[ozmidwifery] routine VE's
Recently there was a question about the evidence for routine VEs in labour. I thought Id contribute this: Forms of care unlikely to be beneficial Frequent scheduled vaginal examinations in labor 31 Thought Id put this in as well. MM Routine directed pushing during the second stage of labor 32 Pushing by sustained bearing down during the second stage of labor 32 Breath holding during the second stage of labor 32 Early bearing down during the second stage of labor 32 Arbitrary limitation of the duration of the second stage of labor 32 'Ironing out' or massaging the perineum during the second stage of labor 32 www.birthpsychology.com/messages/cervical/cervical.html BMJ 1995;311:469 (19August) (exerpts) Study criticises protocols for labour A high proportion of the protocols provided by hospitals for women in normal labour are unsatisfactory, according to a new report from the Clinical Standards Advisory Group. The report cites regular vaginal examination during labour as an example of a routine procedure performed without providing evidence of benefit. All the protocols emphasised that labour should be managed with care and respect for the woman's wishes. But the report says: Some procedures are apparently recommended almost routinely. The assumption that they are necessary, in the interests of the child and woman, may be questioned. For example regular vaginal examinations (at least every 2 or 4 hours), rupture of the membranes at a cervical dilatation of 3-4 cm and the management of the second stage of labour. Comparison of the expected number of vaginal examinations indicated by the protocols with the number actually performed during labour showed that 71% of women had more vaginal examinations than expected. The Benefits of Using Water for Labour and Birth Extract from Water Birth by Janet Balaskas. Midwives who attend water births often have to develop different ways of assessing progress in labour. Instead of routine vaginal examinations to check dilation, the midwife relies on more subtle indicators, such as the womans breathing, vocalisations and movements. In fact, many midwives feel that attending labours and births in water has added an extra dimension to their midwifery skills, including an extra sensitivity to changes in the mother without the need for manual confirmation.
Re: Re: [ozmidwifery] VBAC after more than one c-sec in the perinatal data?
Brenda, It was Janet that wrote the original message. I jumped in when I read that fairly shocking statement for an ob from your colleague :) Sorry for my sarcasm but someone like you will understand! You're incredibly lucky to have 2 good ob's to work with. Maybe I better rein in my sarcasm. I notice that with women all the time (I'm not a midwife, just have an extreme interest in the birthing scene) - they keep going to the same old butchers. You can't seem to get it in their heads that pregnancy/birth does not have to be that way. Good on you for promoting the pro natural obs. I know it's one step at a time but it gets so frustrating seeing what women accept for themselves and their babies :( It's depressing. Keep up the good work! Regards Jayne - Original Message - From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, September 18, 2006 4:43 AM Subject: Re: Re: [ozmidwifery] VBAC after more than one c-sec in the perinatal data? Hi Jayne, Sorry, I thought I was emailing Janet !! You must have wondered who on earth I was ! Did I answer the question you asked ? I work with the support of 2 great OBs on the Mornington Peninsula, neither of them are knife happy. They are both very pro natural (otherwise obviously as the 'homebirth midwife' I wouldn't be collaborating with them). The other 2 OBs in our area are terrified of birth section anything that moves, I have always refused to work with their clients in my private practice. In the Birth Centre where I also work obviously I have to care for the women who choose to attend the 'fear mongerers' I am respectful fair in my care for them. But I can't understand why they choose them as their OBs, even when I tell them what their caesar induction rates are, they still go to them because they are so nice charming, clearly their philosophy of birth isn't relevent !!! If women attend them then request me as birth support/doula or midwife I agree only if they will change their OB to one of the 2 who provide women-centred, evidence based care. That way I know they will have given themselves the best chance of having a normal birth. Most agree to change when I explain the rationale behind my request. Sorry about the email mix up, and the spelling, night duty it's 0430, the brain is on auto pilot ! Regards Brenda. jesse/jayne [EMAIL PROTECTED] wrote: I received the message below of yours Brenda. AS 1 OB colleague states: if we could just prevent the first CS happening she wouldn't be faced with this awful dilemma now ie to VBAC or not. An ob really said that?! My, my must have been one of those more unusual obs! Jayne - Original Message - From: brendamanning To: ozmidwifery@acegraphics.com.au Sent: Saturday, September 16, 2006 3:12 PM Subject: Re: [ozmidwifery] VBAC after more than one c-sec in the perinatal data? Hi Janet, On the Victorian perinatal data collection unit form which should be filled out returned by all midwives to the above unit for every birth (home or otherwise) there is a section which asks: No 41:was the last birth a CS ? No 42: Total no of previous CS? Is this what you mean ? I have recently been midwife at VBAC after 3CS and a VBAC following 2 CS. So they are happening. Just need more of them. AS 1 OB colleague states: if we could just prevent the first CS happening she wouldn't be faced with this awful dilemma now ie to VBAC or not. With kind regards Brenda Manning www.themidwife.com.au - Original Message - From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Saturday, September 16, 2006 1:30 PM Subject: [ozmidwifery] VBAC after more than one c-sec in the perinatal data? Hi all, is there some way in which the perinatal data for each state records vb after multiple c-secs in the hospy system? I wonder if it's too statistically insignificant or is there a part of the data I haven't noticed. I know they're different in each state as well. How about hospy's own data? Are people recording how many c-secs women have before a vb? We really need MIPPs to be recording HBACs so we can contrast that with the truly appalling national average. I've only seen blanket VBAC figures, not how many surgeries prior. Anyone know? J For home birth information go to: Joyous Birth Australian home birth network and forums. http://www.joyousbirth.info/ Or email: [EMAIL PROTECTED] -- 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.
