I am 35 weeks pregnant today. I will be delivering this little Skepchickadee on May 26. That day cannot come soon enough right now. See, Delaney (that’s her name) is breech. My OB says it’s pretty unlikely that she’s going to flip at this point. As far as delivery is concerned, this doesn’t really matter much because I was scheduled for a c-section anyway.
However, what I didn’t realize is how really fucking painful it is to have a breech baby as a pregnancy approaches full-term. Normally, at 35 weeks, your baby is pretty well lodged, head down, into your pelvis. This gives them little opportunity to move around. They kick and squirm and you get a foot in the rib here or there. Mostly it’s annoying. Sometimes it’s sweet. But most off all, it’s super entertaining to poke them in the butt and feel them getting all pissy at you. When I was pregnant with my son, I would waste entire afternoons poking at him, shining flashlights in his face and blasting annoying music into my belly to make him move. I know my last post on pregnancy made it sound really awful, but seriously, it’s so worth it to get pregnant just to get to do that stuff. (It’s payback for all the other stuff.)
But when they don’t get their heads restrained, they become free range fetuses.
So, like right now, I have one foot in my right hip, one foot feeling like its trying to kick my asshole out of place, a hand grabbing onto my ribs, and another hand occasionally using my stomach (not like various parts of the inside of my belly, but like the actual organ) as a squeezy stress ball. Meanwhile her head is moving around in ways that would scare the shit out of anyone who thought the Exorcist head-spinning scene was anatomically plausible.
I spent the majority of the day trying not to vomit and trying not to scream.
I’m half tempted to go trolling the west side of Aurora to see if I can score a bag of pit.
But given the unlikelihood that I’ll find a nice “street vendor” selling synthetic labor induction hormones, I’ve chosen to stay home and take a look at information about breech babies. What I’ve been looking for is information on the odds of this little ass-kicker flipping. Most of what I read says, “It can totally happen!” without any statistics or information beyond that. Occasionally I’ll read an anecdote from a doula who watched a baby flip during labor, but I tend to believe that when someone says they saw something happen once during their entire professional career, as inspiring as that anecdote was supposed to be, it gives me little hope of my ribs being used for something other than monkey bars for the next 3 weeks and 5 days.
Mostly I’ve found sites offering various options for attempting to get your fetus to get in place. I imagine that anything aside from an actual external version (that’s where your doctor manually turns your baby from the outside… which sounds like it’s probably the most painful thing any human can ever experience) there’s not much you can do. But most of it is harmless advice, probably worth it to ease discomfort for a while, like getting down on your knees and forearms.
The thought is that you should try to position yourself in ways that will help prevent your baby from engaging into your pelvis. Once engaged, they can’t reposition. Will it flip your baby? Probably not, I’m guessing. Does it feel fantastic to stretch your hips and have your belly facing down for a while? Oh hell yeah! I recommend this even if your baby isn’t breech… right now I think this pose is so wonderful, I can’t figure out why anyone wouldn’t become Muslim just to have an excuse to do this pose 5 times a day pregnant or not!
But on the page where I found the drawing above, I also found the most disturbing suggestion I’ve found yet:
Using moxibustion to encourage the baby to turn by itself
A very successful “do it yourself” technique with a proven high success rate is to use locally applied heat treatment.
The heat from burning moxa sticks can also be used to stimulate the baby’s movements and encourage it to turn. These sticks, shaped like cigars, are available from herbalists, Chinese medicine stockists and some acupuncturists (who use moxa sticks for other purposes) and they contain tightly rolled dried leaves of the mugwort plant.
Ok… herbs… heat… yeah, it’s obviously pretty craptastic off the bat. And I can’t believe that an OB would suggest her patients start lighting shit on fire and putting said fire near their bellies while inevitably breathing in the smoke from these herbal cigar candle things.
Turns out, yeah, that concept is pretty fucked up. No one is suggesting you put these sticks next to your belly to get your baby to turn. That would be irresponsible, stupid even! That is not how ancient Chinese herbalists do business. So the egg-drop soup is all over my face for thinking something so ridiculous.
So how do I get my daughter to flip?
Sit on a chair and place each foot on a book with your little toes hanging over the edge. Place each stick on another book with the tip in the gap.
