[ozmidwifery] Sports drinks

[Lisa Gierke]

Ovid Technologies, Inc. Email Service
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Results: Anesthesia & Analgesia 

(C) 2002 by International Anesthesia Research Society.

Volume 94(2), February 2002, pp 404-408

An Evaluation of Isotonic "Sport Drinks" During Labor [TECHNOLOGY,
COMPUTING, AND SIMULATION: OBSTETRIC ANESTHESIA]

Kubli, Mark FRCA(UK)*,; Scrutton, Mark J. FRCA(UK)+,; Seed, Paul T. MSc,
Cstat++,; O' Sullivan, Geraldine PhD, FRCA(UK)*
*Department of Anaesthesia, St. Thomas' Hospital, London, United Kingdom;
+Department of Anaesthesia, St. Michael's Hospital, Bristol, United 
+Kingdom; and
++Maternal & Fetal Research Unit, Department of Obstetrics & 
++Gynaecology, Guy's
Kings and St. Thomas' School of Medicine, King's College, London, United
Kingdom Supported by a grant from the Obstetric Anaesthetists' Association,
United Kingdom. September 14, 2001. Address correspondence and reprint
requests to M. Kubli, FRCA, Department of Anaesthesia, St. Thomas' Hospital,
Lambeth Palace Road, London SE1 7EH, United Kingdom. Address e-mail to
[EMAIL PROTECTED]

--

Outline

  Abstract

  Methods

  Results

  Discussion

  References

Graphics

Table 1
Table 2
Table 3
Table 4

Abstract

We compared the metabolic effects of allowing women isotonic "sport drinks"
rather than water to drink during labor. The effect of these drinks on
gastric residual volume was also evaluated. Sixty women in early labor
(cervical dilation P = 0.000) and nonesterified fatty acids (P = 0.000) had
increased and plasma glucose (P = 0.007) had decreased significantly in the
Water-Only group. Gastric antral cross-sectional area after delivery was
similar in the two groups. The incidence of vomiting and the volume vomited
during labor and within the hour of delivery were also similar. There was no
difference between the groups in any maternal or neonatal outcome of labor.
In conclusion, isotonic drinks reduce maternal ketosis in labor without
increasing gastric volume.

--

In recent years, maternal mortality from acid pulmonary aspiration
(Mendelson's
syndrome) (1) has dramatically declined. In the Report on the Confidential
Enquiries into Maternal Deaths in England and Wales (1991-1996), only one
mother died from aspiration (2). There are several factors that may be
associated with this audited improvement. These include the increased use of
regional anesthesia for cesarean delivery, improved training of
anesthesiologists, and, possibly, the introduction of nonparticulate
antacids and H2-receptor antagonists. The role of nothing by mouth during
labor, as recommended in the first Report on the Confidential Enquiries into
Maternal Deaths (1952-1954), is less clear (2).

Women in labor exhibit a state of "accelerated starvation," with rapid
increases in the blood levels of [beta]-hydroxybutyrate, acetoacetic acid,
and the nonesterified fatty acids (NEFAs) from which they are derived and
with a concomitant decrease in blood glucose (3). It has been suggested,
although never scientifically proven, that these changes may have
detrimental effects on uterine activity and the progress of labor (4).

A previous study demonstrated that allowing laboring women to eat a light
diet prevented the increase of plasma ketones and NEFAs (5). However, not
surprisingly, feeding resulted in a significant increase in residual gastric
volume, which could predispose to pulmonary aspiration should a complication
of neuroaxial anesthesia occur or should general anesthesia be required
unexpectedly. Isotonic drinks are rapidly emptied from the stomach and
absorbed by the gastrointestinal tract (6,7) and therefore may theoretically
provide a safer alternative to solid food. The aim of this study was to
evaluate whether isotonic drinks would prevent ketosis without increasing
the risk of potential aspiration.

Methods

St. Thomas' Hospital Ethics Committee granted approval for this project.
After informed written consent, 60 women presenting in early labor (cervical
dilation
(R) (still), with the choice of either orange or lemon flavor. Lucozade
Sport
(still) contains a mixed carbohydrate profile (dextrose, maltodextrin, and
glucose) of 64 g/L, a sodium of 24 mmol/L, potassium of 2.6 mmol/L, and
calcium of 1.2 mmol/L and has a tonicity of 300 mOsm/kg.

Women in the Sport Drinks group were encouraged to consume up to 500 mL (one
bottle) in the first hour and then a further 500 mL every 3 to 4 h.
Additionally, they were allowed to take small quantities of water as
desired. Women randomized to the Water-Only group could consume as little or
as much water as they wanted.

