Re: [ozmidwifery] Hep B, vit K
Thanks Helen, I too don't totally agree with the capture theory and know that it is a debatable topic but that was the information I was looking for thankyou From: Helen and Graham [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Hep B, vit K Date: Fri, 26 May 2006 11:44:12 +1000 Just to add to the debate the NHMRC immunization handbook does recommend it be given as soon as the baby is physiologically stable and preferably within the first 24 hours. Rationales for giving it included preventing vertical transmission from the mother (recognizing that there may be errors or delays in maternal testing or reporting, and horizontal transmission from other household contacts). I wondered if there could be considered a small risk from staff handling the baby e.g. whilst performing neonatal screening tests etc It doesn't say that though. We give it either with the NNST or just before discharge. We have just been having this same conversation/debate at work, as some midwives are calling the birth dose an optional extra dose which is why I looked into it. Everything we do has risk/benefits and immunization debates bring out strong feelings on both sides. I am just pointing out the current National policy on the topic. The NHMRC Immunization Handbook can be downloaded in full at http://www9.health.gov.au/immhandbook/pdf/handbook.pdf if that helps. Helen - Original Message - From: Judy Chapman [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, May 26, 2006 9:03 AM Subject: Re: [ozmidwifery] Hep B, vit K As far as I am award it IS the capture theory. Stick thousands of babies with Hep B vax to maybe save one. For those who do consent at our hospital we give on the day of the Neonatal screening. One of our midwives has looked into the perinatal data in Qld and found that there were not figures for babies who missed the birth dose and caught Hep B in the first few months. We work on the premise that if it says on the hospital supplied literature that babies may feel unwell and need extra fluids after an immunisation, why are we doing that before they even know how to suckle properly? Birth dose is classified as given in the first week. The pressure to give 'at birth', before the poor kid has had time to even draw breath properly, is so they don't get lost in the system. With midwifery clinics we are aware of women who live high risk lifestyles and are at risk of defaulting when it may not be best to do so and we just make sure that it is done before they go home if it is before the neonatal screening. Cheers Judy --- Justine Caines [EMAIL PROTECTED] wrote: Dear Mary and Amanda Exactly Mary! Amanda have you read Sara Wickham's work on Vit K? What is the consent process for Hep B, Are parents aware of the specific populations of risk? I must say the Hep B at birth really shocks me. What are the risk factors for babies who are not in contact with those in high risk groups such as those already infected or sex workers and intravenous drug users? It seems like a capture theory to me and I worry about the level of informed consent. JC -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. 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. -- 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] insulin infusions during labour
try the perinatal protocols guidelines in your state they may help or contact a large teriary hospital such as the Womens and childrens they also may assist with your inquiry - Original Message - From: Ganesha Rosat To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 27, 2006 10:55 AM Subject: [ozmidwifery] insulin infusions during labour Hi guys, I am currently reviewing our hospitals management of diabetic women in labour policy and was hoping for some input. Does any one know the protocol for ceasing insulin infusions post birth or could point me in the direction of some current literature on the subject? Cheers Ganesha
[ozmidwifery] CTG stillbirth
Recently where I work a primip come in at term plus 7 days in early labour about 11pm. She had a CTG at 3pm which was reactive, good variability etc. (they do routine CTG's on post-dates women). The woman wasn't inestablished labour and the midwife suggested she return home. The woman wasn't keen for this so stayed and the FHR was auscultated every couple of hours and was normal, with the woman still not in active labour. Apparently after change of shift the next midwife couldn't find a FHR and USS confirmed the baby had died within the last couple of hours. I wasn't caring for this woman so don't know all the details but apparently she had an uneventful pregnancy although she had presented three times during pregnancy with decreased movements and the CTG's were always normal.To me it just proves again the unreliability of CTG's. Just interested in what others think.Cheers Michelle On Yahoo!7 360°: Your own space to share what you want with who you want!
