RE: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps.

[Sally Westbury]

Hi Gaye,   It is an interesting question about antenatal testing.   I ask all my clients are booked into a hospital as a backup. They are booked through antenatal clinics or GP/Obs or Obstetricians. There is a problem with getting this booking in done properly. As a midwife in WA I cannot order path tests, this is of course done by the doctors and it is their responsibility to provide results to the local hospital. I cannot book people into the hospital, this is the doctor’s responsibility also. Some of the doctors are great and provide copies of blood tests to me so that I can put them in my/clients antenatal records so that it is easy for hospital transfer situations. Other doctors are not so cooperative and will not provide them to me and make it difficult, even though the woman has a right to have copies, for the woman to have a copy. In these instances I trust what is passed on to me by the woman, hope the doctor follows up on anything abnormal and ask the woman to remind the doctor to provide copies for the hospitals records in case of transfer. Sometime the doctors do this, sometimes they don’t. Sometimes the ‘offical’ result documents are in some doctors surgery files only and not accessible in the middle of the night when a transfer has happened.   Having said this I have had a client that declined all blood tests,  due to her own personal belief systems. It is her right. I did speak with her about why these test are done and clearly documented in my antenatal notes the discussion and we both signed the notes.   Um… did that help clarify anything???   Sally Westbury   Hi All,         Just hoping some of you wonderful Homebirth midwives out there can enlighten my ignorance regarding what "routine" antenatal investigations you order for or recommend to your clients, as part of your initial consultation. Is there a standard guideline that you must adhere to?(Apart from the "National Midwifery Guidelines for Consultation and Referral", that is). Or is it only up to the individual practitioner and his/her client to discuss and come to an agreement about what tests she will have and when she must go to hospital?         My reason for asking is the vague responses to our enquiries  we recently encountered when a planned homebirth client presented to hospital for delivery. There was no accompanying antenatal record so we thought it feasible to ask basic questions of the client and her midwife such as blood group, last Hb, etc because it was no longer a normal situation. Is it probable these tests weren't done, because she was hitherto a normal, healthy woman with the right to choose what invasive procedures she had? Sorry to sound stupid but I'm used to the Obstetrician/G.P. who orders every test the lab has ever done and then some, you know - like the questionable Hep C and HIV without prior counselling, but I won't go there!        I've done a couple of Web searches re the evidence (and lack of), and cost-effectiveness of the regular antenatal screen blood tests (I think I read it cost Medicare some $48 million dollars back in 1997), but wanted to know what you guys are practicing out there.        On another tack, I just read this gem in an excerpt from a policy statement by The American Academy of Paediatricians: "Vitamin D drops containing 200iu should be given to all breastfed infants starting in the first two months of life"  Gartner LM et al "Breastfeeding and the use of Human Milk" Pediatrics 2005 Feb; 115: 496-506.    Alaskans born in the middle of winter perhaps? I think our NICU give daily Pentavite from about Day 5, but surely, if there is some sun exposure this routine administration shouldn't be necessary? Do different skin colours absorb it from sunlight at different rates, such as black skin slower, perhaps? Any Lactation Consultants able to comment here please?        Cheers,  Gaye :)