For metabolic assessment, plasma [beta]-hydroxybutyrate, NEFAs, and glucose
were measured in early labor and again at the end of the first stage by
using blood samples. Real-time ultrasonography was used to compare residual
gastric volumes between the two groups (9,10). Examinations were performed
with a high-resolutio

[ozmidwifery] Fluids in labour

[Lisa Gierke]

Haven't read it fully yet!


Ovid Technologies, Inc. Email Service
--
Results: Obstetrical & Gynecological Survey 

(C) 2006 Lippincott Williams & Wilkins, Inc.

Volume 61(10), October 2006, pp 623-625

Increased Intravenous Fluid Intake and the Course of Labor in Nulliparous
Women
[Obstetrics: Management of Labor, Delivery, and the Puerperium]

Eslamian, L; Marsoosi, V; Pakneeyat, Y
Obstetrics Department, Shariati Hospital, Tehran University of Medical
Sciences, Tehran, Iran Int J Gynecol Obstet 2006;93:102-105

--

Outline

  ABSTRACT

  EDITORIAL COMMENT

ABSTRACT

Adequate hydration improves muscle performance during prolonged exercise,
and this should apply to myometrial contractility during labor. In general,
parturients receive intravenous fluid at a rate of 125 mL/hour, amounting to
3 L in 24 hours, but this rate is based on a resting patient not taking oral
fluids and it does not always prevent clinical dehydration. This
prospective, randomized, double-blind study compared the conventional
regimen of 125 mL/hour (group 1) with 250 mL/hour of Ringer solution (group
2). Participants were 300 nulliparous women at term who had singleton
pregnancies of 37 weeks or longer with a cephalic presentation. Labor began
spontaneously in all cases. The 2 groups were matched for maternal and
gestational ages, Bishop score, state of the membranes, birth weight, and
infant gender.

Women in group 1 received a mean of 810 mL of fluid, and women in group 2
1065 mL, a significant difference (P 

Delivering twice as much intravenous fluid during labor as is ordinarily
administered significantly shortened labor in this study of nulliparous
women who spontaneously entered labor at term. This practice may lessen the
risk of prolonged labor and also the need for oxytocin.

--

EDITORIAL COMMENT

(The abstracted report of Eslamian et al is the second randomized trial to
address the issue of whether a higher rate of intravenous fluid
administration shortens spontaneous labor. The first was by performed by
Garite et al (Am J Obstet Gynecol 2000;183:1544). Because they are the only
2, it is worthwhile to compare and contrast them. Both used virtually
identical methodologies, studying healthy nulliparous women at or near term,
in spontaneous early labor with a singleton vertex fetus. In both studies,
randomization was to isotonic intravenous fluid (lactated Ringer or saline)
at a rate of either 250 mL/hour or 125 mL/hour. In the Garite study, women
used epidural anesthesia, but in the Eslamian study they did not.

In the Garite trial, the total duration of labor (from admission until
delivery) was shorter by approximately 1 hour in the 250 mL/hour group (484
vs 552 minutes), a difference that was not statistically significant. Fewer
women in the 250 mL/hour group underwent labor augmentation (49% vs 65%),
and fewer underwent cesarean delivery (10% vs 17%), but these differences
were not statistically significantly different either. Women in the 250
mL/hour group received a mean volume of intravenous fluid of 2487 mL versus
2008 mL in the 125 mL/hour group or, on average, 308 mL and 218 mL,
respectively, for each hour of labor. The fluid in excess of that mandated
by the protocol derived from prehydration for epidural placement and
discretionary nursing administration in response to concerning fetal heart
rate features.

In the Eslamian trial, labor was shorter by approximately 2 hours in the 250
mL/hour group (253 vs 386 minutes), and this difference was statistically
significant. Overall, labors in the Eslamian trial were 3 to 4 hours shorter
than in the Garite trial, and women received smaller volumes of fluid, a
mean of 1065 mL in the 250 mL/hour group and 810 mL in the 125 mL/hour group
or, on average, 252 mL versus 126 mL, respectively, for each hour of labor.
Fewer women in the 250 mL/hour group underwent labor augmentation (8% vs
20%), and fewer underwent cesarean (16% vs 23%), but only the former
difference was statistically significant, and that there would be a
difference was not a formal prespecified hypothesis.

There were no differences in neonatal outcomes between the offspring of
women in the 250 mL/hour group and the offspring of those in the 125 mL/hour
group in either trial, nor did maternal outcomes differ between groups.
Specifically, pulmonary edema was not reported to have occurred.

