Yesterday was a bit of a flop - had a very questionable registrar who had no
history on my client (well hadn't bothered reading which she should have
being a high risk patient, in more ways than just a VBAC). She had trouble
finding the cervix and continued on to say it was closed. I asked if it was
at least soft and she said yes, but on speaking to my client who apparently
checked for herself only hours before, she said it was definitely hard and
closed - so I am really questioning this registrar who had no idea... My
client is going public at Monash... Registrar made her another appointment
for next Friday (11 days post dates) which I thought was good in that they
are giving her the opportunity to go into spontaneous labour - but we had to
ask her several times for a scan to check placenta function / fluid since
she was going overdue ('no, you had one at 19 weeks you don't need anymore
for a pregnancy - how about some monitoring?') - to which we reminded her
that in her last pregnancy, the umbilical cord fell off the placenta as baby
was born via caesar... *argh* - it was a complete nightmare for poor mum and
me to listen to it! She said yes about a balloon induction but then said no
they don't have the skills to do it - very confusing - it was like she had
no idea what was going on. So mum is freaking out, will be going for more
monitoring and a scan on Tuesday morning to which mum is more relieved to
get confirmation of the placenta and fluid being okay. I think if this
registrar turns up when mum is in labour, she will have a heart attack. If
she makes it to Friday, she has an appointment with the consultant, so
she'll get more sense out of it... I really hope she can hang in there.

Best Regards,
 
Kelly Zantey
Director, www.bellybelly.com.au & www.toys4tikes.com.au
Gentle Solutions For Conception, Pregnancy, Birth & Baby
Australian Little Tikes Specialists

-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Kathy
McCarthy-Bushby
Sent: Thursday, 22 September 2005 9:33 PM
To: Ozmidwifery
Subject: Fw: [ozmidwifery] Oral EPO dose for cervix?



----- Original Message -----
From: "Kathy McCarthy-Bushby" <[EMAIL PROTECTED]>
To: "Kelly @ BellyBelly" <[EMAIL PROTECTED]>
Sent: Thursday, September 22, 2005 9:29 PM
Subject: Re: [ozmidwifery] Oral EPO dose for cervix?


