Dear List,
I am sending on behalf of Joy Johnson as her replies to the list don't seem
to be getting through.
Annie Sprague RN RM M&CH
Independent Midwife
34 Shiers St.
Alphington 3078
Melbourne Aust.
Ph. (03) 94973625
----------
From: "Johnston" <[EMAIL PROTECTED]>
To: "Annie Sprague" <[EMAIL PROTECTED]>
Subject: FW: Tricks of the trade
Date: Thutues19 22Aug jun19991999 ju7:43 PM
Dear Annie
please forward this on to ozmidwifery, as my messages aren't getting
through.
bye&love Joy
-----Original Message-----
From: Johnston [mailto:[EMAIL PROTECTED]]
Sent: Sunday, 15 August 1999 17:55
To: ozmidwyfs
Subject: RE: Tricks of the trade
Nigel and all
I have to agree with you here, Nigel, and I think you have said it all very
clearly.
I am very concerned about maternity services in which women are told "women
who are past 41 weeks are induced", or "if you have had a previous caesar we
have to monitor continuously", or any other protocol. The correct
statement, in my opinion is something like "we recommend this or that, for
the following reasons: ... " I was recently in a hospital with a woman who
was in advanced VBAC labour, who refused continuous monitoring. The doctor
became quite distressed, and said "I have to tell you that you are going
against my recommendation, and the recommendation of the ..... hospital.
You are taking responsibility for the result of your refusal." The woman
replied, as best she could in strong labour, "yes, and my midwife will
listen to my baby from time to time and advise me if I need to change my
mind."
I am also concerned about independent midwives who present their clients
with a pseudo-medical prescription for routine herbs, vitamins,
homoeopathics, acupuncture, and even physical things like relaxation
techniques, exercise balls or aquanatal classes. I think most midwives will
talk about these things because they are available, but only recommend an
'intervention' if there seems to be a valid reason.
But since Linda asked a specific question about what other midwives do, I
will add my thoughts about nipple stimulation for induction. Oxytocin
release occurrs with light touch on the nipples - and I tell women that they
can stimulate their nipples through their clothes. I demonstrate on myself,
as it's not something that most people are used to doing.
I encourage the woman to bring on a contraction, stay upright, mobile and
active through the contraction, then rest or do other things for a couple of
minutes before doing it all again. If she needs to sit, the exercise ball
is good, as the woman's posture is upright, and it tilts the pelvis
anteriorly, and hopefully brings the baby into an occiput anterior position
and improves the application of the fetal head to the internal os of the
cervix.
If the nipple stimulation is continued every 4 or 5 minutes over a period of
time, such as an hour, the woman's body will either take over, or she will
get sick of it and decide it's not working. It is very much in her control,
unlike the contractions that are stimulated when the rate of syntocinon is
increased to a schedule. The process can be repeated later.
The effectiveness of this method is, I believe, dependent on the readyness
of the woman to labour. And remember that the 'flight or fight' hormones
such as adrenaline will block the oxytocin. This is illustrated by cats and
other mammals who are making a nest in preparation for birth. If there is a
threat - some sort of predator - the cat will leave that nest and seek out
another, putting her labour on hold until she feels safe. Stranger danger
is a very potent force in the human parturient too. How many times does a
woman say her labour was going well until she walked into the hospital. She
needs to accept the midwife who greets her (often a stranger), and settle in
to a new nest, before getting on with the job. A woman who says nipple
stimulation doesn't do anything may be embarrassed about touching herself.
A midwife and woman who have learnt to work together and trust each other
will be able to do something here. But if the woman doesn't trust the
midwife, it may be difficult. The woman may prefer the medical / surgical
induction.
Joy Johnston
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]]On Behalf Of CATHY AND
NIGEL BOCK AND DUNCAN
Sent: Sunday, 15 August 1999 8:43
To: Andy Campbell; oz midwifery
Subject: Re: Tricks of the trade
Dear Linda,
There are many recipes for encouraging labour, however it must be said
the formulae for succesful birth should not include any interference
whether obst. or midwifery initiated.
The first course of action for yourself would be to give the power back
to the women to decline induction at 42 weeks by informing them of the
gradual but slight increases in morbidity associated with expectant
management. WE should never dictate any action to any birthing women
our role is to advise. With this information clients can then enforce
their right to decide the pros and cons of expectant versus induction
management.
I have heard many recipes from the use of uterine toning herbs to
contraction enhancing root products, the use of gin, bowel stimulants
from sugar solutions to spicy foods and castor oil, to acupressure,
hypnotherapy, orgasmic sex and nipple stimulation, bumpy car journeys
to various formats of activity washing and polishing wooden floors for
example.
The truth is some will work on various people where others they wont.
The indian women who dines on very spicy food and has regular bowel
movements will not largely benefit from bowel stimulation, the women
who has a direct anterior presenting baby will feel less benefit of
polishing floors to the lady with an op presenting baby.
Check dates from your clients if their is an incongruence with any
performed USS which correlates to your continued Antenatal assessments
of gestation, identify any emotional or pyschological barriers to
birth, and then discuss the physical aspects.
Give the power to your clients and be with them in THEIR decision.
"In the light of the availible evidence, the best policy is to offer
women a choice of induction of labour by the best method available once
the duration of pregnancy has WITH CERTAINTY attained 41 weeks or
more." Enkin et al Offord 1995.
"Post term pregnancy, another indication for induction of labour, is a
rare occurance; its true incidence is only 4-6%........." Crowley 1991
cited wagner 1994.
Good references for more gentle forms of induction are to be found in
Spiritual midwifery, and Davis's Heart and Hands.
Hope these thought s help.
Nigel
===
>From Cathy Bock and Nigel Duncan.
at
BIRTHING HANDS (Homebirth, ante/post natal care and hospital support)
[EMAIL PROTECTED]
0414 886827 or 0414 554840
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