Re: [ozmidwifery] Re Episiotomy

[Nikki Macfarlane]

Oh Denise, so beautifully asked - without a trace of rancour or cynicism! Physiological third stage is one of my more obvious irritations - the one I probably become most passionate about. Listening to caregivers talk about the Cochrane trials and how they recommend managed third stage drives me nuts. Having scoured through all the original papers used for the Cochrane trial it is so clear that there were many flaws in the studies they reviewed. Bath was only one of many! Third stage is even more of an issue here now with an amazingly high number of parents opting for cord stem cell storage through private companies - there is no public bank. They are always surprised when we communicate to them that their obstetrician will receive $500 from the storage company for each stem cell collection he/she makes.We currently have a big drive from EPI-No as well of the same ilk - each doctor stocking these ridiculous contraptions receives a payout. No surprise then that many doctors are encouraging the women they care for to use them. Never mind that Epi-No were unable to satisfactorily reply to any of my questions to them. Bit the same as the storage of stem cell companies here - asked them some pretty direct questions 6 months ago - they were going to find out the answers but clearly were unable to - or unable to share their findings! Not that I am a believer in "money driving the health care system" of course.   Nikki Macfarlane Childbirth International www.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas ----- Original Message ----- From: Denise Hynd To: [EMAIL PROTECTED] Sent: Sunday, June 15, 2003 2:39 AM Subject: Re: [ozmidwifery] Re Episiotomy Dear Nikki   Are you sensing that possibily the results of the HOOP study maybe reminiscent of the Bath study on physiological third and more recently the Breech Trial in that the results may be influenced or contaminated by the expereince of the operators? Denise ----- Original Message ----- From: Nikki Macfarlane To: [EMAIL PROTECTED] Sent: Friday, June 13, 2003 4:02 AM Subject: Re: [ozmidwifery] Re Episiotomy Thanks for the clarification Lesley and Marilyn. The HOOP trial conclusions was what I had read in MIDIRs some time ago and had assumed that this was what was being recommended by midwifery organisations. I am pleased to see that the trial results have been interpreted differently by some.   After reading the HOOP trial I was frustrated that they did not seem to provide enough information to determine why it was that the hands poised group had a significantly higher rate of manual removal of placenta. I can't think of any reason why this would be so - unless the midwives caring for these women were applying a different type of care for the third stage, either consciously or subconsciously, to the hands poised group. If they were providing different care, why was this? Perhaps a different subconscious attitude towards this type of care? Or something they were uncomfortable with? And if so, how did that affect other aspects of the trial?   Can anyone else think of any reason the hands poised group would have significantly higher levels of manual removal?   Nikki Macfarlane Childbirth International www.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas