Sonja, I answered this question a few posts ago. I'll cut and paste it again
for you ......
In the two places I have worked over here:
First = I could suture once the drs deemed me competent. It was private, so
fair enough but I will not be assessed by a dr.
Second is a public hospital and I have been told that currently I am not
allowed to suture. They are waiting for the head obstrician to agree to
midwives suturing. Then I will be required to complete a learning pack and
pass competencies (the jr drs do not have to do this and have far less
experience of suturing than me). Anyhow, I have said that I will suture if
the women wants me to, and will suffer the consequences. However I am on the
postnatal/antenatal ward for the forseeable future so can't test the system
; )
Rachel
From: "Sonja" <[EMAIL PROTECTED]>
Reply-To: [email protected]
To: <[email protected]>
Subject: Re: [ozmidwifery] Question
Date: Wed, 21 Sep 2005 21:09:46 +1000
what do you mean "you are not allowed to suture in Australia", or do you
mean within the hospital you work?
Sonja
----- Original Message -----
From: "wump fish" <[EMAIL PROTECTED]>
To: <[email protected]>
Sent: Wednesday, September 21, 2005 10:09 AM
Subject: RE: [ozmidwifery] Question
> I wouldn't suture a 3rd or 4th degree tear at all - at home or in
hospital
> for a number of reasons. A 3rd+ degree is not within my expertise and
can
> lead to long term complications if not done properly. I would rather it
was
> done by someone with expertise and experience in a well lit theatre.
Also
> you would need really good analgesia (ie. a spinal block) to effectively
> suture without causing agony. There is no reason that partner and baby
can't
> be in theatre with the woman during the suturing, and she can have skin
to
> skin and breastfeed.
>
> Our hospital guidelines in the UK were that all 2nd degree tears should
be
> sutured. This was based on the fact that there was no evidence to
support
> not suturing, and that you would suture an arm or leg injury if it
involved
> muscle. I have a few problems accepting this standpoint (too long to go
> into). In practice I leave it up to the woman do decide. I explain the
> guidelines and the theory behind them. Give her an explanation about her
> tear (and show her with a mirror if she wants). Explain any concerns I
have
> - if a vessel is bleeding, or tissues are poorly aligned. Then ask her
what
> she wants me to do.
>
> It was quite interesting to follow up these women in the community. Some
who
> declined suturing (who I thought probably needed it) healed really well.
A
> colleague had a woman who did not want to be sutured following an epis -
her
> perineum healed perfectly. I caught her second baby at home and I would
> never have guessed she had had a previous epis (intact this time). My
best
> friend declined my suturing at her homebirth even though she described
her
> perineum as an exploded mattress (5th baby and bad tears + stitches with
> all). A year on and she still raves about how much better healed and
less
> painful her perineum was unsutured.
>
> So, I guess what I am saying is that perhaps we suture too much. Perhaps
the
> perineum is designed to tear and heal. Anyhow, I am not 'allowed' to
suture
> here in Australia, so I will probably lose the skill anyway.
>
> Rachel
>
>
>
>
> >From: "Philippa Scott" <[EMAIL PROTECTED]>
> >Reply-To: [email protected]
> >To: "ozmidwifery" <[email protected]>
> >Subject: [ozmidwifery] Question
> >Date: Wed, 21 Sep 2005 07:59:02 +1000
> >
> >This question/assumption was put forward on another list & I wondered
> >whether you wonderful women would be able to answer it for me as I have
no
> >idea really.
> >
> >What happens if the mother sustains a 3rd or 4th degree tear at a
> >homebirth?
> >
> >Do they then have to travel to a hospital to get it all repaired?
Surely
> >this would increase the possibility of infections and post birth
problems?
> >
> >I know there is NO WAY a midwife could stitch up that serious a tear so
was
> >just curious about what would happen in that situation (if anyone
knows??)
> >
> >
> >Cheers
> >Philippa Scott
> >Doula
> >Birth Buddies
> >Supporting Women ~ Creating Life
> >President - Friends of the Birth Centre Townsville
>
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