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Thanks Tania, Lois and
Marilyn,
it all helps. Andrea, I
would love to come to Sydney for Maggie's workshop (I've heard her talk at two
futurebirth conferences, and she's wonderful). I just feel that I would like
someone around for a while while I'm starting out. It's not only that I've been
trained in the system, it's also because of my relative
inexperience. That's why I'm thinking that a year in a caseload practice
(not many in my area - none in fact) in NZ or UK wpuld give me the grounding I
need.
Denise, I totally
sympathise. I too am working on NMAP and MC stuff, and really don't know
what to do next. Oh for a (big) fairy godmother.
blessings to you
all,
Liz
----- Original Message -----
Sent: Saturday, July 17, 2004 5:30
AM
Subject: Re: [ozmidwifery] Birth summary
forms
Hi Tania:
I don't think there is any research that
indicates an increased risk of the cervix closing during a physiological third
stage or expectant management of third stage. The risk of the cervix closing
before the birth of the placenta is associated with active management of third
stage that is it (the risk) increases after the oxytocic has been
administered, hence the often or apparently aggressive delivery of the
placenta in active management. There is increased risk of PPH with expectant
mangement of third stage (note not true physiological management) as evidenced
in the trials on the Cochrane data base. I have read discussions that argue
that this increased risk of PPH may be due to provider/care giver
error in how they manage expectant management ie how aggressive are they with
placental delivery are they prepared to watvh and wait as jan has
indicated?
marilyn
----- Original Message -----
Sent: Wednesday, July 14, 2004 5:02
PM
Subject: Re: [ozmidwifery] Birth
summary forms
Liz
As a mid student, I have also wondered about
the cervix closing before the placenta is birthed. With the birth of my
third child (at home) we opted for a physiological third stage and have
since done some research on the timing of cord clamping. It seems there is a
lot of supportive literature for delayed cord clamping with one of the few
factors against it being the fear of the cervix closing before birth of the
placenta.
Tania
----- Original Message -----
Sent: Wednesday, July 14, 2004 6:59
PM
Subject: Re: [ozmidwifery] Birth
summary forms
Hi Jan,
thanks so much for
your post. I too would love to work outside the hospital system however
being a recent graduate and having no-one to "apprentice" me, I lack the
confidence to do so. I feel my only option is to work overseas for a while
(an expensive option with 3 children and partner in tow). In the meantime
I embrace the wise-woman knowledge I encounter on this list. I have
another question too. The docs where I work have the fear that the cervix
will close before the placenta can birth. I think this is their reasoning
for manual removals if they are not out in the specified time frame. Is
this because of the syntocinon given for medically managed third stage, or
is this a realistic possibility also for physiological third stage? Once
again, forgive my ignorance.
blessings,
Liz.
----- Original Message -----
Sent: Sunday, July 11, 2004 6:42
AM
Subject: Re: [ozmidwifery] Birth
summary forms
Hi Liz
I'm lucky that I work outside the hospital
system so the guidelines used are safety and the mother's wishes. While
ever there is no bleeding I leave well enough alone. It is not good to
meddle when conducting a physiologic third stage. Although emergency
drugs are in the family fridge they are not used unless excessive
bleeding necessitates it.
In this particular case the woman had
been vomiting towards the end of a very long first labour so she was
exhausted after giving birth. After warm herbal tea for fluid
replacement (and some home-made chocolate brownie to restore her blood
sugar levels) she put her newborn son to the breast but after that she
just wanted to close her eyes and sleep.
As it was well past
midnight, that was what I wanted as well,
I tucked my client into
her bed where she promptly fell asleep. I slept (very lightly) on the
floor beside her. When she awoke in the early hours of the morning she
emptied her bladder. I thought the placenta would come away then, but it
didn't, so as the baby was still asleep, tucked in with his father, we
had a cup of tea and went for a walk.
It was some walk, along the
northern end of Bondi Beach, climbed up Ben Buckler and walked another
two blocks over the top of the hill. She was ready to come home then as
she felt she wanted to empty her bowels. So we headed home and sat on
the toilet again and with a mighty push the placenta was expelled.
