1) A woman is being induced when her cervix is not ripe. We do not use prostaglandins often enough to induce labour. In my experience if the cervix is softening and the operator can wedge a finger in that is the green light for ARM. In fact it would be better to use prostaglandins to complete the ripening process. Some women will come into labour on this alone thus avoiding the need for IV Synt and its overwhelming contraction patterns.
2) It is often an inexperienced operator who is performing the ARM. Often not the same person who assessed the women prior to the induction.
Jenny
Jennifer Cameron FRCNA FACM
ProMid
Professional Midwifery Education Service
0419 528 717
----- Original Message ----- From: "Denise Fisher" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Friday, November 05, 2004 10:36 AM
Subject: [ozmidwifery] cold epidurals
Someone recently mentioned the advent of 'cold epidurals', where the epidural is put in place before an induction is started. I'd not heard of this before and was shocked! But is it unreasonable? Vincent & Chestnut (1998) gave the administration of IV oxytocin intrapartum as the most useful predictor of which women will request epidural anaesthesia during labour. What's the incidence?? I don't know but guess it's pretty high. When would be the best time to put an epidural in - when a woman is distressed and moving experiencing strong labour pain, or before it all starts and she is lying still and quiet?
It's the outcome here, ie use of cold epidurals, that horrifies me when it should be the number of unnecessary inductions or perhaps the way inductions are conducted that force a woman into acute pain so quickly that should be reviewed.
It's a while since I've worked in birthing suite. Those of you who are familiar with inductions why do they HAVE to be so rugged?
Denise
*************************************** Denise Fisher, MMP, IBCLC Health e-Learning http://www.health-e-learning.com [EMAIL PROTECTED]
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