Light the sticks (they burn with no flame but an intense heat and pungent smell) and position the hot tip as close as possible to the outside of each little toe, with the heat directed at the point just above the toe nail. Leave in place for 20 minutes. Be careful not to touch the skin as you will burn yourself. The heat should be as strong as you can tolerate, for the best effect.
![[Place each foot on a book with your little toes hanging over the edge]](http://www.birthinternational.com/articles/images/breech_4.jpg)
WHAT… THE…?!?!
I’m supposed to burn my fucking feet? Using sticks that are so hot you can’t see the flame? Are you kidding me?
Every part of my body is either achy, sore, tired or being kicked and grabbed and your answer is to put fire next to my feet because this will help my baby move? And you’re not being an asshole? You’re actually trying to help? And enough people do this in real life that you are willing to suggest this with a totally straight face?
Can I just step out of some-random-blogger mode and talk to you as a medical professional*? Ok, as your doctor, I’m going to recommend that you NEVER EVER EVER do this. Do not put invisible, but not imaginary, fire next to your feet. Do not do this when you are pregnant. Do not do this when you are not pregnant. Do not do this unless you are already dead.
This is what happens when Big Reflexology gets into bed with Big Ear Candles… while Big Reason gets sent out on a beer run. Seriously… that’s the only explanation I can come up with for this:
AÂ randomised controlled trial indicates that at approximately 70% of breech babies will turn using this method. If the baby does not turn from its breech position, external cephalic version should be attempted just before labour begins.
Someone thought there was enough validity to putting cigars near your feet, in order to cure a butt down fetus, to actually do a study. Like someone got money to do this study? And I can’t find a job? Maybe I’m not coming up with stupid enough studies.
So, let’s, for the sake of why the hell not, take a look at this “randomised controlled trial“. For the sake of brevity, I will just show you the stuff you need to know. More information is on the toe burner page.
Francesco Cardini MD; Huang Weixin, MD
Journal of the American Medical Association, November 11, 1998 – Vol 280, No 18, pp1580-1584.
Context
Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomised controlled trial has evaluated the efficacy of this therapy.Patients
Primigravidas in the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of breech presentation.
Most babies are head down (cephalic) by 32 weeks. The number of breech presentations ranges between 15 and 20% at this point. However, come delivery, only about 4% are breech. So 33 weeks isn’t any time to start panicking about having a breech baby, but it’s certainly something you want to be aware of. Of breech babies at 33 weeks, somewhere between 70-80% will end up cephalic.
Wait… what did the article claim? 70% of women who try moxibustion will end up with head down babies? How… completely unremarkable and predictable. But what does the study say?
Interventions
The 130 subjects randomised to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech position. The 130 subjects randomised to the control group received routine care but no interventions for breech position. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks of gestation and delivery.Main Outcome Measures
Fetal movements counted by the mother during 1 hour each day for 1 week; number of cephalic presentations during the 35th week and at delivery.Results
The intervention group experienced a mean of 48.45 fetal movements vs 35.35 in the control group. (P<.001;95% confidence interval [C1] for difference, 10.56-15.60). During the 35th week of gestation 98 (75.4%) of 130 fetuses in the interventions group were cephalic vs 62 (47.7%) of 130 fetuses in the control group (P<.001; relative risk (RR), 1.58; 95% CI 1.29-1.94). Despite the fact that 24 subjects in the control group and one subject in the intervention group underwent external cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs 81 (62.3%) of the fetuses in the control group (P=.02; RR, 1.21; 95% CI, 1.12-1.43).Conclusions
Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.
Blah blah blah. 75% of the babies whose moms willingly lit their feet on fire were cephalic at birth. 62% of the babies whose moms weren’t so stupid got flipped.
The researchers and the article writer decided that this means foot cooking works.
I’m not a research scientist, or a scientist, or a researcher, but what I see is that one group’s outcome (which happened to be the one with the intervention) being exactly the same as what you’d expect to see anywhere at any time with any large group of pregnant women, and not faring better… not even statistically insignificantly better… not better at all. Exactly where you’d expect them to be, between 70 and 80%.
So why did the control group have such low numbers? The only thing I can say about that is that they had… (wait for it)… cold feet! ZING!
Honestly though, even if this study showed that sticking your feet in a bonfire would definitely flip your baby, 100% of the time, that doesn’t mean it’s a good idea. Pregnancy lowers your body’s ability to fight infection. Getting burnt increases your risk of infection. Therefore, my expert professional medical* opinion is that you do not, under any circumstances, put your skin within an inch of a burning cigar/candle/stick on purpose for any extended period of time. And I would define “extended” as “more than a second”.
