or BL 60) alongside moxa improves outcomes in some studies.

Postures that help

Knee-chest position and forward-leaning postures used between moxa sessions help open the pelvis and give the baby room to turn:

• Knee-chest position — kneel with chest and forearms on the floor, bottom in the air; hold for 10-15 minutes, twice daily.
• Cat-cow on hands and knees.
• Forward leaning over a birth ball or peanut ball.
• Avoid prolonged reclining in the days you are doing moxa; sit upright on a firm chair.
• Spinning Babies techniques (online resource) provide a structured set of postures used by many UK midwives.
• Swimming and aquatic exercise — useful between sessions.

Cautions and contraindications

• Stop moxa if you feel unwell, dizzy, contraction-like sensations, fluid loss, or any vaginal bleeding — and contact your midwife.
• Avoid moxa if you have placenta praevia, polyhydramnios, oligohydramnios, ruptured membranes, vaginal bleeding, signs of preterm labour, or in multiple pregnancy without specialist input.
• Do not use moxa in babies, on damaged skin, or near a smoke detector.
• Always tell your midwife and obstetrician you are doing moxibustion.
• Do not use moxa in confined or poorly ventilated rooms; open a window.

What to expect

• Increased fetal movement during and immediately after sessions — the most consistent observation.
• A warm, slightly tingly sensation over the toes; never a burn.
• If the baby turns, you may feel a distinct shift — described variously as a "swoosh", a roll, or a sudden change in where you feel hiccups and kicks.
• Confirmation — your midwife can confirm cephalic position by palpation; in some cases a scan is offered.
• If the baby doesn't turn by the end of 10 days, your midwife will discuss ECV or planned delivery options. Moxa not working is a common and expected outcome — it improves the odds, it doesn't guarantee them.

Frequently asked questions

Does moxibustion really work for breech babies?

Yes. The Cochrane review and several RCTs show moxibustion at BL 67 between 33-37 weeks significantly increases the rate of cephalic version. The effect is particularly clear when combined with postural exercises.

When should I start moxibustion?

The best window is 33-35 weeks — early enough that the baby still has room and fluid to turn. It can be tried up to 37 weeks if needed.

Can I do moxa myself at home?

Yes — that's how most women use it. I teach the technique in clinic, then you continue at home with a partner's help.

Is moxibustion safe in pregnancy?

Yes when used correctly at BL 67 between 33-37 weeks. Most acupuncture points are avoided in pregnancy, but BL 67 is specifically used because of its safe and well-evidenced effect on fetal turning.

What if the baby still doesn't turn?

Your midwife will discuss ECV (external cephalic version) at 37 weeks, then planned caesarean if ECV fails or is declined. Moxibustion improves the odds; it doesn't guarantee outcome.

Does it hurt?

No — only a warm sensation. If it feels too hot, move the stick further from the skin.

Can I have acupuncture at the same time?

Yes — combining acupuncture at BL 67 with moxibustion improves outcomes in some studies. Treatment is brief and well tolerated.

What about smokeless moxa?

Smokeless moxa sticks work well and are useful indoors. Traditional moxa sticks produce more smoke but slightly more warmth. Both work.

To discuss moxibustion for breech presentation or to learn the technique, contact me or book a consultation at my Wokingham clinic.

My Pregnancy Guide

Related reading: Moxibustion for breech (full clinical page) | Mugwort benefits | Pregnancy sciatica

← Back to blog