> Hi Kelly,
> The balloon can be used for any primip or multip with an unripe cervix
with
> baby in a cephalic position. The balloon seems to be far safer with 
> far
less
> side effects than the prostaglandin gel (which of course can not be 
> used
in
> vbac women). I have also seen the balloon used in women planning a 
> vbac after 1 and 2 c/s with success. Ooops, i'd better clarify, the 
> balloon is not used for women with a breech baby. what i meant to say 
> that the woman
I
> was talking about had previously had a c/s for a breech baby and 
> achieved
a
> vbac with the next baby in a head down position in the second 
> pregnancy.
The
> balloon has only been around in recent years and it may not exist in 
> all hospitals, but it is worth looking into. We were initially all a 
> bit sceptical in our unit when the balloon was introduced, but in 
> hindsight,
we
> can see that the balloon is a far safer option than the prostaglandin 
> gel for both the mother and baby. Keep on reminding the woman that she 
> can do this regards
> kathy
> ----- Original Message -----
> From: "Kelly @ BellyBelly" <[EMAIL PROTECTED]>
> To: <[EMAIL PROTECTED]>
> Sent: Thursday, September 22, 2005 4:06 PM
> Subject: RE: [ozmidwifery] Oral EPO dose for cervix?
>
>
> Thank-you so much for this info Kathy - do they use this on other 
> women
too,
> apart from the vbac or breech women? I've just never heard of it 
> before!
>
> Best Regards,
>
> Kelly Zantey
> Director, www.bellybelly.com.au & www.toys4tikes.com.au Gentle 
> Solutions For Conception, Pregnancy, Birth & Baby Australian Little 
> Tikes Specialists
>
> -----Original Message-----
> From: [EMAIL PROTECTED]
> [mailto:[EMAIL PROTECTED] On Behalf Of Kathy 
> McCarthy-Bushby
> Sent: Thursday, 22 September 2005 3:38 PM
> To: [email protected]
> Subject: Re: [ozmidwifery] Oral EPO dose for cervix?
>
>
> Hi Kelly,
> Kate has given you a great reply on balloon inductions which have been 
> safely used with vbac induction. After insertion of the balloon, the 
> woman may begin contracting and the balloon may fall out once the 
> woman is
dilated
> to 3-4cm, or if the balloon doesn't fall out overnight, then it is 
> removed the next morning, followed by artificially rupturing the 
> membranes. Some women experience period pain, back pain, difficulty 
> urinating and early labour signs with the balloon in place and a very 
> small percentage are unable to tolerate the balloon at all, so it is 
> usually removed. I
remember
> caring for a woman at 39 weeks with a history of elective c/s for a 
> breech baby who was being induced for a particular reason for the 2nd 
> pregnancy, she had the balloon inserted, it stayed in overnight, she 
> had lots of contractions overnight, but not in established labour, 
> next morning the balloon was removed, an ARM perforned at 10am, by 
> 1.30 pm she had given birth vaginally to a beautiful girl.
>
> Your Client has options here, an induction should not be considered 
> until she is post dates just like any other primip who hasn't laboured
regardless
> of whether she has laboured or  not in the past eg 41 weeks. Another 
> woman
I
> know was 10 days post dates when she went into spontaneous labour on 
> the 11th day after starting EPO the day before and she gave birth 
> vaginally to her baby as well (she now has had 2 successful vbacs). 
> The plan was that
she
> would see the Doctors on day 12 to discuss induction or c/s, but of
course,
> it wasn't necessary. I have seen women successfully acheive a vbac
following
> ARM and syntocinon induction, but of course, very close fetal 
> monitoring
is
> required and the woman's chances of acheiving a vbac drop to about 
> 50%,
but
> it is nonetheless possible. It can be helpful to consider natural 
> alternatives following an ARM to avoid syntocinon infusion eg nipple 
> stimulation, accupressure.
>
>  Another opption to consider would be offering some sort of compromise 
> to the Doctor eg more frequent assessment of the baby's well being can 
> help
the
> woman buy more time to await labour. Another way to deal with the 
> Doctor
is
> to ask "why" or use BRAN eg 'what are the benefits, risks, 
> alternatives or options of doing nothing" for vaginal birth, c/s or 
> awaiting spontaneous labour, induction etc..... Kathy
> ----- Original Message -----
> From: "Kelly @ BellyBelly" <[EMAIL PROTECTED]>
> To: <[email protected]>
> Sent: Thursday, September 22, 2005 11:58 AM
> Subject: RE: [ozmidwifery] Oral EPO dose for cervix?
>
>
> Thank-you so much for this, have forwarded it to her... She's still 
> going
at
> 40w3d with no signs of anything happening as yet, appointment with the
high
> risk Ob tomorrow where I know there will be talk of induction / 
> caesar... Can you please tell me more about this balloon induction - 
> not heard of it before? Want to be armed with info for what's to come 
> with the challenge tomorrow...
>
> Best Regards,
>
> Kelly Zantey
> Director, www.bellybelly.com.au & www.toys4tikes.com.au Gentle 
> Solutions For Conception, Pregnancy, Birth & Baby Australian Little 
> Tikes Specialists
>
> -----Original Message-----
> From: [EMAIL PROTECTED]
> [mailto:[EMAIL PROTECTED] On Behalf Of Kathy 
> McCarthy-Bushby
> Sent: Tuesday, 20 September 2005 5:49 PM
> To: [email protected]
> Subject: Re: [ozmidwifery] Oral EPO dose for cervix?
>
>
> Hi Kelly,
> The website www.birthrites.org has a page on natural induction 
> including information on EPO doses either orally or vaginally, nipple 
> stimulation, accupressure (4 fingers above the inner aspect of the 
> ankle bone). EPO, is great for women planning a vbac for ripening the 
> cervix, but if she
doesn't
> get into labour naturally, EPO can make the cervix ripe for ARM and 
> the balloon induction has been safely used for vbac women with an 
> unripe
cervix.
> kathy
> ----- Original Message -----
> From: "Kelly @ BellyBelly" <[EMAIL PROTECTED]>
> To: <[email protected]>
> Sent: Monday, September 19, 2005 12:05 PM
> Subject: [ozmidwifery] Oral EPO dose for cervix?
>
>
> Hello everyone,
>
> I know it's probably a bit late to try this, but I have a mum who's 
> hoping for a VBAC, EDD today but in order to beat a caesar (they wont 
> induce her
of
> course) we're thinking of giving EPO a go to help with ripening her
cervix.
> I have read somewhere that 500mg tid is often used - can anyone 
> confirm or recommend dosage they have used? She'll ask a herbalist 
> none the less, but often I find they aren't well versed on specifics 
> for preg & baby like
this.
> Also her BP is creeping up a little, she had pre-eclampsia with the 
> first but obviously done well with this pregnancy - will this still be 
> okay with EPO or is there something else I could recommend? I think 
> she's actually quite frightened having had a previous caesar hence the 
> blood pressure (she's had a great BP otherwise) so I am going to meet 
> with her tomorrow
to
> hopefully relax her about a vaginal birth. She's told me in fewer 
> words she's frightened but I think she's keeping it in - will have a 
> big chat tomorrow.
>
> Best Regards,
>
> Kelly Zantey
> Director, www.bellybelly.com.au & www.toys4tikes.com.au Gentle 
> Solutions For Conception, Pregnancy, Birth & Baby Australian Little 
> Tikes Specialists
>
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