It is biologically plausible that adequate hydration would improve uterine
muscle performance, as it does in long-distance runners (Maughan RJ, Noakes
TD. Sports Med 1991;12:16), although the type of muscle (smooth vs striated)
and nature of work (intermittent vs frequently repetitive) obviously differs
between labor and running. Moreover, in neither study was the hydration
status of the participants assessed, and neither study was blind or masked,
which, even if laborious, could have been accomplished and wou

Re: [ozmidwifery] No Contractions

[diane]

Title: Message



Thanks All, for your thoughts,
Not so sure it was rest and be thankful stage as 
she had already had involuntary pushing happening for a while with the first bit 
of second stage contractions that were only very short, and she had brought baby 
down to on view at that stage, it was then they dropped right off and when bub 
was almost crowning that they stopped. I didnt feel comfortable to have her sit 
there with low FH and head 1/4 out! 
 
Dont think there was a psychological block as she 
had even stated earlier " i cant wait to feel that burning, stretching then I 
know it is almost here"
 
We dont have on site doctors but have strict 
criteria for transfer or to call in the consultant. We dont put up synto, that 
would require transfer. I even thought about yelling BOO to scare her and get a 
fetus ejection reflex!! : )
 
She had been self regulating her fluid intake, but 
it could have been helpful to get some carbs, and usually I would do this but 
she had been vomiting a reasonable amount and felt it best to stick with fluids, 
perhaps some cordial could have helped.
 
Would love some good references on the Ketones too, 
we get hounded badly about hydration.
Cheers,
Di

  - Original Message - 
  From: 
  Lisa 
  Gierke 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Friday, October 06, 2006 4:15 
  PM
  Subject: RE: [ozmidwifery] No 
  Contractions
  
  No 
  Mary wasn't directing this at you or anyone in general really...just feel for 
  Di...as think she did a great job as some hospital midwives would have 
  thrown it in the too hard basket and called the doc for the vaccumm waay 
  before; what with the fetal distress and all (tongue in cheek). And yep 
  beating up on ourselves is  a real midwife trait isn't it! Especially 
  when you have rotton doctors and others putting their 2 cents worth in about 
  you decsions!
  Can 
  anyone think of the reference for the ketone thingy?..
  LisaX
  

-Original Message-From: 
[EMAIL PROTECTED] 
[mailto:[EMAIL PROTECTED] On Behalf Of Mary 
MurphySent: Friday, 6 October 2006 3:52 PMTo: 
ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] No 
Contractions

Hi Lisa, there was 
definitely no intent of implied criticism when I said “no should 
haves”.  Just a reminder that we beat up on ourselves all the time 
.  “OH maybe I should have, shouldn’t have”. etc.  We each have to 
respond to the best of our clinical judgment, in the way we see it, at the 
time.  It is hard to say “I would do this when” because there is no 
hard and fast rule, just that rush of adrenalin and a sense of alarm that 
makes us act.    Sorry I can’t elaborate further. I agree 
about the fluids.  In fact quite a while ago I read some articles about 
the presence of keytones being normal in labour.  sorry can’t remember 
where. MM
 




From: 
owner-ozmidwifery@acegraphics.com.au 
[mailto:owner-ozmidwifery@acegraphics.com.au] 
On Behalf Of Lisa 
BarrettSent: Friday, 6 
October 2006 1:19 PMTo: 
ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] No 
Contractions
 

Sorry Mary If my language 
inferred "should have" but when would you get a woman to push without a 
contraction?. Exception maybe breech out to nape of neck with worries about 
the baby's condition.

 

IV fluids doesn't constitute any 
part of normal physiological labour unless I've missed something 
vital.

 

When asked for opinion in future 
I will refrain from giving any unless my language is less 
confrontational.

Lisa 
Barrett

  
  - Original Message - 
  
  
  From: Mary 
  Murphy 
  
  To: ozmidwifery@acegraphics.com.au 
  
  
  Sent: 
  Friday, October 06, 2006 8:17 AM
  
  Subject: RE: 
  [ozmidwifery] No Contractions
  
   
  
  Di, It sounds as 
  tho you managed a difficult situation in the best way you knew, and that 
  is all one can do.  You are now seeking to learn from it and we will 
  obviously give you tips based on our experiences.  Don’t feel that 
  you “should have “etc.  Many midwifery authors in all kinds of 
  natural birthing magazines like Midwifery Today etc, have spoken about the 
  “rest and recovery stage” where the body needs to gather its strength for 
  the final stage.  It usually happens at the end of a demanding first 
  stage and the woman showing signs of tiredness. I am old enough to 
  remember doctors saying “turn her on her side and give her a rest, Sis”, 
  in a time when IV fluids, synto drip and epidurals were available but not 
  used so aggressively.  At the transition between the first and second 
  stage in a primip, the  urge to push with each contraction needs to 
  be resiste

[ozmidwifery] Keytones-confusing

[Mary Murphy]

“In summary, the
literature suggests that mild to moderate ketosis is a normal

consequence of labour
although the association between high ketonuria and the

progress of labour is
inconclusive. There is also no evidence to inform the debate

about the beneficial or
detrimental effect of ketone bodies to the mother or fetus. It

appears that ketosis only
becomes a problem when it exceeds, what is assumed to

be, normal levels. Normal
ketone levels tend to be exceeded when labour becomes

prolonged. There is no
conclusive evidence demonstrating that prolonged labour

causes an over-production of
ketone bodies or an over-production of ketone bodies

causes prolonged labour.”

