are you saying that the plus or minus 30% of women that are strep B pos all be referred to an ob, even if they are well women with no complications??? Sonja ----- Original Message ----- From: "Jenny Cameron" <[EMAIL PROTECTED]> To: <ozmidwifery@acegraphics.com.au> Sent: Saturday, May 21, 2005 12:38 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation
> I take everyones point about it being useful and probably essential for > midwives in rural areas to be able to cannulate but don't forget the core > skills of midwifery practice during labour are support and assessment of > progress and the ability to recognise potential problems. I don't feel > comfortable hearing that midwives are performing induction of labour > cannulations etc. Or inserting bungs for IV antis for GBS for that matter, > If a woman is GBS pos then she should be referred and OBs involved. Who > orders the antis?? > > Jenny > Jennifer Cameron FRCNA FACM > PO Box 1465 > Howard Springs NT 0835 > > 0419 528 717 > ----- Original Message ----- > From: "Miriam Hannay" <[EMAIL PROTECTED]> > To: <ozmidwifery@acegraphics.com.au> > Sent: Saturday, May 21, 2005 7:43 AM > Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation > > > > From a student's perspective any discussion on what > > constitutes a core midwifery skill really interests > > me. > > > > we have a template that needs to be completed and > > signed off by supervising midwives regarding epidural > > maintenance. we are supposed to witness a few and then > > do the top ups ourselves and also remove the catheter > > after the birth, document etc. This is obviously > > regarded as an important midwifery skill by our > > educators. However, I know of VERY few students who > > have been given the opportunity to acquire cannulation > > skills. In the tertiary hospital I am currently placed > > in the RMOs do all the cannulation. Midwives can do it > > but must do a course to become accredited. This course > > is not available to students, and as far as i am > > aware, you must have done a grad years in the hospital > > to access the course. To me this seems ridiculous! I > > have no intention of doing a GMP, instead intending to > > apprentice in private practice before setting out my > > own shingle. How on earth can I safely practice in the > > private sector if i am not confident in establishing > > iv access? to me this is a core midwifery skill that > > while hopefully rarely utilised is of critical > > importance when needed. It is a skill I would much > > prefer to develop than doing maintenance and clean up > > for our anaeshetists. > > > > Also, on the thread of epidurals and instrumental > > births...in my limited experience what Marilyn > > mentions is borne out. I have been involved in several > > births with epidural blocks and have only seen > > instrumental birth needed when coached pushing was > > utlised. In those cases where the power of the uterus > > was allowed to facilitate descent until we had head on > > view no assistance was required. The power of these > > women's bodies birthed their babies despite the block > > and it was marvellous to watch. > > > > Miriam (2nd year Bachelor of Midwifery Flinders uni of > > SA) > > > > > > --- Marilyn Kleidon <[EMAIL PROTECTED]> wrote: > >> LOvely, Alesa that is exactly how I had experienced > >> epidurals being set up in the USA. However, I have > >> been told here that these large syringes that > >> require top ups are more innovative than the > >> infusion (pcea) pumps : I can't see how, even though > >> I can see (in some ways) that if this is the > >> technology we are using then midwives should be ofay > >> with it?? And yes I had never experienced the > >> epidural as being anything but turned off in second > >> stage in fact, at least until 2002 when i left it > >> was common practice to allow passive descent so that > >> active pushing did not commence until the head was > >> on view. With this practice I saw very few > >> instrumental births. Can anyone give me the > >> justification for these syringe type epidurals > >> requiring top ups over the infusion pumps? > >> > >> marilyn > >> ----- Original Message ----- > >> From: Alesa Koziol > >> To: ozmidwifery > >> Sent: Friday, May 20, 2005 6:17 AM > >> Subject: [ozmidwifery] re epidural top ups > >> > >> > >> Dear List > >> Have read this thread with great interest. Not > >> wishing to get into the debate regarding whose skill > >> it is to perform this task I just wanted to share > >> our experience. The move away from an epidural that > >> required top ups in labour to infusion pumps came > >> about when the midwives refused to perform the > >> topups or push a bolus down the epidural line > >> manually. We insisted on the anaesthetists doing > >> this task as they were responsible for the integrity > >> of the line and most certainly for its placement. > >> Our anaesthetists got sick of returning again and > >> again to do this and researched an alternative for > >> themselves that we were happy to work with. In our > >> setting a midwife will assist the anaesthetist with > >> equipment required for epidural insertion, however > >> she never ever pushes any fluids down the line > >> manually. Priming the line is all done by the > >> anaesthetist, he/she connects all lines, filter and > >> tubing to a syringe and together they check the > >> settings on the syringe driver and turn it on. Works > >> for us, women have the analgesia they request, > >> midwives turn the pump off when second stage is > >> noted and many women push their infant actively- > >> although there is still a high number of > >> instrumental births > >> Cheers > >> Alesa > >> > >> Alesa Koziol > >> Clinical Midwifery Educator > >> Melbourne > > > > Find local movie times and trailers on Yahoo! Movies. > > http://au.movies.yahoo.com > > -- > > This mailing list is sponsored by ACE Graphics. > > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > > > > > -- > > Internal Virus Database is out-of-date. > > Checked by AVG Anti-Virus. > > Version: 7.0.308 / Virus Database: 266.11.5 - Release Date: 4/05/2005 > > > > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