Re: [ozmidwifery] CTG stillbirth
CTG's can only reveal what is happening at that moment and are subjective to interpretation.Often a CTG can look positively awful, and yet after FBS the pH is fine - and how often have many of us taken an emergency C/S to theatre because of a trace that was not reassuring - to have a screaming, healthy baby emerge (thank goodness, as you are on stand-by with resus). This is very sad Michelle, but you cannot say this has happened because CTG's are unreliable. The CTG at 3pm was probably reflecting accurately - and the poor midwife who was responsible for performing that CTG will be feeling bad enough as it is. Just my thoughts having been through a similar situation.. Sadie - Original Message - From: Michelle Windsor To: Ozmidwifery Sent: Saturday, May 27, 2006 5:15 PM Subject: [ozmidwifery] CTG stillbirth Recently where I work a primip come in at term plus 7 days in early labour about 11pm. She had a CTG at 3pm which was reactive, good variability etc. (they do routine CTG's on post-dates women). The woman wasn't inestablished labour and the midwife suggested she return home. The woman wasn't keen for this so stayed and the FHR was auscultated every couple of hours and was normal, with the woman still not in active labour. Apparently after change of shift the next midwife couldn't find a FHR and USS confirmed the baby had died within the last couple of hours. I wasn't caring for this woman so don't know all the details but apparently she had an uneventful pregnancy although she had presented three times during pregnancy with decreased movements and the CTG's were always normal. To me it just proves again the unreliability of CTG's. Just interested in what others think. Cheers Michelle On Yahoo!7 360°: Your own space to share what you want with who you want!
Re: [ozmidwifery] CTG stillbirth
Hi Michelle, CTG's have been proven to be very inaccurate, for various reason such as interpretation etc. In fact 80% of all CTG's will show some abnormality, which is staggering considering it is such a widely spread and heavily relied on tool. Why is it used?, because in most hospital's it is the best available. That is why some places are moving from CTG alone towards biophysical profiles in birth suite which is far more accurate. Often a suspicious CTG will be shown ok with BPP and the women is left alone without further interference and vice vera. Very sad.. - Original Message - From: Sadie To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 27, 2006 5:38 PM Subject: Re: [ozmidwifery] CTG stillbirth CTG's can only reveal what is happening at that moment and are subjective to interpretation.Often a CTG can look positively awful, and yet after FBS the pH is fine - and how often have many of us taken an emergency C/S to theatre because of a trace that was not reassuring - to have a screaming, healthy baby emerge (thank goodness, as you are on stand-by with resus). This is very sad Michelle, but you cannot say this has happened because CTG's are unreliable. The CTG at 3pm was probably reflecting accurately - and the poor midwife who was responsible for performing that CTG will be feeling bad enough as it is. Just my thoughts having been through a similar situation.. Sadie - Original Message - From: Michelle Windsor To: Ozmidwifery Sent: Saturday, May 27, 2006 5:15 PM Subject: [ozmidwifery] CTG stillbirth Recently where I work a primip come in at term plus 7 days in early labour about 11pm. She had a CTG at 3pm which was reactive, good variability etc. (they do routine CTG's on post-dates women). The woman wasn't inestablished labour and the midwife suggested she return home. The woman wasn't keen for this so stayed and the FHR was auscultated every couple of hours and was normal, with the woman still not in active labour. Apparently after change of shift the next midwife couldn't find a FHR and USS confirmed the baby had died within the last couple of hours. I wasn't caring for this woman so don't know all the details but apparently she had an uneventful pregnancy although she had presented three times during pregnancy with decreased movements and the CTG's were always normal. To me it just proves again the unreliability of CTG's. Just interested in what others think. Cheers Michelle On Yahoo!7 360°: Your own space to share what you want with who you want!
RE: [ozmidwifery] CTG stillbirth
Hello Michelle Last week something strange has happened. Two colleague midwives had a stillbirth at home. A very normal labour, half an hour second stage, good heartbeats. When the babys head was born they saw meconium in the mouth (the water was clear when it broke minutes before). The baby was flat and gave no reaction. They tried to reanimate and called urgency. The baby died later that day. Yesterday I spoke to a colleague that works in a hospital. She told that they had on that same day (17th of May) a similar story. A woman came a few days overdue for a monitor. The monitor showed a non variable heartbeat. They controlled with another monitor, even flatter tracé, than the STAN monitor and emergency C-section. Baby had apgar 0 at birth. Clear fluid at the c-section, meconium aspirated from the lungs! After reanimation, baby lives but has very bad brain scans, so is severely damaged. The people of the tertiare hospital were called and when they came to pick up the baby, they told that they didnt understand what was happening: they had the same day already five similar cases. I think this is all very strange. Greetings from rainy Belgium Lieve Lieve Huybrechts vroedvrouw 0477740853 -Oorspronkelijk bericht- Van: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] Namens Michelle Windsor Verzonden: zaterdag 27 mei 2006 11:16 Aan: Ozmidwifery Onderwerp: [ozmidwifery] CTG stillbirth Recently where I work a primip come in at term plus 7 days in early labour about 11pm. She had a CTG at 3pm which was reactive, good variability etc. (they do routine CTG's on post-dates women). The woman wasn't inestablished labour and the midwife suggested she return home. The woman wasn't keen for this so stayed and the FHR was auscultated every couple of hours and was normal, with the woman still not in active labour. Apparently after change of shift the next midwife couldn't find a FHR and USS confirmed the baby had died within the last couple of hours. I wasn't caring for this woman so don't know all the details but apparently she had an uneventful pregnancy although she had presented three times during pregnancy with decreased movements and the CTG's were always normal. To me it just proves again the unreliability of CTG's. Just interested in what others think. Cheers Michelle On Yahoo!7 360°: Your own space to share what you want with who you want!