[ozmidwifery] Midwife Directory Cancelled...
Dear all, Epic coming up! Just a quick email to let you all know that I am no longer doing the Australian midwife directory thanks to all those who sent in their information. I have come up with several problems: disagreement, very limited response and even an email from some rude person who said that I participate on the list to get more people to come to my website, and she was disagreeing with the idea of having certain advertisers on my site who sell books when I should be supporting the bookshop associated with this list and so on. This does not bother me but reaffirmed so many things to me. I invested $2000 to attend a brilliant (huge understatement!) business, mind and money conference this Thursday-Sunday and I would have paid double for what I got out of it. It had some of the best speakers/professionals in the world on everything from marketing to business they are all self-made millionaires sharing their secrets. Also last week, I have had a one-on-one mentoring session for a few hours with the amazing Australian business womens network creator who gave me some great advice, including insight of the process of lobbying from pharmaceutical companies to the government to accept the new cervical cancer vaccine into the PBS (?), how it was done and from what viewpoint to, seal the deal when initial lobbying was not working. From these two sources, I have come to realise that there are too many deep-seated paradigms, particularly in response to what I am trying to do (that I am not going to be able to change). I should be focusing my energy on what I do, changing my own paradigms and helping me to grow who of us has the time with children, work etc.? We have to all optimise our time and work smarter, not harder. At the end of the day, we all run businesses of some form, and if we all keep preaching to the converted or staying in our comfortable paradigm-based ways, then with this time-consuming, hard work so many of us/you do with lobbying and fighting for maternity services it will just go on forever. Well all just be seen as annoying poodles nipping at the ankles of politicians, the media or other leaders everytime there is a problem, when there is a better way to do things that needs to be tapped into and effectively utilised. Its such a waste of precious time and energy and given how many years this has been going on for some issues its obviously not working! This is not to say the hard work everyone has done is useless or unskilled, this is not criticism on anyones part and I am not saying anyone is better than the other - I sincerely hope this is seen as constructive advice as I learnt this from some very highly respected people. I am simply saying that I believe there is a better way to do this we can make change happen but first we must change ourselves. I will now focus on solely promoting the Doula and I believe for the reasons I mentioned above, the Doula will continue to grow at a fast rate, and the private midwife will take lots more time to be seen as a mainstream option. Because there are many passionate people out there willing to promote the Doula in so many forms and places, within their comfort zone and more importantly, outside. You see ads about Doulas everywhere, there are real-life Doula networking groups across Australia where many women turn up very regularly, passionate and willing to do what they need and share advice and information as a whole. They are asked their opinion on changes that need to be made, what could be done better, what is great about it They get involved in activities all the time and get themselves out there, not caring if they end up surrounded by a group of pro-caesarean women or whatever because she sees the opportunity. I am not saying this is the case for all midwives, but I have seen so many eager Doulas doing whatever it takes to get out there!!! I also know some midwives dont want to do hospital birth. But wont doing that show the true value of a private midwife to those less informed when she gets a great birth? Isnt this a prime opportunity to get your target market referring others to you? Just a thought. I know that I will no doubt come up with opposition and criticism for what I am doing/saying, this is something they discussed at the conference those that do things differently in their industries will come up against all this criticism, labels and judgement, but this no longer bothers me at all. I have tried my best, and now I need to do my own thing until the day something different occurs from within where I can help, where work is a joint effort and in an effective way my door is always open. The mainstream generally do not know who the MC / Private Midwife is and what they do. They need to know this, it is essential for your growth! Ive even suggested a few promotional activities in the past and its been rejected, where I could help with my site give more exposure to the MC. I do know there is a
Re: [ozmidwifery] Midwife Directory Cancelled...
Kelly, I hope you will reconsider a Midwife Directory. From a consumer's point of view, it is extremely useful. Four years ago I was pregnant with my third baby when the idea of home birth came across my radar for the first time. With awareness of only very mainstream sources I had a VERY VERY difficult time finding an independent midwife. One of the places I looked was in mainstream forums but I had no luck there. At that time I knew no one who knew anyone who had had a home birth and did not know where to begin looking for a care provider. A Midwife Directory on a site like Belly Belly could help someone in that situation. The existence of a Midwife Directory would also help to inform people that there IS such a thing as an independent midwife. Four years ago I thought a midwife was a nurse who helped doctors deliver babies (cringe). Rachele -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Midwife Directory Cancelled...
Joyous Birth has listings for private midwives as well as links to community hb groups nationally. Due to the now dicey political nature of hb, particularly in QLD, it's members only. So send women our way if they want that info. It says on our website that we provide that info. : ) J - Original Message - From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Cc: Kelly @ BellyBelly [EMAIL PROTECTED] Sent: Monday, September 18, 2006 11:30 AM Subject: Re: [ozmidwifery] Midwife Directory Cancelled... Kelly, I hope you will reconsider a Midwife Directory. From a consumer's point of view, it is extremely useful. Four years ago I was pregnant with my third baby when the idea of home birth came across my radar for the first time. With awareness of only very mainstream sources I had a VERY VERY difficult time finding an independent midwife. One of the places I looked was in mainstream forums but I had no luck there. At that time I knew no one who knew anyone who had had a home birth and did not know where to begin looking for a care provider. A Midwife Directory on a site like Belly Belly could help someone in that situation. The existence of a Midwife Directory would also help to inform people that there IS such a thing as an independent midwife. Four years ago I thought a midwife was a nurse who helped doctors deliver babies (cringe). Rachele -- 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.
