What your describing is the risk based protocol vs the culture based one. UNfortunately the recent evidence shows more babies were missed using the risk based protocol that the culture based one. This is all covered on the web sites posted. Whenever you practice prophylactic treatments you are going to be treating some people unnecessarily it's the nature of the beast!! We don't have the test(tests) to positively identify those mthers who have a 100% chance of their babies becoming septic with GBS. And yes it does become a pathogen again we don't know all the triggers that make it change from being normal flora. Of course women refuse the antibiotics and I personally have never known anyone who has had a baby become ill or die from GBS disease. And I have attended births at home and in hospital with women who have refused the antibiotics(after testing positive) or who birthed before the iv could be set up and we simply watched the baby closely especially taking temp's 4/24 for 48 hours and regularly for the first week. However, if you read the web sites you must become aware that thinking you can pick who will have a sick baby from health status of the mother can be risky and erroneous. Though I have to say I would think babies in the one-to-one continuity of care model would be much safer than those with multiple providers and early discharge.
marilyn ----- Original Message ----- From: "Ken WArd" <[EMAIL PROTECTED]> To: <ozmidwifery@acegraphics.com.au> Sent: Monday, May 23, 2005 3:14 AM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation > Do they really need iv ab's, or are we over treating as usual? The vast > majority of these babies are fine. Maybe we should only be treating those > women with prom, not those in active labour, especially those with intact > membranes. Another reason for leaving membranes intact i.e. no arm's. > as we all carry GBS can it be pathologic? > > -----Original Message----- > From: [EMAIL PROTECTED] > [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron > Sent: Monday, 23 May 2005 10:34 AM > To: ozmidwifery@acegraphics.com.au > Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation > > > I guess not if they need IV antibiotics. > Jenny > Jennifer Cameron FRCNA FACM > PO Box 1465 > Howard Springs NT 0835 > > 0419 528 717 > ----- Original Message ----- > From: "Sally Westbury" <[EMAIL PROTECTED]> > To: <ozmidwifery@acegraphics.com.au> > Sent: Sunday, May 22, 2005 3:30 PM > Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation > > > > 30% of women are not normal???? Gosh. > > > > -----Original Message----- > > From: [EMAIL PROTECTED] > > [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron > > Sent: Sunday, May 22, 2005 1:27 PM > > To: ozmidwifery@acegraphics.com.au > > Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation > > > > GBS is not normal. What is the cut-off point for midwifery care & scope > > of > > Px? > > > > Jennifer Cameron FRCNA FACM > > PO Box 1465 > > Howard Springs NT 0835 > > > > 0419 528 717 > > ----- Original Message ----- > > From: "Ken WArd" <[EMAIL PROTECTED]> > > To: <ozmidwifery@acegraphics.com.au> > > Sent: Saturday, May 21, 2005 5:06 PM > > Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation > > > > > >> Why involve an obs for GBS? As long as correct procedure is followed, > >> there > >> is little chance of transmission. We give oral abs if prom iv in > > labour. > >> We > >> don't induce for 48hrs, rather just keep an eye on the woman's temp > > and > >> ctg > >> at 18hrs and and 24hrs following. We have never had a problem. Our drs > > rx > >> the abs, antenatally when the woman is diagnosed at 37/40. A lot of > > our > >> women elect not to be swabbed, and again no probs. All babies are > >> monitored > >> temp etc for 24hrs and parents aware of what to watch for. Lets keep > > drs > >> away from normal women having nice pregnancies and babies > >> > >> -----Original Message----- > >> From: [EMAIL PROTECTED] > >> [mailto:[EMAIL PROTECTED] Behalf Of Jenny > > Cameron > >> Sent: Saturday, 21 May 2005 12:39 PM > >> To: ozmidwifery@acegraphics.com.au > >> 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. > >> > >> > >> -- > >> No virus found in this incoming message. > >> Checked by AVG Anti-Virus. > >> Version: 7.0.322 / Virus Database: 266.11.14 - Release Date: > > 20/05/2005 > >> > > > > -- > > 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. > > > > > > -- > > No virus found in this incoming message. > > Checked by AVG Anti-Virus. > > Version: 7.0.322 / Virus Database: 266.11.14 - Release Date: 20/05/2005 > > > > > -- > 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. > -- This mailing list is sponsored by ACE Graphics. 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