 

This is part of chapter 3 of
a textbook whose name I couldn’t find in the reference on google. 
However, it was just one of many to debate the normality or not of keytonuria. Most
come down on the side of “ Keytonuria does not translate to serum ketones
without the presence of other symptoms.  And Keytonuria does not necessarily
mean keytoacidosis”.  

RE: [ozmidwifery] No Contractions

[Lisa Gierke]

Title: Message



No 
Mary wasn't directing this at you or anyone in general really...just feel for 
Di...as think she did a great job as some hospital midwives would have 
thrown it in the too hard basket and called the doc for the vaccumm waay before; 
what with the fetal distress and all (tongue in cheek). And yep beating up 
on ourselves is  a real midwife trait isn't it! Especially when you have 
rotton doctors and others putting their 2 cents worth in about you 
decsions!
Can 
anyone think of the reference for the ketone thingy?..
LisaX

  
  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] On Behalf Of Mary 
  MurphySent: Friday, 6 October 2006 3:52 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] No 
  Contractions
  
  Hi Lisa, there was 
  definitely no intent of implied criticism when I said “no should haves”.  
  Just a reminder that we beat up on ourselves all the time .  “OH maybe I 
  should have, shouldn’t have”. etc.  We each have to respond to the best 
  of our clinical judgment, in the way we see it, at the time.  It is hard 
  to say “I would do this when” because there is no hard and fast rule, just 
  that rush of adrenalin and a sense of alarm that makes us act.  
    Sorry I can’t elaborate further. I agree about the fluids.  
  In fact quite a while ago I read some articles about the presence of keytones 
  being normal in labour.  sorry can’t remember where. 
  MM
   
  
  
  
  
  From: 
  owner-ozmidwifery@acegraphics.com.au 
  [mailto:owner-ozmidwifery@acegraphics.com.au] 
  On Behalf Of Lisa 
  BarrettSent: Friday, 6 
  October 2006 1:19 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] No 
  Contractions
   
  
  Sorry Mary If my language inferred 
  "should have" but when would you get a woman to push without a contraction?. 
  Exception maybe breech out to nape of neck with worries about the baby's 
  condition.
  
   
  
  IV fluids doesn't constitute any 
  part of normal physiological labour unless I've missed something 
  vital.
  
   
  
  When asked for opinion in future I 
  will refrain from giving any unless my language is less 
  confrontational.
  
  Lisa 
  Barrett
  

- Original Message - 


From: Mary 
Murphy 

To: ozmidwifery@acegraphics.com.au 


Sent: Friday, 
October 06, 2006 8:17 AM

Subject: RE: 
[ozmidwifery] No Contractions

 

Di, It sounds as 
tho you managed a difficult situation in the best way you knew, and that is 
all one can do.  You are now seeking to learn from it and we will 
obviously give you tips based on our experiences.  Don’t feel that you 
“should have “etc.  Many midwifery authors in all kinds of natural 
birthing magazines like Midwifery Today etc, have spoken about the “rest and 
recovery stage” where the body needs to gather its strength for the final 
stage.  It usually happens at the end of a demanding first stage and 
the woman showing signs of tiredness. I am old enough to remember doctors 
saying “turn her on her side and give her a rest, Sis”, in a time when IV 
fluids, synto drip and epidurals were available but not used so 
aggressively.  At the transition between the first and second stage in 
a primip, the  urge to push with each contraction needs to be resisted 
for a little while and breathed through, so that there is no pushing on a 
cervix that is not completely out of the way. We often can’t reach that 
little bit at the back, but it is still there. We talk of an anterior lip, 
but there can be a posterior one too.   The urge to push is 
triggered by the baby putting pressure on the nerves, even tho there is 
still a lip etc.  Pushing without contractions is not usually the most 
productive thing, but as I said, you handled it the best way you knew 
how.remeber the discussion on”undirected pushing”?  I am sure you will 
get lots of tips which will help us all in our practice no matter where we 
are. Cheers, 
MM

RE: [ozmidwifery] Wounds

[Lisa Gierke]