And, since there is a small human being gnawing the hell out of my diaphragm, I’ll leave you with that so I can go cry… both in pain and for the sake of humanity.
Pro tip: use condoms
*I am not, by any standards – legal, mythical or approved by the Insane Clown Posse – a medical professional.
Wooooow. Just wooow. I literally have no words. I just stared at the picture without reading the article for about five minutes because I was mesmerized. I just . . . couldn’t . . . look . . . away.
This is definitely a visual “If it wasn’t for my horse,” moment.
Elyse, I think I have some road flares I’m not using…
Having experienced a kickboxing fetus during my first pregnancy, I completely understand the combination of extreme discomfort and hilarity! There was nothing worse than feeling my dear daughter dancing on my cervix while her face was pressing outward like an alien birth…
To this day she still destroys her bed sheets while sleeping. Hmm, I wonder if I should set the dust ruffle on fire?
48%, not 62. But I agree it’s too weak evidence for such an outrageous idea.
@Bjornar:
No, 62% were cephalic.
Now I keep singing Queen’s “Tie Your Mother Down”, but with the words Burn Your Fetus Down.
Burn your fetus down
Burn your fetus down
Lock your daddy out of doors
I don’t need him nosing around
Burn your fetus down
Burn your fetus down
Give me all your salve tonight
@Sam Ogden: You picked the correct Queen song.
Well I find fire is normally a pretty effective way of dealing with infectious parasitic lifeforms, but generally only the ones I want to get rid of in the end.
As I was reading the article I did wonder whether they were suggesting “smokin’ him out”.
Many a strange image was conjured in my head, brought a whole new meaning to the phrase “bush fire”.
Elyse, I’m very disappointed that you didn’t title your entry as, “Once more, into the breech”
When I have a breech baby, I’m using that title. You had your chance. Puns are more important now than ever.
Once again condom stock is on the rise and women across the land stitch their vaginas closed.
I hereby nominate every comment in this thread, even those that have not been written yet, as COTW.
Somone explain to my why JAMA would print this alleged “research” which appears to be easily debunked in ten minutes by a woman under constant assault by eight pounds (approx) of directionally challenged, proto-teenager?
We often complain about how mass media fails us when reporting science but why do we have to put up with science media reporting woo?
Oh! Interesting.
I went to JAMA’s website and it turns out that every second week in November they do a “special report” covering a specific topic or modality.
For example, the November 2006 topic was Men’s Health.
It just happens that the November 1998 special topic was “woo”.
I apologize to JAMA for assuming they had thrown away all editorial integrity. It turns out they just threw it out for one month.
I will repeat, for those who have missed it:
I’m so glad I’m a boy.
@SkepLit: COTW.
Also, Elyse, have you tried….ha, just kidding. I know how fucking annoying that is!
The drawing cracked me up. I just finished my Companion Animal class and the illustration is so much a species swap for the pose female cats give when in estrus. It’s called “Elevator Butt”
@SkepLit:
That woman is also sleep deprived and was on codeine while debunking said study.
Perhaps the folks at JAMA were also drugged and pregnant in November 1998.
So I hope that cracking up over every word of this post doesn’t make me too much of an inconsiderate bastard…. Is it ok to rank the post as “seriously funny” if I also express serious sympathy for your predicament?
@Ing213:
“Elevator butt” sounds like something you get when you don’t take the stairs often enough.
@Elyse: Serves me right for thinking I could read.
…and I thought the guy that had the Alien burst out of his chest had it bad… ;-)
Also…obligatory
http://imgs.xkcd.com/comics/trimester.png
@Elyse:
“…I would waste entire afternoons poking at him, shining flashlights in his face…”
Jeez, you were sticking *flashlights* up there? You got WAY too much time on your hands.
@Reverend Kel:
I’m fairly certain that if you turn your Google safe search off for a minute, you’ll find that you don’t need much time on your hands to find alternative uses for flashlights.
If you leave safe search on, you might find that there are other places to stick the flashlight to entertain yourself while pregnant. I promise you, those are so disappointingly boring, you may stop reading Skepchick altogether. Leave the safe search off.
