Re: [ozmidwifery] whats happening ?

[Marilyn Kleidon]

Hi Lynne: yes it is weird how transfers can cluster sometimes. Exhausting. Regarding the Mg SO4 and >BP, one young woman I worked with in Seattle developed high BP after we made the hospital transfer(we transferred for maternal exhaustion, she had been labouring hard for 2 days and was still 3cm, BP had been stable at home, no other sx except that she had had heartburn/reflux throughout the pregnancy and i have wondered since if this masked any epigastric pain) anyway BP went from 120/70 at home to 138/88 on arrival at hospital, to 144/90 to finally 160/100, this was after the epidural but while we were awaiting the stat liver function tests which the ob ordered "just in case" actually apologising for ordering them as we all thought the elevated BP wasdue to the stress of the transfer.She had HELLP syndrome, so Mg SO4 and much careful monitoring, she went to complete in 2hrs and pushed her baby out in between vomitting from the Mg SO4. There was thick to mod mec liquor too, baby was 8lb and vigorous at birth. She stayed in hospital 3 days on meds until her bloods were normal and BP stable, baby very jaundiced really should have had phototherapy but parents declined and went home. Mum also somewhat jaundiced (I guess the hemolysis). Baby was under paediatric care, lost >10% in first week, milk took a good 7 days to really come in once it did baby made a slow but steady weight gain. WE, the midwives were somewhat anxious, but paed was ok with it doing homevisits and sun baths for baby (trust me the UV index in Seattle is not to be worried about). Long story, sorry. So yes the milk did come in just later.   marilyn ----- Original Message ----- From: Lynne Staff To: [EMAIL PROTECTED] Sent: Thursday, July 10, 2003 2:14 PM Subject: Re: [ozmidwifery] whats happening ? Hi Jan Must be something in the water - I had 3 t/f to hosp as well in the past 2 months. One  - a primigravida - C/B after BP shot through the roof antenatally and SROM at 37 weeks. She did labour, but for whatever reason, her body did not open, and her BP sneaking up higher and higher despite Mg So4 and hydrallazine. Home now but lactation did not establish and she has tried everything. Is anyone aware of MgSo4 or hydrallazine having an impact on lactation?   Another had the most amazing labour - had been labouring for quite some time before she called (as she and partner had been happy working together). First baby. After some time I asked if I could examine her - something wasn't right - she had the most awful back pain and the babe was not OP - the head VERY deep in the pelvis and had been for some weeks prior to birth. Head was +2 and covered with lower segment. Looking for cervix and finally located it very high and anterior behind the right obturator foramen. Pinhole in size and the lower segment/cervix paper thin. No wonder she had this dreadful backache. I began to massage the tine hole in her cervix very gently - within 5 mins had opened to 3-4. Another 2 hrs later, still awful backache (imagine the stretch on her posterior ligaments), and still the same. Some more gentle massage and the cervix opened to 5-6. Into bath, but backache absolutely unbearable after another hour. Penney asked me to massage again, but my short little fingers could only coax it to 8 where it stayed for the next hour. She decided to go to hosp for some pain relief (!), and when we arrived I organised an epidural for her. Asked to check her again before the anaesthetist arrived, because it might change what she wanted to do - anterior lip, backache gone and she pushed out her baby after I phoned the anaesthetisit to say we wouldn't be requiring him after all. All of us crying - one exhausted but oh so triumphant woman.   Third primigravida, who laboured beautifully at home and the baby just did not come past caput on view despite everything we tried. So decided to go to hosp, where she had a reseonably difficult ventouse - no analgesia (her choice) - she just wanted to have the baby. Hospital staff were wonderful in each case - women and their partners treated with respect and each of the women has come away feeling good about the transfer.   Whew! Sorry about the length of this posting but needed to talk! Thanks for the opening, Jan. From another very tired and continually learing midwife - Lynne :-) ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Sent: Thursday, July 10, 2003 11:14 PM Subject: [ozmidwifery] whats happening ? bad run? unbelievable 5 births this month3 c/s trans from homebirth 1 normal del priv hosp 1 normal del home what is happening  bewildered tired and yuk jan