Hi Janet
Out of interest how does your wound give you trouble? Gee what a pain after
all that time!
Lisa

-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Janet Fraser
Sent: Friday, 6 October 2006 3:54 PM
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] Wounds


I haven't seen research but I'd be interested. It seems counterintuitive to
me to blow dry a perineum. I imagine we have a sensible built in healing
system that's used to a normally lubricated genital area. The c-sec wound
still gives me trouble now and then thanks to my built in apron so that's
more a case for drying, I'd think. Looking forward to some evidence : ) J
- Original Message - 
From: "brendamanning" <[EMAIL PROTECTED]>
To: ; <[EMAIL PROTECTED]>
Sent: Friday, October 06, 2006 1:04 PM
Subject: [ozmidwifery] Wounds


Apologies for the x posting.

Have a query on behalf of a colleague.
Does anyone know of any research regarding the use of warm air (ie hair
driers) to help heal peri & abdo wounds.
We did it years ago & it went "out" possibly with the moist wound healing
phase. She is after actual research for evidence based prac, has googled &
MIDIRd for it but nothing so far.

I will ask our skin integrity nurse too.
Any research you all know of ?

With kind regards
Brenda Manning
www.themidwife.com.au

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RE: [ozmidwifery] No Contractions

[B & G]

Why only hanging around the door. I have had them come in and push me
out to then tell the mother how to push and ''look I ''saved'' them!
Barb

-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Lisa Gierke
Sent: Friday, 6 October 2006 3:57 PM
To: ozmidwifery@acegraphics.com.au
Subject: RE: [ozmidwifery] No Contractions



In defence of Di...she obviously works in a hospital with registrar
potentially hanging around the door..Sometimes 'best practice' may need
to be modified to prevent the women from ending up with an instrumental
birth..or synto...or an epidural ..or even a CS The lesser of
two evils. The docs are not going to tolerate a 'rest & be thankful'
stage going on for hours espeically with decels in the fh!! (Yep even
hospital midwives know about rest & be thankful)So lets give her a break
...and walk in her shoes for abit heh! Does anyone think the contrations
may have dropped of simply because she had a big baby and she was tired?
Sounds like a more likely scenario to me than theories about
overloading. Lisa




Hi  Di,

Just a point on fluids in labour - if a woman is overloaded with 
fluid (via a drip) her system,  vasopressin (antidiuretic hormone) 
will kick in to stop her body being flooded with fluid.  This hormone 
is produced from the same source as oxytocin (posterior putuitary 
glad).  Perhaps this was why the contractions dropped off.

Why not let the woman herself dictate what she was drinking?  As a 
rough guide, about 1 cup of fluid  per hour is often suggested.  The 
ketones in her urine (unless they are alarmingly high) are a sign 
that her body is working well and mobilising her fat stores to give 
her energy etc for labour.

I agree that the "rest and be thankful" stage is often misunderstood 
- if a woman is lucky enough to get a break, especially in a strong 
labour, then she should not be robbed of it!  I deliberately put this 
stage on the new Birth Day panels that I developed for teaching about 
second stage, because it is often
glossed over in classes and women don't know about it.

It is fantastic that you are seeking answers to these questions - 
that's the best way to learn - from experience!

Warm regards,

Andrea


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Visit  to subscribe or unsubscribe.

Re: [ozmidwifery] Wounds

[Janet Fraser]

I haven't seen research but I'd be interested. It seems counterintuitive to
me to blow dry a perineum. I imagine we have a sensible built in healing
system that's used to a normally lubricated genital area. The c-sec wound
still gives me trouble now and then thanks to my built in apron so that's
more a case for drying, I'd think. Looking forward to some evidence : )
J
- Original Message - 
From: "brendamanning" <[EMAIL PROTECTED]>
To: ; <[EMAIL PROTECTED]>
Sent: Friday, October 06, 2006 1:04 PM
Subject: [ozmidwifery] Wounds


Apologies for the x posting.

Have a query on behalf of a colleague.
Does anyone know of any research regarding the use of warm air (ie hair
driers) to help heal peri & abdo wounds.
We did it years ago & it went "out" possibly with the moist wound healing
phase. She is after actual research for evidence based prac, has googled &
MIDIRd for it but nothing so far.

I will ask our skin integrity nurse too.
Any research you all know of ?

With kind regards
Brenda Manning
www.themidwife.com.au

--
This mailing list is sponsored by ACE Graphics.
Visit  to subscribe or unsubscribe.

