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Re: external versionFrom: CheriVH@aol.comTue Apr 16 14:08:12 1996
My role in external version has always been as an assistant to the physician, but in reality, we are both massaging the baby around into position. Four hands are used. The assistant generally is responsible for elevating the presenting part, but usually ends up nudging the baby in the right direction. Epidural anesthesia has never been used at any of the three hospitals where I have worked. We start an IV and use SQ terbutaline before beginning. The procedure is done with ultrasound guidance. Our success rates have generally been about 75%. The women I have assisted have never complained of excessive pain. A couple of tricks I bring to the process are these: 1. I spend some time teaching the mother a few basic relaxation techniques before we begin and emphasize the importance of relaxation during the procedure. 2. I use positive language to describe the procedure, e.g. telling her that we will be massaging the baby into position. This helps to decrease anxiety, and thus tension. 3. I give the mother a role in the version. I tell her that visualization is very powerful and that she should imagine the baby doing a somersault and turning around the right way while we're doing the massage. I ask her to silently tell the baby to turn while we're doing our jobs. I don' t have any idea whether this serves any useful purpose other than to relax and empower the mother, but it certainly doesn't hurt and may even be helpful. I describe this visualization to her in very confident and matter-of-fact language, as I want her to believe that it works even if I have my own doubts. Too much research has proven the benefits of the placebo for me to want to seem skeptical of the value of her efforts. Cheri Van Hoover, CNM Kaiser Hospital Redwood City, CA
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