RE: [ozmidwifery] intermittent auscultation
Hi Sue, I think you have missed the point. The alternative is not continuous fetal monitoring. As the research shows this is not best practice. The alternative is perhaps guidelines that say 15 minutely in second stage for low risk women. As these guidelines say: The American College of Obstetricians and Gynecologists (ACOG) states that with specific intervals, intermittent auscultation of the FHR is equivalent to continuous EFM in detecting fetal compromise.4 ACOG has recommended a 1:1 nurse-patient ratio if intermittent auscultation is used as the primary technique of FHR surveillance.4 The recommended intermittent auscultation protocol calls for auscultation every 30 minutes for low-risk patients in the active phase of labor and every 15 minutes in the second stage of labor.4 Continuous EFM is indicated when abnormalities occur with intermittent auscultation and for use in high-risk patients. Table 1 lists examples of the criteria that have been used to categorize patients as high risk. http://www.aafp.org/afp/990501ap/2487.html -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] laparoscopy
Can I also suggest Francesca Naish's excellent book The Natural way to Better babies - offers really good info from an alternative practitioners view, includes things on improving reproductive health using acupressure/puncture, herbal naturopathic remedies reflexology. cheers Jennifairy brendamanning wrote: Madelaine, I'm sure you have already discussed that obesity is a primary cause of infertility. It's amazing how successful weight loss is in achieving pregnancy when other more complex treatments diagnoses have failed though. Brenda - Original Message - *From:* Madelaine Akras mailto:[EMAIL PROTECTED] *To:* ozmidwifery@acegraphics.com.au mailto:ozmidwifery@acegraphics.com.au *Sent:* Friday, July 29, 2005 10:19 PM *Subject:* [ozmidwifery] laparoscopy I have a patient that I am treating for infertility. Her gyno has recommended she have a laparoscopy to investigate possible causes. She is feeling uncomfortable with this procedure due to the risks. She has also been told that being overweight may also increase these. Can anyone advise or assist me please. Are there any other safe procedures avaiable to determine the same?? Madelaine Akras Naturopath No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.9.7/60 - Release Date: 28/07/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.9.7/60 - Release Date: 28/07/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
Sally, I think you have a very valid point could argue it effectively. Good luck ! Brenda - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 3:03 PM Subject: Re: [ozmidwifery] intermittent auscultation Interesting line on intermittent auscultation. If mws aren't given the OK to listen intermittently, then every woman would be strapped to a CTG machine with its accompanying restrictions of time and position. Having done a placement recently where CTG's were the norm because of the hospital's tight risk guidelines - VBACs, PROM, anyone with oxytocin up for induction or aumentation, any mec (even if it was only thought to be mec), slow progress, and then the more real risks with unhealthy moms or babes; there were so few women who were in the category for intermittent listening. I totally agree that listening every 5 minutes would be disturbing to any woman's sacred space and time, and have had the luxury of self regulating how and when I listen in second stage by working independently. With today's dialogue around evidence based practice etc, mws are going to have to get their research hats on quickly to add to our unique body of knowledge, otherwise these crazy guidelines will stay in place. There may not be good evidence to support 5 minutely monitoring in low risk women, but we're in a world where the alternative is continuous monitoring and the benefits of this are not well supported either, just preferred by too many. The NICE guidelines also suggest continuous monitoring for 15 minutes every hour as an alternative to totally continuous monitoring thus allowing some change of position and ambulation. ??? My radical nature says unplug all the machines and get back to truly supporting women -high or low risk by giving them proper continuity of care by midwives working as midwives not technicians. The taste of high tech land I'm getting is very sour. Anyone know what the guidelines are in The Netherlands, where midwife supported homebirths abound and their PMR, c/section rates, epidural rates are all so much lower than ours?? Sue Just a thought Sally - the real argument would become whether abnormal states in labour, in this case in second stage, can be detected by other means - such as observation or mother's intuition etc etc. I would suggest they can but again our research hats need to be applied to support the things we do know. I would like to go further with today’s radical thought. I believe there is not evidence to support the 5 minutely interval of intermittent monitoring in a low risk population in second stage of labour. What do people think about this. Do you think I could argue this point effectively?? Sally Westbury __ NOD32 1.1176 (20050722) Information __ This message was checked by NOD32 antivirus system. http://www.nod32.com -- 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.
RE: [ozmidwifery] intermittent auscultation
I certainly have never seen any evidence. All one gets is textbooks and protocol manuals telling you that you must but not referencing the reason. Cheers Judy --- Sally Westbury [EMAIL PROTECTED] wrote: I would like to go further with today's radical thought. I believe there is not evidence to support the 5 minutely interval of intermittent monitoring in a low risk population in second stage of labour. What do people think about this. Do you think I could argue this point effectively?? Sally Westbury Send instant messages to your online friends http://au.messenger.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
This is so true. We constantly have to justify our belief in the natural process of birth and should a mishap happen in midwifery care, the midwife is all but burnt at the stake. By contrast, most hospitals have regular mortality meetings to discuss medical mishaps, these are in house and only for the purpose of medicos discussing amongst themselves. The results are not for sharing with midwives or any other interested parties. I often wonder why it is that so much utter stupidity becomes common practice - not only in medical circles - and yet the common sense approach is ignored, riduculed or just not taken seriously. Sue The only thing necessary for the triumph of evil is for good men to do nothing Edmund Burke - Original Message - From: brendamanning [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 9:33 AM Subject: Re: [ozmidwifery] intermittent auscultation I notice that it is expected that Midwives base their practice on evidence research. It would appear on the other hand that the medical profession are able to practice on whatever they believe. They do not feel obliged to justify their preference or practice. Why is this so? Why are midwives always feeling they must justify themselves? Why do you allow it ? Who in fact are we accountable to in real life? Our clients, ourselves our peers only ? Or ..?? Brenda - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the somebodies, in positions of power, have set a standard that a reasonable midwife has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to. There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrly to continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- 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. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.9.7/60 - Release Date: 28/07/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or
Re: [ozmidwifery] intermittent auscultation
Once a month, where I work, we have a Practice Improvement Committee Meeting. Here midwivesand obstetricians gather to discuss the ongoing direction of our unit, (low risk, mainly midwife led). We also discuss any adverse outcomes together, no finger pointing, no laying of blame, to make sure that in that same situation next time we can all work better as a team for the greater good of the woman, her baby, and her family. So far, this has worked very well. Sally ---Original Message--- From: Susan Cudlipp Date: 07/30/05 21:25:46 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] intermittent auscultation This is so true. We constantly have to justify our belief in the natural process of birth and should a mishap happen in midwifery care, the midwife is all but burnt at the stake. By contrast, most hospitals have regular mortality meetings to discuss medical mishaps, these are "in house" and only for the purpose of medicos discussing amongst themselves. The results are not for sharing with midwives or any other interested parties. I often wonder why it is that so much utter stupidity becomes common practice - not only in medical circles - and yet the common sense approach is ignored, riduculed or just not taken seriously. Sue "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke - Original Message - From: "brendamanning" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 9:33 AM Subject: Re: [ozmidwifery] intermittent auscultation I notice that it is expected that Midwives base their practice on evidence research. It would appear on the other hand that the medical profession are able to practice on whatever they believe. They do not feel obliged to justify their preference or practice. Why is this so? Why are midwives always feeling they must justify themselves? Why do you allow it ? Who in fact are we accountable to in real life? Our clients, ourselves our peers only ? Or ..?? Brenda - Original Message - From: "Mary Murphy" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the "somebodies", in positions of power, have set a standard that "a reasonable midwife" has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to.There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrlyto continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention.Surely as professionals we can use our skills to make the call on whether auscultation is needed or not.I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, "Sally Westbury" [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. "A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation." Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous
[ozmidwifery] ventouse information
Hi all, can anyone direct me to online resources on the use and risks of ventouse? I have the info from ACE but that's about it really. Best, J Joyous Birth Home Birth Forum - a world first!http://www.joyousbirth.info/forums/ Accessing Artemis Birth Trauma Recoveryhttp://health.groups.yahoo.com/group/accessingartemis
Re: Fw: [ozmidwifery] Encouraging twins into a good presentation.
This thread on twin births is most interesting and insightful. I have been fortunate to atttend twin births several times over the years, but it never used to be considered the drama that it seems to be nowadays, and I think this is largely due to ill-advised interference which gives rise to problems, which gives rise to the perception that the twins are the problem rather than the way they were managed! This month we have had 5 sets of twins where I work. Only one set was born vaginally! I visited this mother today and we talked about the birth. No 1 was spontaneous SVD ( 3790g!) by the midwife, and then the dr took over for no 2. There was only 6 minutes between 1 2 - the second bag of waters was ruptured and bub delivered by high Keillands - obviously great haste to get second twin born. The woman had an epidural but it was not effective and she found the second birth very painful (what a surprise!) Both babies are doing very well. I remember a twin birth about 20 years ago in UK. No 1 was SVD but again the doc took over from midwife for no 2, did ARM before the secong baby had entered the pelvis, got a cord prolapse, panicked and rushed to theatre. There was unfortunately a 20 minute delay in performing the emergency C/S and twin 2 sustained injury causing cerebral palsy. I knew this family and it took about 15 years for them to get any compensation, they had to undergo a lengthy and distressing legal battle, as well as raising a child with significant disability. It seems that the medical view is to get twin 2 out as quickly as possible with no regard for physiology. Most insist on an epidural so that they can manually extract no. 2 by reaching in to grasp a foot and bring it down. I don't know what the answer is to having a 'normal' twin birth. I can understand the view of the parents in the DVD wishing to go it alone and trust their own instincts. But it is a tricky one. Few midwives are able to take on care of twins, they would certainly be villified by the medical profession. Yet hospital twin birth is almost always highly medicalised. Sue The only thing necessary for the triumph of evil is for good men to do nothing Edmund Burke - Original Message - From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 1:44 AM Subject: Re: Fw: [ozmidwifery] Encouraging twins into a good presentation. The risk of cord prolapse is increased with a presenting part that is NOT cephalic, however, there is a great deal of adrenalin production obstetrics which I am dubious about. Nature does have another protection in the event of cord prolapse called Wharton's jelly in the cord. When we try to ligate the vessels after birth by tying cord tape or dental floss around it, we have to really put our whole body weight and strength into getting it tight enough to stop blood flow through those vessels EVEN WHEN THE PULSE HAS STOPPED in the cord for many minutes. So, although no one wants to have a cord prolapse, and, of course, smart, prompt action should be taken, I have come to suspect pronouncements by obstetricians about what would have happened if had not occurred. The greatest danger in cord prolapse, in my view, is during second stage with a primip having the cord pinched between the bony pelvis and the bony head. Another extreme danger might be the pack a day (Or more) smoking mom who has a skinny umbilical cord and already compromised baby. I think that a big part of midwifery is educating each other and pregnant women to look more objectively at the drama that surrounds complications in birth and ask ourselves is the mythology actually true. Thanks for posting that story, Jo, because it's definately not right to just quote wonderful stories where everything turned out perfectly by just sitting on hands. My question that I always come down to with modern obstetrics is How many are killed or injured by the fear who would have lived if they had gone out and squatted in the woods somewhere? It's a juggling act, for sure. There have been so many second twins that die or are injured in medical care and somehow those stories are buried. I think this is one of the reasons that more families in N. America are saying The hell with it, we'll take our chances with Mother Nature and accept responsibility for the consequences. Gloria Lemay Quoting Lindsay Yvette [EMAIL PROTECTED]: - Original Message - From: Lindsay Yvette [EMAIL PROTECTED] To: Jo Bourne [EMAIL PROTECTED] Sent: Friday, July 29, 2005 12:42 PM Subject: Re: [ozmidwifery] Encouraging twins into a good presentation. Thanks Jo, that's really good to know just in case that happened to me. I'll mention possible cord prolapse to the midwife Ob when I see them next. Gloria I've seen that website, seen the stills read the birth story though not bought the DVD. I've seen another DVD of a planned twins
Re: [ozmidwifery] intermittent auscultation
That would be wonderful Sally, I wish more places had that attitude. I have attended some of our monthly morbidity meetings but midwives are not generally included. Sue "The only thing necessary for the triumph of evil is for good men to do nothing"Edmund Burke - Original Message - From: sally williams To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 7:31 PM Subject: Re: [ozmidwifery] intermittent auscultation Once a month, where I work, we have a Practice Improvement Committee Meeting. Here midwivesand obstetricians gather to discuss the ongoing direction of our unit, (low risk, mainly midwife led). We also discuss any adverse outcomes together, no finger pointing, no laying of blame, to make sure that in that same situation next time we can all work better as a team for the greater good of the woman, her baby, and her family. So far, this has worked very well. Sally ---Original Message--- From: Susan Cudlipp Date: 07/30/05 21:25:46 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] intermittent auscultation This is so true. We constantly have to justify our belief in the natural process of birth and should a mishap happen in midwifery care, the midwife is all but burnt at the stake. By contrast, most hospitals have regular mortality meetings to discuss medical mishaps, these are "in house" and only for the purpose of medicos discussing amongst themselves. The results are not for sharing with midwives or any other interested parties. I often wonder why it is that so much utter stupidity becomes common practice - not only in medical circles - and yet the common sense approach is ignored, riduculed or just not taken seriously. Sue "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke - Original Message - From: "brendamanning" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 9:33 AM Subject: Re: [ozmidwifery] intermittent auscultation I notice that it is expected that Midwives base their practice on evidence research. It would appear on the other hand that the medical profession are able to practice on whatever they believe. They do not feel obliged to justify their preference or practice. Why is this so? Why are midwives always feeling they must justify themselves? Why do you allow it ? Who in fact are we accountable to in real life? Our clients, ourselves our peers only ? Or ..?? Brenda - Original Message - From: "Mary Murphy" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the "somebodies", in positions of power, have set a standard that "a reasonable midwife" has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to.There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrlyto continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention.Surely as professionals we can use our skills to make the call on whether auscultation is needed or not.I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On
RE: [ozmidwifery] ventouse information
Title: Message have you tried maternity wise? jo -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Janet FraserSent: Saturday, July 30, 2005 10:16 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] ventouse information Hi all, can anyone direct me to online resources on the use and risks of ventouse? I have the info from ACE but that's about it really. Best, J Joyous Birth Home Birth Forum - a world first!http://www.joyousbirth.info/forums/ Accessing Artemis Birth Trauma Recoveryhttp://health.groups.yahoo.com/group/accessingartemis --No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.9.5/58 - Release Date: 7/25/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.9.5/58 - Release Date: 7/25/2005
RE: [ozmidwifery] ventouse information
Title: Message AnOsteopath may have some info on it, maybe try through the association, ora local practitioner? It is probably another of those practices (ventouse) that hasn't been looked into beyond 'saving' babies lives in the birth process. I would think its Osteos and the like that know more about long term impacts. Megan From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Janet FraserSent: Sunday, 31 July 2005 10:45 AMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] ventouse information They don't have anything on how it might affect a baby. No one does. J - Original Message - From: Dean Jo To: ozmidwifery@acegraphics.com.au Sent: Sunday, July 31, 2005 8:34 AM Subject: RE: [ozmidwifery] ventouse information have you tried maternity wise? jo -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Janet FraserSent: Saturday, July 30, 2005 10:16 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] ventouse information Hi all, can anyone direct me to online resources on the use and risks of ventouse? I have the info from ACE but that's about it really. Best, J Joyous Birth Home Birth Forum - a world first!http://www.joyousbirth.info/forums/ Accessing Artemis Birth Trauma Recoveryhttp://health.groups.yahoo.com/group/accessingartemis --No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.9.5/58 - Release Date: 7/25/2005 --No virus found in this outgoing message.Checked by AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.9.5/58 - Release Date: 7/25/2005
RE: [ozmidwifery] ventouse information
Title: Message One of the presentations at ICM was about ventouse. There are known side effects. Minor ones include caput succanadeum which is swelling of the scalp and cephal haematoma which is bruising between the skull bone and its membrane covering. The major one was a sub apponeuretic haemorrhage which I think is inside the skull and so the bleeding is less limited because there is more space, and the baby can lose quite a bit of blood. It can also cause pressure on the brain. The midwife suggested that hourly head circumferences after a ventouse might pick these up early. However, they are very rare. The higher the baby when the ventouse is applied, and the longer the time it is applied seems to be important. The pressure should not be on continuously for more than ten minutes, and the obstetrician should not use it for more than 2-3 contractions. I have had a quick look through the program, but can't find the midwife's name. She also mentioned an australian doctor who has a website with a lot of info about ventouse. I will check my notes and get back to you. Just going out for a bike ride with the family. Nicole. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Megan LarrySent: Sunday, July 31, 2005 11:37 AMTo: ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] ventouse information AnOsteopath may have some info on it, maybe try through the association, ora local practitioner? It is probably another of those practices (ventouse) that hasn't been looked into beyond 'saving' babies lives in the birth process. I would think its Osteos and the like that know more about long term impacts. Megan From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Janet FraserSent: Sunday, 31 July 2005 10:45 AMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] ventouse information They don't have anything on how it might affect a baby. No one does. J - Original Message - From: Dean Jo To: ozmidwifery@acegraphics.com.au Sent: Sunday, July 31, 2005 8:34 AM Subject: RE: [ozmidwifery] ventouse information have you tried maternity wise? jo -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Janet FraserSent: Saturday, July 30, 2005 10:16 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] ventouse information Hi all, can anyone direct me to online resources on the use and risks of ventouse? I have the info from ACE but that's about it really. Best, J Joyous Birth Home Birth Forum - a world first!http://www.joyousbirth.info/forums/ Accessing Artemis Birth Trauma Recoveryhttp://health.groups.yahoo.com/group/accessingartemis --No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.9.5/58 - Release Date: 7/25/2005 --No virus found in this outgoing message.Checked by AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.9.5/58 - Release Date: 7/25/2005
Re: [ozmidwifery] intermittent auscultation
So true Sue!! - hung out to dry then burnt at the stake! - Original Message - From: Susan Cudlipp [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 7:23 PM Subject: Re: [ozmidwifery] intermittent auscultation This is so true. We constantly have to justify our belief in the natural process of birth and should a mishap happen in midwifery care, the midwife is all but burnt at the stake. By contrast, most hospitals have regular mortality meetings to discuss medical mishaps, these are in house and only for the purpose of medicos discussing amongst themselves. The results are not for sharing with midwives or any other interested parties. I often wonder why it is that so much utter stupidity becomes common practice - not only in medical circles - and yet the common sense approach is ignored, riduculed or just not taken seriously. Sue The only thing necessary for the triumph of evil is for good men to do nothing Edmund Burke - Original Message - From: brendamanning [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 9:33 AM Subject: Re: [ozmidwifery] intermittent auscultation I notice that it is expected that Midwives base their practice on evidence research. It would appear on the other hand that the medical profession are able to practice on whatever they believe. They do not feel obliged to justify their preference or practice. Why is this so? Why are midwives always feeling they must justify themselves? Why do you allow it ? Who in fact are we accountable to in real life? Our clients, ourselves our peers only ? Or ..?? Brenda - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the somebodies, in positions of power, have set a standard that a reasonable midwife has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to. There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrly to continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- 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
Re: [ozmidwifery] intermittent auscultation
Hi listers I will check our policies at work when I am there next, but all our policies have research that is referenced to it! So I will check our monitoring policy and let you know :-) Katrina attachment: smallnps2.jpg www.niagaraparkshow.com.au