Re: [ozmidwifery] Re:
Dear all, coincidently, I heard one of my colleagues consent a women last night on Vit K and she informed the mother that babies have little or novit K at birth until the gut flora can develop and thence oral absorption begins. This was not my understanding of the facts, but as I was not able to put my finger on the source and veracity of my info, said nothing to the other MW. But I would like to know the real facts. Can anyone help? - Original Message - From: penny burrows To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 27, 2006 7:47 AM Subject: [ozmidwifery] Re: One thing that I wonder about: Routine supplementation with any vitamin seems to be a bad idea for pregnant women as well as for babies. Do we know the effects of supplementation with vitamin K on pregnant women? What intricate balances might this be upsetting? It seems like this could be another, if more natural form of blanket treatment. If we truly believe that mother nature has designed things well and the newborn low levels are there for a reason, then do we want to boost the levels available in mum's milk? More to ponder, Penny - Original Message - From: Sue Cookson To: ozmidwifery@acegraphics.com.au Sent: Friday, May 26, 2006 8:11 PM Subject: Re: [ozmidwifery] Re: Hi,With the new Konakion MM it's the other way around. It has been designed by increasing it's absorbability in fat to be more affective if given orally. It has NOT been proven to be as effective as the old Konakion in being absorbed by the IM route. They are waiting to see if the surveillance of the new Konakion through Australia, Switzerland and a few other countries is as effective IM as it is oral. The oral route has been found to give a higher vit K cover than the IM route over a few weeks.THere is so much misinformation about vit K. It is available to the baby through breastmilk and maternal supplementation does increase neonatal serum K levels. What more do we want??And by the way, all formla fed babies should be excluded from any study due to the addition of vit K to formulas. ie babies planned to be formula fed do not need vit k!!Suestudent midwifebirth practitionervit K has been my research assignment for the past three years If a solution is designed to be given IM is it absorbed effectively if given via the GI tract ? No mention of this in the literature accompanying the Konakion. Most IM meds are NOT designed to be administered or guaranteed by the pharmaceutical company to be effective if given orally. It may be neutralised by gastric secretions, I am unaware of any research re this. Anyone else know of any ? If you are going to introduce a foreign substance into the GI tract of a baby you'd want to have a good reason be sure that it was being absorbed wouldn't you ? With kind regards Brenda Manning www.themidwife.com.au - Original Message - From: "diane" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, May 26, 2006 6:48 PM Subject: Re: [ozmidwifery] Re: Apart from the fact it tastes like Sh** (very bitter). Been reading about Vit K all day today . Seems like a pretty good option as far as the statitistics go. http://www.nhmrc.gov.au/publications/_files/ch39.pdf they recommend further research into the effectiveness of supplimenting brestfeeding mothers to increase the vit K in breastmilk as an effective suppliment. Di - Original Message - From: "Kelly @ BellyBelly" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, May 26, 2006 5:30 PM Subject: RE: [ozmidwifery] Re: Just a side question if that's okay - what are your opinions on oral vitamin K versus injection? Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Andrea Quanchi Sent: Friday, 26 May 2006 3:24 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Re: The place I work we give it when we do the NST. It was a midwife decision not an evidence based one. Like giving it with the vit K it is easier to do it at a predictable time so that it doesn't get overlooked. The midwives wanted not to do it at birth as they were wanting to do as little as possible to interupt Mum and baby, As we need to have a signed consent form to give it and the mothers have often not filled this is prior to birth it was very interupting to get all this"Done" on the birth day and we find it not an issue later when everyone has had time to sit down read the literature and discuss it. Of course then we do have a number of mums who decline to have it which is their right and is not an issue at all. Andrea Q On 25/05/2006, at
Re: [ozmidwifery] CTG stillbirth
