Re: [ozmidwifery] MORE ACTIVE MANGAEMENT

[Jenny Cameron]

Hi Julie
This is fundus fiddling and may lead to incoordinate uterine action and 
partial separation. As long as there is no excessive bleeding it is safe to 
watch and wait.
Jenny
Jennifer Cameron FRCNA FACM
ProMid
Professional Midwifery Education  Service
0419 528 717
----- Original Message ----- 
From: "Julie Garratt" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Monday, March 07, 2005 2:53 PM
Subject: RE: [ozmidwifery] MORE ACTIVE MANGAEMENT


Hi all,
When a placenta fails to birth in a reasonable amount of time??? Do you
"rub up a contraction or is this "fundus fiddling" going to interfere
with the process maybe leading to no contraction at all. I'm asking
because I've read both points of views and I'm a bit confused.
Julie, Student midwife.
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Mrs Joanne M
Fisher
Sent: 02 March 2005 21:57
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Hi Sue,
You mentioned adding "an ice pack to her uterus".  How does this work?
I'm
guessing it is meant to decrease the blood flow to that area, but how
does
this help the placenta birth?
Cheers, Joanne.
----- Original Message ----- 
From: "Sue Cookson" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Thursday, February 24, 2005 11:59 PM
Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT

> Hi,
> I would definitely treat this woman like all others and assume
> physiological 3rd stage is sufficient.
> I have never actively managed a 3rd stage, and have given
syntometrine 3
> times only after placentas were born - all in my early days of
homebirth.
> I always prefer to;
> a) make sure women are well hydrated going into 2nd stage so they
can
> tolerate volume loss
> b) if bleeding is serious go into "deliver placenta mode"
> I always catch and therefore can measure blood loss at a glance
> I engage the mother first and tell her she's bleeding and that I
need
> her to focus and deliver her placenta
> I always give herbs as a first line of attack- shepherd's purse has
> always been my first choice
> I would rub up a ctxn, add an ice pack to her uterus if one
available
> Then with her assistance pushing I would apply cord traction and see
if
> the placenta would come
> Repeat this maybe twice
> Then contemplate manual removal if necessary (not had to yet...)
>
> I have managed 5 large haemorrhages (over 1.5 litres measured) in
this
> manner and have not had to transfer anyone yet.(I have a
> haemoglobinometer with which I can measure Hbs on the spot over the
next
> few weeks if necessary..)
> This management regime was taught to me by John Stevenson and always
> seems to work.Up until very recently, I have always worked alone.
>
> Isn't it interesting all the different ways we'd handle this
depending
> on our personal experiences?
>
> By the way, late last year I witnessed the worst PPH I'd ever seen -
> mainly because of the management in the hospital (it was a hospital
> support not a homebirth), and with all the hands you could ever
imagine
> -I'd say too many - the woman was severley depleted. Drips in etc
etc
> but too much too late. A cord pulling midwife, and then no
> acknowledgement of when she needed help (irrespective of my pleas)
plus
> she underestimated the blood loss by more than 100% (she thought
600ml,
> and it was measured by weight (? accuracy) to be more like 1400ml)
and
> then the woman was taken to theatre - more time, more blood, why not
a
> manual removal then and there??
>
> Aaaah. Expect no PPH but stay on your toes ...always my motto.
>
> Sue

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