On
reflection, there was no obvious oedema in the lower birth canal, so I
assumed this was simply a case of a very fit woman, with very strong
abdominal and pelvic floor muscles that trapped the placenta
temporarily.
We still look back on this experience and have a laugh
at the memory of the neighbours (also super-fit early morning walkers)
out on Bondi Beach congratulating my client on having the baby - not
knowing that his placenta was still in situ as we were talking!
I
always get satisfaction when completing the Perinatal Data forms for the
Dept of Health.
Although there are not a great number of homebirths
recorded, the long third stages that often occur at home must affect the
state's records of the average time
taken.
Cheers
Jan
Jan
Robinson Independent Midwife Practitioner
National Coordinator
Australian Society of Independent Midwives
8 Robin Crescent South
Hurstville NSW 2221 Phone/Fax: 02 9546 4350
e-mail address:
<[EMAIL PROTECTED]> website: www.midwiferyeducation.com.au
On
10/07/2004, at 8:30 PM, Liz Newnham wrote:
Dear
Jan,
what
did you do in the situation about the placenta? Where I work at
present the doctors get twitchy if a placenta hasn't birthed within an
hour, let alone eight (mind you - labour ward - tertiary hospital,
policy of CCT). Forgive my ignorance.
Liz.
-----
Original Message -----
From:
Jan
Robinson
To:
[EMAIL PROTECTED]
Sent:Friday,
July 09, 2004 6:59 AM
Subject:Re:
[ozmidwifery] Birth summary
forms
Hi Sue
Not sure what
birth summary forms are, but my Birth Register is simply an excel
spreadsheet with all the details .. name address age etc. all the
demographics. then time membranes ruptured (if less than an hour
before birth ... etc..) number of vaginal examinations (i love
entering zeros!) , length of each stage position for each stage ...
time of birth , date of birth lots of stuff plus comments for anything
interesting like placentas in situ for eight hours , what we did about
it , what type of sutures were used, etc. The reason for it all being
on a spreadsheet is so that I can statistically analyse it to get the
average age of my clients, average duration of labour, first stage
etc. It might be handy one day. I would have to get m y daughter to
help me with the analysis as I am not brilliant using Excel, ... one
of my clients set it up for me many years ago ... It's easy enough to
do if you understand Excel. I think Robyn THompson sets hers up on
some similiar type of spreadsheet.. she was going to market it at one
stage. Hilda Bastian also had a brilliant one set up to go underd the
HBA banner. It was the best idea I had ever seen as it also had the
facillity for anylisising social data as well. She was going to get
hers to a marketable stage too but then the homebirth movement seemed
to crumble temporarily and it has been lost to us. It would be a great
project for HBA to tackle, but we could also get the NSWPD people to
provide us with a template for their data sheet with add ons. The USA
midwives have one that Maralyn Kleidon would know about but she is in
the states at the moment. Perhaps we could put pressure on the College
to produce a workable one for all homebirth midwives that could be
used to collect research data for their IPM Accreditation program that
they are getting set up. Lots of possibilities
Did you get the
papers I sent you? We need to get the new forms from Centre Link
now.
Haven't got mine yet, they tell me they don't have anymore as
they had a printing mishap so I will have to go up to my local office
to get then.
Hope you and Arthur are both well. Give my love to
Penny.
Jan
Jan Robinson Independent Midwife
Practitioner
National Coordinator Australian Society of Independent
Midwives
8 Robin Crescent South Hurstville NSW 2221 Phone/Fax: 02
9546 4350
e-mail address: <[EMAIL PROTECTED]> website:
www.midwiferyeducation.com.au
On 07/07/2004, at 5:12 PM, Sue
Cookson wrote:
Hi all,
Can anyone email me copies of
their birth summary forms please?
Am looking to rewrite my own, but
would love some of your inspiations and insights.
Many
thanks,
Sue and Penny
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