RE: [ozmidwifery] No Contractions

[Mary Murphy]

Hi Lisa, there was definitely no intent of
implied criticism when I said “no should haves”.  Just a reminder
that we beat up on ourselves all the time .  “OH maybe I should have,
shouldn’t have”. etc.  We each have to respond to the best of our
clinical judgment, in the way we see it, at the time.  It is hard to say “I
would do this when” because there is no hard and fast rule, just that
rush of adrenalin and a sense of alarm that makes us act.    Sorry I can’t
elaborate further. I agree about the fluids.  In fact quite a while ago I read
some articles about the presence of keytones being normal in labour.  sorry can’t
remember where. MM

 









From: owner-ozmidwifery@acegraphics.com.au
[mailto:owner-ozmidwifery@acegraphics.com.au]
On Behalf Of Lisa Barrett
Sent: Friday, 6 October 2006 1:19
PM
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] No
Contractions



 



Sorry Mary If my language inferred "should have"
but when would you get a woman to push without a contraction?. Exception maybe
breech out to nape of neck with worries about the baby's condition.





 





IV fluids doesn't constitute any part of normal physiological
labour unless I've missed something vital.





 





When asked for opinion in future I will refrain from giving
any unless my language is less confrontational.





Lisa Barrett







- Original Message - 





From: Mary Murphy






To: ozmidwifery@acegraphics.com.au 





Sent: Friday, October
06, 2006 8:17 AM





Subject: RE: [ozmidwifery]
No Contractions





 





Di, It sounds as tho you managed a
difficult situation in the best way you knew, and that is all one can do. 
You are now seeking to learn from it and we will obviously give you tips based
on our experiences.  Don’t feel that you “should have
“etc.  Many midwifery authors in all kinds of natural birthing
magazines like Midwifery Today etc, have spoken about the “rest and
recovery stage” where the body needs to gather its strength for the final
stage.  It usually happens at the end of a demanding first stage and the
woman showing signs of tiredness. I am old enough to remember doctors saying
“turn her on her side and give her a rest, Sis”, in a time when IV
fluids, synto drip and epidurals were available but not used so aggressively.
 At the transition between the first and second stage in a primip, the
 urge to push with each contraction needs to be resisted for a little
while and breathed through, so that there is no pushing on a cervix that is not
completely out of the way. We often can’t reach that little bit at the
back, but it is still there. We talk of an anterior lip, but there can be a
posterior one too.   The urge to push is triggered by the baby
putting pressure on the nerves, even tho there is still a lip etc. 
Pushing without contractions is not usually the most productive thing, but as I
said, you handled it the best way you knew how.remeber the discussion
on”undirected pushing”?  I am sure you will get lots of tips
which will help us all in our practice no matter where we are. Cheers, MM

RE: [ozmidwifery] No Contractions

[Lisa Gierke]

In defence of Di...she obviously works in a hospital with registrar
potentially hanging around the door..Sometimes 'best practice' may need to
be modified to prevent the women from ending up with an instrumental
birth..or synto...or an epidural ..or even a CS The lesser of two
evils. The docs are not going to tolerate a 'rest & be thankful' stage going
on for hours espeically with decels in the fh!! (Yep even hospital midwives
know about rest & be thankful)So lets give her a break ...and walk in her
shoes for abit heh!
Does anyone think the contrations may have dropped of simply because she had
a big baby and she was tired? Sounds like a more likely scenario to me than
theories about overloading.
Lisa




Hi  Di,

Just a point on fluids in labour - if a woman is overloaded with 
fluid (via a drip) her system,  vasopressin (antidiuretic hormone) 
will kick in to stop her body being flooded with fluid.  This hormone 
is produced from the same source as oxytocin (posterior putuitary 
glad).  Perhaps this was why the contractions dropped off.

Why not let the woman herself dictate what she was drinking?  As a 
rough guide, about 1 cup of fluid  per hour is often suggested.  The 
ketones in her urine (unless they are alarmingly high) are a sign 
that her body is working well and mobilising her fat stores to give 
her energy etc for labour.

I agree that the "rest and be thankful" stage is often misunderstood 
- if a woman is lucky enough to get a break, especially in a strong 
labour, then she should not be robbed of it!  I deliberately put this 
stage on the new Birth Day panels that I developed for teaching about 
second stage, because it is often
glossed over in classes and women don't know about it.

It is fantastic that you are seeking answers to these questions - 
that's the best way to learn - from experience!

Warm regards,

Andrea


--
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Re: [ozmidwifery] No Contractions

[Lisa Barrett]

Sorry Mary If my language inferred "should have" 
but when would you get a woman to push without a contraction?. Exception maybe 
breech out to nape of neck with worries about the baby's condition.
 
IV fluids doesn't constitute any part of normal 
physiological labour unless I've missed something vital.
 