@Elyse: I’ve had to turn safe search off a few times to find photo reference for artwork. It can be… distracting.
@Elyse:
Ah, serendipity is a wonderful thing. If I weren’t such a prevert, I wouldn’t have found out there was a filter working on my Google! Thank you, Elyse. Life is disgusting again.
I was exposed to the “pungent” smell of moxa outiside the integrative medicine treatment room in vet school.
It smells exactly like pot.
@Glow-Orb:
Who would waste pot on their feet? That’s the most stoned thing I’ve ever heard!
Well, it’s less awkward than what one friend was told to do. A “medical intuitive” told her to record herself saying loving and reassuring things. Then she was to spend several hours a day tilted upside down with a speaker playing those comments between her legs to try to get the baby to turn to get closer to the voice.
I didn’t work. I told her she should have read the menu at Roscoe’s – that’d entice anybody.
An external version isn’t the most painful thing a human can experience; manual dilation of the cervix is. Just so we’re clear on that.
And I’m totally jealous if your ability to lay face down with your ass in the air, even if it doesn’t make baby flip. Damn you, anterior placenta! Daaaaamn you!
My kid is now 11 months old. In my pre-birth yoga class for moms-to-be there were 2 whose babies were breech. Here in Germany, midwives often try alternative methods (acupuncture, hoemeopathy) when normal medicine fails or if the mother-to-be feels more comfortable with alternative stuff.
That said, both moms whose babies were breech tried moxibustion, plus some other alternative methods, and one baby did inded turn around after moxibustion.
As far as the heat of moxibustion is concerned (my grandmother was into TCM…), the heat is actually not that high, since the herbs don’t actually burn, but smoulder, and you’re NOT supposed to hold them so close that you get burned.
@Anda:
If both of those women tried drinking cranberry juice and singing songs about spiders and one of their babies flipped but the other didn’t, would you be telling us that one mom had success with that method?
70% of babies who are breech after 32 weeks end up properly heads down. All the anecdotes in the world are not going to change the fact that 70% of the breech babies whose mother tries moxibustion also end up heads down.
This means that the real ancient Chinese secret here is that you can get a lot of white people to do whatever you want by telling them that their feet and some herbs are magic.
Reality: Burning things is not magic. Your feet are not magic. Chinese people, especially, are not magic… and to suggest otherwise is just plain old racist.
As for whether you actually burn your feet, the instructions are to put the sticks as close as you can handle. From the photos on the site, this is less than a centimeter. I would highly recommend not putting anything that is on fire near your skin at any time, but especially while pregnant.
As for your grandmother, I’m sure she was a wise and lovely lady. My grandmother prayed to saints to cure my father’s celiac disease as a baby. And it worked! He’s been eating gluten for 54 years now. Ancient Irish secret!
Ugh. This is such a bummer. The proper control would be to heat BL67 and then some other acupuncture point. Now you’re cookin’! The differences observed are likely due to a treatment effect. Women with heat on the spot feel the temperature and physiological/psychological corrections kick in. Those that just received “care” do not exhibit the treatment effect.
It is the classical problem with this kind of test. You cannot randomize or placebo control. People know that they receive treatment because it is a physical stimulus. If you do the same treatment in a different spot you will see an identical response. It has likely nothing to do with the moxa on the spotsa.
Multiple replicates should also be customary for this journal. Reviewers must have been asleep.
Elyse, time is still on your side so things might just take a turn for the better, so here’s best wishes for a cephalic presentation.
You realize the whole thing could have been avoided with less phallic presentation.
That position – (attempting) to sit on your heals, forehead on the floor, arms outstretched above your head – is called Child’s Pose, and is by far one of the most comfortable yoga positions, pregnant or not.
Compared to what the Chinese traditionally did to women’s feet, that’s probably quite hrmless and relaxing…
It might be Schadenfrude (but it’s probably that while my baby is also in breech position, I’m only about 30 weeks at the moment and not QUITE to the point of rampant discomfort you are) but this entry gave me a giggle.
Actually, the part I loved most is the bit where you noted how fun it is to poke the Hell out of your fetus for your own amusement. So. Very. True. I’ll tap him constantly just to get him pissed off and riled up and punching me back or to see if I can get a fist or a foot to poke out of my belly (creepy much?). It’s totally payback and as crappy as I feel 90% of the time, it’s often my best form of entertainment, which is sad.