Hi Sadie,I guess the thing is that alot of people believe that a normal CTG (not in labour) is reassuring for fetal well being for the next 24 hours. Obviously this wasn't the case for this baby.You said about doing emergency C/S for unressuring trace only to have the baby come out screaming don't you think this shows CTG's are unreliable?Cheers MichelleSadie [EMAIL PROTECTED] wrote: CTG's can only reveal what is happening at that moment and are subjective to interpretation.Often a CTG can look positively awful, and yet after FBS the pH is fine - and how often have many of us taken an emergency C/S to theatre because of a trace that was not reassuring - to have a screaming, healthy baby emerge (thank goodness, as you are on stand-by with resus). This is very sad Michelle, but you cannot say this has happened because CTG's are unreliable. The CTG at 3pm was probably reflecting accurately - and the poor midwife who was responsible for performing that CTG will be feeling bad enough as it is. Just my thoughts having been through a similar situation..Sadie- Original Message - From: Michelle Windsor To: Ozmidwifery Sent: Saturday, May 27, 2006 5:15 PM Subject: [ozmidwifery] CTG stillbirthRecently where I work a primip come in at term plus 7 days in early labour about 11pm. She had a CTG at 3pm which was reactive, good variability etc. (they do routine CTG's on post-dates women). The woman wasn't inestablished labour and the midwife suggested she return home. The woman wasn't keen for this so stayed and the FHR was auscultated every couple of hours and was normal, with the woman still not in active labour. Apparently after change of shift the next midwife couldn't find a FHR and USS confirmed the baby had died within the last couple of hours. I wasn't caring for this woman so don't know all the details but apparently she had an uneventful pregnancy although she had presented three times during pregnancy with decreased movements and the CTG's were always normal.To me it just proves again the unreliability of CTG's. Just interested in what others think.Cheers Michelle On Yahoo!7 360°: Your own space to share what you want with who you want! The LOST Ninja blog: Exclusive clues, clips and gossip.
Re: [ozmidwifery] CTG stillbirth
I think it shows one person's interpretation of a CTG... - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 27, 2006 9:39 PM Subject: Re: [ozmidwifery] CTG stillbirth Hi Sadie, I guess the thing is that alot of people believe that a normal CTG (not in labour) is reassuring for fetal well being for the next 24 hours. Obviously this wasn't the case for this baby. You said about doing emergency C/S for unressuring trace only to have the baby come out screaming don't you think this shows CTG's are unreliable? Cheers MichelleSadie [EMAIL PROTECTED] wrote: CTG's can only reveal what is happening at that moment and are subjective to interpretation.Often a CTG can look positively awful, and yet after FBS the pH is fine - and how often have many of us taken an emergency C/S to theatre because of a trace that was not reassuring - to have a screaming, healthy baby emerge (thank goodness, as you are on stand-by with resus). This is very sad Michelle, but you cannot say this has happened because CTG's are unreliable. The CTG at 3pm was probably reflecting accurately - and the poor midwife who was responsible for performing that CTG will be feeling bad enough as it is. Just my thoughts having been through a similar situation.. Sadie - Original Message - From: Michelle Windsor To: Ozmidwifery Sent: Saturday, May 27, 2006 5:15 PM Subject: [ozmidwifery] CTG stillbirth Recently where I work a primip come in at term plus 7 days in early labour about 11pm. She had a CTG at 3pm which was reactive, good variability etc. (they do routine CTG's on post-dates women). The woman wasn't inestablished labour and the midwife suggested she return home. The woman wasn't keen for this so stayed and the FHR was auscultated every couple of hours and was normal, with the woman still not in active labour. Apparently after change of shift the next midwife couldn't find a FHR and USS confirmed the baby had died within the last couple of hours. I wasn't caring for this woman so don't know all the details but apparently she had an uneventful pregnancy although she had presented three times during pregnancy with decreased movements and the CTG's were always normal. To me it just proves again the unreliability of CTG's. Just interested in what others think. Cheers Michelle On Yahoo!7 360°: Your own space to share what you want with who you want! The LOST Ninja blog: Exclusive clues, clips and gossip.
Re: [ozmidwifery] Re:
Hi,I have several different thoughts on Vit K, they do contradict each other a bit, Firstly, with regards to supplementing, most women would supplement pre-pregnancy and first three months with folic acid to prevent neural tube defects- so why would you not consider the same for HDN- HOWEVER why does mother nature give babies"low levels" of vit K ???,With regards to giving oral vit K,we try so hard to promote breast feeding and avoid BMS;obviously for many reasons, but one of them being it (BMS) changes thebalanceof the GI system, so why introducea preparation thatis specially prepared for IM administration- surelyitwould cause some sort of irritation/ unbablanceto the GIS.It is such a big topic, and I am probably a bit of a fence sitter on it,I suppose it's just a decision each parent has to make, with (hopefully) an informedconsent.VickySue Cookson [EMAIL PROTECTED] wrote: Hi Brenda,The surveillance is the reporting of neonates suspected of having HDN caused by low levels of vit K - not a randomised trial - everyone agrees an RCT would be impossible due to the low numbers of babies who do have problems, and the difficulty proving that the problem is caused by whatever vitamin K deficiency may be. Levels of vitamin K drop due to other problems such as liver or gut related pathologies - most of the babies who have died from late onset K deficiency have in fact had undiagnosed liver problems.And the discussion around diet, supplements etc is interesting, but if you spend enough time around big hospitals and see the pitiful state a lot of women are in these days - obese, addicted to coca cola, first choice of a meal after birth is a Big Mac, than you start to see a whole picture of why we might need to make sure people are getting some food groups. Hmm,Sue Thank youSue, So. why haven't hospitals in Oz been given this info when they are administering this drug, mainly IM (perhaps ineffectively)on a daily basis to 100's of babies ?? The healthy neonates aside, what if it doesn't work effectively on the 'at risk' babies it was designed to assist? Are they part of a randomised trial,happening without parental consent ? Brenda - Original Message - From: Sue Cookson To: ozmidwifery@acegraphics.com.au Sent: Friday, May 26, 2006 8:11 PM Subject: Re: [ozmidwifery] Re: Hi,With the new Konakion MM it's the other way around. It has been designed by increasing it's absorbability in fat to be more affective if given orally. It has NOT been proven to be as effective as the old Konakion in being absorbed by the IM route. They are waiting to see if the surveillance of the new Konakion through Australia, Switzerland and a few other countries is as effective IM as it is oral. The oral route has been found to give a higher vit K cover than the IM route over a few weeks.THere is so much misinformation about vit K. It is available to the baby through breastmilk and maternal supplementation does increase neonatal serum K levels. What more do we want??And by the way, all formla fed babies should be excluded from any study due to the addition of vit K to formulas. ie babies planned to be formula fed do not need vit k!!Suestudent midwifebirth practitionervit K has been my research assignment for the past three years If a solution is designed to be given IM is it absorbed effectively if given via the GI tract ? No mention of this in the literature accompanying the Konakion. Most IM meds are NOT designed to be administered or guaranteed by the pharmaceutical company to be effective if given orally. It may be neutralised by gastric secretions, I am unaware of any research re this. Anyone else know of any ?If you are going to introduce a foreign substance into the GI tract of a baby you'd want to have a good reason be sure that it was being absorbed wouldn't you ?With kind regards Brenda Manning www.themidwife.com.au- Original Message - From: "diane" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, May 26, 2006 6:48 PM Subject: Re: [ozmidwifery] Re: Apart from the fact it tastes like Sh** (very bitter). Been reading about Vit K all day today . Seems like a pretty good option as far as the statitistics go. http://www.nhmrc.gov.au/publications/_files/ch39.pdfthey recommend further research into the effectiveness of supplimenting brestfeeding mothers to increase the vit K in breastmilk as an effective suppliment.Di - Original Message - From: "Kelly @ BellyBelly" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, May 26, 2006 5:30 PM Subject: RE: [ozmidwifery] Re:Just a side question if that's okay - what are your opinions on oral vitamin K versus injection?Best Regards,Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support -Original
RE: [ozmidwifery] Re:
My understanding is that the preparation is designed to be absorbed from all tissues, especially to meet the challenges of the oral route, MM From: Vicky so why introducea preparation thatis specially prepared for IM administration- surelyitwould cause some sort of irritation/ unbablanceto the GIS.