When asked for opinion in future I will refrain 
from giving any unless my language is less confrontational.
Lisa Barrett

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Friday, October 06, 2006 8:17 
  AM
  Subject: RE: [ozmidwifery] No 
  Contractions
  
  
  
  Di, It sounds as tho 
  you managed a difficult situation in the best way you knew, and that is all 
  one can do.  You are now seeking to learn from it and we will obviously 
  give you tips based on our experiences.  Don’t feel that you “should have 
  “etc.  Many midwifery authors in all kinds of natural birthing magazines 
  like Midwifery Today etc, have spoken about the “rest and recovery stage” 
  where the body needs to gather its strength for the final stage.  It 
  usually happens at the end of a demanding first stage and the woman showing 
  signs of tiredness. I am old enough to remember doctors saying “turn her on 
  her side and give her a rest, Sis”, in a time when IV fluids, synto drip and 
  epidurals were available but not used so aggressively.  At the transition 
  between the first and second stage in a primip, the  urge to push with 
  each contraction needs to be resisted for a little while and breathed through, 
  so that there is no pushing on a cervix that is not completely out of the way. 
  We often can’t reach that little bit at the back, but it is still there. We 
  talk of an anterior lip, but there can be a posterior one too.   The 
  urge to push is triggered by the baby putting pressure on the nerves, even tho 
  there is still a lip etc.  Pushing without contractions is not usually 
  the most productive thing, but as I said, you handled it the best way you knew 
  how.remeber the discussion on”undirected pushing”?  I am sure you will 
  get lots of tips which will help us all in our practice no matter where we 
  are. Cheers, 
MM

RE: [ozmidwifery] No Contractions

[B & G]

Hi,
Thanks for that point Andrea because I had the opposite where I had
really encouraged oral fluids and dietary intake. 
I had a young primip T+3 who experienced spurious labour for 2 days,
visiting BS each day 'just in case', on the beginning of her 3rd
presentation she was admitted given Pethidine and temazepam to settle at
2030 primarily because she was tired on her feet and I suppose people
felt sorry.
Anyway I have a phone call at home 0100 she was up in BS labouring. On
arrival- 2:10 mild/mod very excited and very awake with very heavy
eyelids. I reassessed settled her again encouraging sleep etc but what
really got me was the foetal heart. The rate was already sitting on 154
baseline. Thinking needing rehydration gave her a full jug of water and
encouraged her to maintain her fluids, was given breakfast, an another
jug after breakfast was given for her -no change in contractions
pattern.
Took her case to team review and I am sorry to say but I am the firm
believer 3rd presentation to BS is a warning 'time for baby out',
listening to that message with her permission a decision was made to
augment and get her going. I again mentioned to the consultant the
foetal heart baseline being high for post dates- why?
To cut a long story short after these -ARM, epidural, IV fluids, synto,
foetal HR now with baseline 162 and Cx 5 cm when I left for my fellow
Team Midwife following me after 12 hours with her. She required Vaccum 3
1/2 hours later as the FH at rocketed up to 180 - 200 and she was fully.
Indication Foetal Distress with a summation for the foetal tachy being
she was dehydrated!
I too am a believer that the women 'know' when to drink and eat and I
really encourage this.
Any suggestion why to this scenario?
Barb


-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Andrea
Robertson
Sent: Friday, 6 October 2006 11:56 AM
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] No Contractions


Hi  Di,

Just a point on fluids in labour - if a woman is overloaded with 
fluid (via a drip) her system,  vasopressin (antidiuretic hormone) 
will kick in to stop her body being flooded with fluid.  This hormone 
is produced from the same source as oxytocin (posterior putuitary 
glad).  Perhaps this was why the contractions dropped off.

Why not let the woman herself dictate what she was drinking?  As a 
rough guide, about 1 cup of fluid  per hour is often suggested.  The 
ketones in her urine (unless they are alarmingly high) are a sign 
that her body is working well and mobilising her fat stores to give 
her energy etc for labour.

I agree that the "rest and be thankful" stage is often misunderstood 
- if a woman is lucky enough to get a break, especially in a strong 
labour, then she should not be robbed of it!  I deliberately put this 
stage on the new Birth Day panels that I developed for teaching about 
second stage, because it is often
glossed over in classes and women don't know about it.

It is fantastic that you are seeking answers to these questions - 
that's the best way to learn - from experience!

