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Hi Marilyn and others. I just wanted to add to your comments Marilyn about Australia being so litigation minded and what this is doing to our stats and our women. Coming from NZ, where we certainly have our own share of problems and defensive practice, it would seem that intervention 'just in case' is much more routine to that I am accustomed to also. I believe this is largely due to the medical profession providing maternity care v's midwifery care which is the norm 'back home'. It is no surprise that the C/S rate here is at least 10% higher, more in specific area's.
I know a lot of us are quick to criticise the USA for intervention and litigation but it appears we are no better off and in some cases, much worse off? I too have witnessed a lot more retained placenta's, evolced cords and secondary PPH's and larger than normal blood loss's resulting in blood transfusions. The midwives I trained with in NZ, support the notion of physiological 3rd stage unless otherwise indicated. I am sure that 'routine' active management has a lot to answer for.
What concerns me more than ever, is the staff who seem so blarzay about it all - the intervention and resulting complications - some quite horrific!. Is this because this is something that happens on such a regular basis that it is now considered normal? Perhaps it has something to do with student midwives practicing and learning in medicalicised settings and not having the opportunity to see and partake in normal pregnancy, labour and birth? I think it would be good for us all to spend some time with a homebirth midwife just to see 'another' way of birthing where birth is not managed but rather supported. I really believe we all need to do our bit in returning some normality to birth and some basic rights back to women.......
Kim.
----- Original Message -----
Sent: Tuesday, March 01, 2005 4:59 AM
Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
> Hello Marilyn
> I am surprised that litigation- mad America sanctioned midwives performing
> MROP. If the placenta is difficult to remove manual removal may result in
> death from shock as well as haemorrhage.
> Jenny
> Jennifer Cameron FRCNA FACM
> ProMid
> Professional Midwifery Education Service
> 0419 528 717
> ----- Original Message -----
> Sent: Tuesday, March 01, 2005 2:24 PM
> Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
>
>
> > Jenny:
> >
> > I know that what you say is Australian practice and if i were attending
> > homebirths here I would always transfer rather than do a manual removal
of
> > either a partially detached placenta or retained products however it
> > wasn't
> > considered outside of a midwife's scope of practice in the USA where I
> > practised (california and washington state), in fact it was required by
> > state law that i be capable of carrying out this procedure. The exact
> > procedure is detailed in Varney's Midwifery third edition, p. 843, Chap
> > 68.
> > Most certaily considered part of the midwife's scope of practice. I
would
> > suggest that any birth attendant practicing in an out of hospital
setting
> > should at least know what to do and have practiced the procedure just in
> > case which is what Sue was saying is her situation. I have never
actually
> > done the procedure myself but was knowledgeable of it, tested on it with
> > simulation (as it is NOT something you practice on someone) and aware
when
> > it is necessary. Definetely quite different than removing a placenta
> > trapped
> > in the vaginal vault, the os, or lower segment.
> >
> > marilyn
> >
> > ----- Original Message -----
> > Sent: Sunday, February 27, 2005 9:00 PM
> > Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
> >
> >
> >> Manual removal of a separated placenta is different to manual removal
of
> >> a
> >> placenta still attached to the uterine wall. Removing a separated
> >> placenta
> >> from the os or lower segment is not difficult but it is uncomfortable
for
> >> the woman. Manually detaching a placenta from the uterine wall is
> >> barbaric
> >> and traumatic and should not be carried out unless under adequate
> >> anaesthetic and fluid replacement. Granted a partially separated
placenta
> > is
> >> a high risk situation as bleeding will continue until separation.
> >> Although
> >> this is an emergency we would better to summon help and use bi-manual
> >> compression to slow/stop the bleeding until assistance arrives. If you
> >> are
> >> performing true manual removal of the placenta and membranes (ie
> >> partially
> >> separated placenta ) as a midwife you are practising outside your scope
> >> of
> >> practice.
> >> Jenny
> >> Jennifer Cameron FRCNA FACM
> >> ProMid
> >> Professional Midwifery Education Service
> >> 0419 528 717
> >> ----- Original Message -----
> >> Sent: Monday, February 28, 2005 7:31 AM
> >> Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
> >>
> >>
> >> > Hi Sue,
> >> > I was taught that if doing a manual removal would effectively save
the
> >> > woman's life, then that was the best option. Obviously a risk vs
> >> > benefit
> >> > type of situation. The doctor I trained with did the occasional
manual
> >> > removal at home rather than the time challenging option of
> >> > transferring,
> >> > and always with the woman's cooperation. I work rurally, and
sometimes
> > the
> >> > speed of the bleed and the distance from hospital would equal real
> > damage
> >> > to the woman. As I said in my posting, I have not had to perform a
> > manual
> >> > removal, but I can and would if it was a life saving procedure.
> >> >
> >> > I thought the hospital acted very dangerously by delaying many
aspects
> > of
> >> > their management of the PPH I witnessed last year, and that all up, a
> >> > manual removal there and then would have been the quickest and safest
> >> > option. Instead the woman went on to lose much more blood over
another
> > 40
> >> > minutes or so until in theatre, and then faced the choice of
> > transfusion.
> >> > I found that management very scary.
> >> >
> >> > I have witnessed one manual removal in a hospital on the delivery bed
> >> > after the cord tugging GP/Obs broke the cord whilst trying to extract
> > the
> >> > placenta (after a forceps delivery). He simply went straight in after
> > the
> >> > placenta and delivered it quite quickly. The woman was not too
> > perturbed!!
> >> > (and hadn't had any drugs either).
> >> >
> >> > So I guess it's a matter of training, attitude, access and
> >> > appropriateness - all to be assessed in a very short time frame if a
> > real
> >> > bleed is occurring.
> >> >
> >> > Sue
> >> >
> >> >
> >> >> I am a bit confused here - can you please explain how you do manual
> >> >> removal in the home situation? Surely this is too dangerous a
> >> >> procedure
> >> >> to do at home? Thanks Sue
> >> >>
> >> >> ----- Original Message -----
> >> >> *Sent:* Monday, February 28, 2005 1:34 PM
> >> >> *Subject:* Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
> >> >>
> >> >> Totally agree Sue. I was taught manual removal too and exactly
the
> >> >> same re
> >> >> when to apply gentle but firm CCT. However, for a manual removal
> >> >> at home you
> >> >> do need maternal cooperation and did have one incidence in
Seattle
> >> >> where we
> >> >> had to transfer for prolonged moderate/heavy blood loss that
just
> >> >> would not
> >> >> settle and uterus that kept getting boggy. Para 3 with several
> >> >> years between
> >> >> each of the births, third birth being precipitous, placenta
> >> >> delivered easily
> >> >> (dirty duncan if you know what I mean) physiologically but
> >> >> bleeding would
> >> >> not subside and mum kept soaking a pad in an hour, could not
stand
> >> >> a hand
> >> >> going past the introitus and was happy to go to the hospital.
> >> >> Estimated
> >> >> blood loss was 1600mL including theatre, a pin head size piece
of
> >> >> membrane
> >> >> was all they could find. Mum declined transfusion and was home
the
> >> >> next day
> >> >> tired but happy.
> >> >>
> >> >> marilyn
> >> >>
> >> >
> >> > --
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> >> >
> >>
> >>
> >> --
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> >>
> >
> >
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