Hi Judy,
After reading your post it reminded me of what one of my friends said (she is a midwife and works for MSF). She was in western Africa and if a person had a Hb over 80 they would use them as a blood donar if they needed one!!
Cheers
Michelle
Maternity Ward Mareeba Hospital <[EMAIL PROTECTED]> wrote:
Maternity Ward Mareeba Hospital <[EMAIL PROTECTED]> wrote:
Just a comment on why so many PPH deaths in underdeveloped countries. At a symposium I went to in Saudi Arabia many years ago one of the speakers was an African Dr. His subject was anemia in the underprivelaged and he spoke of how severely anaemic many of the women are. As a result PPH is more quickly devastating than in a woman with a normal (or nearly normal) Hb level.CheersJudy
>>> [EMAIL PROTECTED] 02/28/05 07:05am >>>
Hi everyone. Back on the list and great topics abound !!
I wrote a critical analysis last yr on active vs expectant management forma
global perspective. Interestingly the infamous Hinchinbrook trial did
acknowledge the type of labours. However there were significant
discrepancies in my observation of the methodology eg: the confidence of
midwives to support expectant management and no record of home births.
I have personally noted a large no of women having a pph following active
management (according to the 500 defn) but also following induction of
labour , particularly withg syntocinon. In some areas such as homebirth
these drugs are never used for IOL, in addition to countries like Germany
where I have heard of acupuncture now being offerred for IOL in the hospital
setting.
There are 2 main issues with PPH. The g! lobal maternal mortality rate is
approx 600, 000 women die a year (of reported deaths). Over 90% of these
deaths are in developing countries and largely due to PPH. Drugs like synto
are viewed by some authors as problematic as many tropical areas cannot
refridgerate and therefore cannot use synto. There is move afoot to look at
other methods that do not require refridgeration. One begs the question,
why so many deaths ? Is it related to the various experiences of managment
by TBA's who attend to most of the births ? Is it related to the fact
thousands of women spend days in labour and on their own ? Is it
dehydration ? Malnutrition ? The list goes on........... It certainly is
related to a poor level of care and pathetic govt priorities in my view, to
not ensure as many women as possible have pregnancy birth and postpartum
care.
In my view this is where the true crisis of PPH lies.
Having said that.&n! bsp; There is no global or even national standardised
measurement of loss (process), nor is there an agreed global standardised
definition of pph as many of you have so aptly pointed out.
Certainly I think there is need for further research comparing the active
and expectant magmt techniques where there is no confidence bias, that
incorporates accurate defns of labour type also. Even a RCT looking at IOL
with synto vs No IOL of women 39-42 weeks and comparing their loss could be
significant.
Thanks Sue for your insights on your practice and the wonderful knowledge of
John's wisdom. In my experience I always keep arnica and the australian bush
flower essences on hand and discovered through my kinesiology practice about
ten yrs ago the need for a woman to have a homeopathic known as Ustilago
Maidus twice antentally and three times in the immediate postpartum.
I have then seen it used on three more occasions and would not hes! itate to
have it on hand, particularly for remote rural areas.
On another note, I have also noted that pph is common for women who have a
precipitous labour. Often these women appear to be in shock after the high
of a beautiful, sometimes intense or furious labour.
On an emotional and spiritual reflection of practice, I have also noted it
is not uncommon for women who have experienced abuse to have a very very
fast or very very long labour also. And a pph. It is afterall the essence
of the life/death paradigm and I try to remain aware of this particularly if
the dissasociation and trauma of unrecognised abuse arises in labour. I
think it is important when a pph is not obviously drug induced or actively
induced, we are alert to what the 'triggers' of the emotion around a pph
could be.
Again, another reason highlighting the importance of one-to-one midwifery
care.
Also a comment re the G10 P9 woman - I would c! onsider assessing the wishes
of the woman, the previous history, the current history and emotional
wellbeing as to whether the synto would be needed. I have also heard and
would be glad to follow up with the cnc who gave me this info that there is
current research concluding that the grand multi status is no longer a
factor for routine synto.
Kind Regards to you all
Sally-Anne Brown
***********************************************************************************
This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.
Any unauthorised use, alteration, disclosure, distribution or review of this email is prohibited. It may be subject to a statutory duty of confidentiality if it relates to health service matters.
If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone or by return email. You should also delete this email and destroy any hard copies produced.
***********************************************************************************
Find local movie times and trailers on Yahoo! Movies.
