Ornament

The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Ornament

Outline and Bibliography for External Version


The federal government now says it's OK for pregnant women and young children to be
injected with mercury in the H1N1 vaccine.
However, if there were more mercury-free vaccine available, they would recommend that pregnant women and young children get that instead.
Don't be fooled!  Thimerosal is a form of mercury!
Autism rates dropping in California—is phase-out of thimerosal the reason? [from 2005]
Current thinking is that only genetically vulnerable babies will be affected by the thimerosol . . . maybe even as low as 1 out of 200 or 0.5%.
But if it's your child, it's 100%.  Read this mother's story about her children's recovery from mercury-related autism.

EXTERNAL CEPHALIC VERSION

  1. History
    1. Probably practiced in antiquity
    2. Referenced in 1807 OB textbook (Wigand).
      1. 1843, Hubert (Correction of 'vicious' presentations)
      2. 1889, Pinard (as in fetoscope)
      3. "Treatise on abdominal palpation" included how-to's on external version
    3. Popular until the 1940s in the USA, fell into disuse
    4. Has had fervent advocates and opponents throughout.
    5. Resurrected as a high-tech procedure in the mid 1970s
  2. Philosophy...Paradigms and Protocols
    1. What is external cephalic version?
      1. Version equals turning
      2. External: from the outside
      3. Cephalic: so the head is down
      4. Could be through any of a number of techniques
      5. Other version..internal podalic..not today's topic
    2. Why turn babies?
      1. Risks of breech delivery (vaginal or abdominal)
      2. T-Lie: birth impossible sans version or Caesarean
      3. Relative risk:benefit ratio questions
        1. Reduce the rate of Caesareans
        2. Reduce the cost of care ($) (Gifford, et al., 1995)
      4. Routine ECV reduces the rate of malpresentation at onset of labor from 3-4% to less than 2%
    3. Why not turn babies?
      1. Safety questions
        1. Cord accidents
        2. Placental accidents
        3. Fetomaternal bleeds (2% - 28% range)
        4. Fetal intracranial bleeds? (Becroft, 1989)
      2. Most babies will turn on their own, anyhow
        1. Spontaneous version rate after 32 wks = 57% (Westgren et al., 1985)
        2. Spontaneous version rate after 33 weeks = 26% (Van Veelen et al. 1989)
        3. Spontaneous version rate after 37 wks = 18% (Wallace et al. 1984)
      3. Caesareans are a safe option
        1. Slight increase in maternal morbidity and mortality
    4. When should versions be done? (or not done)
      1. Early and often (74-97% success) (Scaling 1988; Ranney 1973)
      2. > 37 weeks G.A. (46-68% success, various studies)
      3. Anytime the baby is non-cephalic (incl. SROM)
    5. Where should versions be done?
      1. In the practitioner's office
      2. In a tertiary care setting, with an OR ready
      3. Wherever the woman happens to be
    6. Who should perform the version?
      1. The woman's primary care provider
      2. A perinatologist
      3. The TBA or a other culturally appropriate person
      4. The woman herself (posture, visualization)
    7. How is version accomplished?
      1. Literature references to hypnosis, moxibustion, auricular plasters, prayer, homeopathy, visualization, and postural changes (breech tilt, etc.)
      2. Massage techniques such as la sobada
      3. Tocolysis, anesthesia, ultrasound guidance
      4. Abdominal/uterine relaxation necessary
      5. Placental location?
      6. Forward roll vs. back flip (baby, not mother!)
  3. What is the role of the midwife?
    1. Assess fetal lie and position each visit
    2. Educate self to the controversies and options available
    3. Possible strategies to encourage spontaneous version
      1. Relaxation, "self-hypnosis", incorporate the mother's personal and spiritual beliefs (mind-body connection)
      2. Breech tilt exercises (not well studied)
        1. knee-chest q 2hrs ATC p. 37 weeks
        2. supine, pelvis elevated. 10 min. tid p. 30 wks
      3. Refer for version as appropriate. In some settings, the midwife may perform versions.
      4. External version by any means (conventional or unconventional) is an intervention! Be honest with oneself!

BIBLIOGRAPHY

This Web page is referenced from another page containing related information about Prenatal Breech Issues

 


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