Warm regards,

Andrea

At 07:24 PM 5/10/2006, you wrote:
>Hi Wise women,
>Just want to throw this out there for comments/suggestions. Had a
>birth the other night that was a bit worrying at the time. Good 
>outcome lovely 4200g baby girl. Mum (primip) had SROM at clinic 
>visit at 830 am then went home and established at about 1630, came 
>in contracting moderately at 1900hrs was 4-5cm , I took over her 
>care at 2000hrs. Lovely very motivated mum, well read and attended 
>classes, well supported by partner and mum and mum in law and 
>sister. Ctx hotted up to 3-4 minutely and stronger, was drinking 
>well but had a few small vomits, and next UA showed small ketones 
>and SG 1.030, but was still drinking well and ctx remained strong 
>and regular so didnt want to put in a cannula. VE at 1130 showed an 
>anterior lip, still a bit thick. Wasnt able to wee again after that 
>but head was well down.
>
>Was actively pushing with some ctx at 0100 with signs of full
>dilatation (nice purple line!) Contractions really started to drop 
>off, became about 4minutely and only about 20secs of good strength. 
>Mum getting quite tired at this stage but more focussed and excited 
>than earlier. At this point I did put up some fluids as I thought 
>with the ctx dropping off combined with her fatigue she might need 
>some hydration. She pushed babe up to on view (birth stool) but made 
>little more progress over next 20mins or so. Fluids running in flat 
>out but no sign of increased ctx. Babes HR started to drop to around 
>80 which at first had good recovery , so I wasn't too worried but 
>after a while were staying there for a minute or so each time before 
>climbing back to 100. At this point with encouragement she managed 
>to push bub up to almost crowning and that was the last of the 
>contractions!!! Obviously not easy to get FH at this stage but was 
>quite low and stay

Re: [ozmidwifery] Wounds

[Jan Robinson]

Hi Brenda and all
My clients always self-manage their wounds with warm air from their dryer.
How much enhancement of healing occurs I do not know, but I DO know that each and every one of them reports that it is SO SOOTHING ...  they never dab their wound with anything at all.
Cheers
Jan
Jan Robinson Independent Midwife Practitioner
National Coordinator  Australian Society of Independent Midwives
8 Robin Crescent   South Hurstville   NSW   2221 Phone/Fax: 02 9546 4350
e-mail address: <[EMAIL PROTECTED]>  website: www.midwiferyeducation.com.au
On 6 Oct, 2006, at 13:04, brendamanning wrote:

Apologies for the x posting.

Have a query on behalf of a colleague.
Does anyone know of any research regarding the use of warm air (ie hair driers) to help heal peri & abdo wounds. 
We did it years ago & it went "out" possibly with the moist wound healing phase. She is after actual research for evidence based prac, has googled & MIDIRd for it but nothing so far.

I will ask our skin integrity nurse too.
Any research you all know of ?

With kind regards
Brenda Manning 
www.themidwife.com.au
<[EMAIL PROTECTED]>

[ozmidwifery] Wounds

[brendamanning]

Apologies for the x posting.

Have a query on behalf of a colleague.
Does anyone know of any research regarding the use of warm air (ie hair driers) 
to help heal peri & abdo wounds. 
We did it years ago & it went "out" possibly with the moist wound healing 
phase. She is after actual research for evidence based prac, has googled & 
MIDIRd for it but nothing so far.

I will ask our skin integrity nurse too.
Any research you all know of ?

With kind regards
Brenda Manning 
www.themidwife.com.au
BEGIN:VCARD
VERSION:2.1
N:;[EMAIL PROTECTED]
FN:[EMAIL PROTECTED]
ORG:themidwife
TEL;HOME;VOICE:0359862535
TEL;CELL;VOICE:0409194623
TEL;HOME;FAX:0359862535
EMAIL;PREF;INTERNET:[EMAIL PROTECTED]
REV:20061006T030430Z
END:VCARD

Re: [ozmidwifery] No Contractions

[Michelle Windsor]

Hi Di,     This reminds me of scenario that a cousin of mine had with her second bub.  Her contractions basically stopped I think when she was fully and she did end up having some synto to get them going again.  But what had happened was that the midwife (who said she could have bitten her tongue as soon as she said it!) said to her that she would probably have to work hard as she had a good size baby on board.  My cousin said that she became really frightened and the contractions just died.  I wonder if there was anything holding your woman back?  Although you said she seemed excited and focussed.     As far as her pushing without contractions, I think if you have a fetal bradycardia and possibly a compromised bub then it becomes priority to get the baby out. It might just be head compression, but it might not.       Cheers  Michelle 
    diane <[EMAIL PROTECTED]> wrote:  Hi Wise women,  Just want to throw this out there for comments/suggestions. Had a birth the other night that was a bit worrying at the time. Good outcome lovely 4200g baby girl. Mum (primip) had SROM at clinic visit at 830 am then went home and established at about 1630, came in contracting moderately at 1900hrs was 4-5cm , I took over her care at 2000hrs. Lovely very motivated mum, well read and attended classes, well supported by partner and mum and mum in law and sister. Ctx hotted up to 3-4 minutely and stronger, was drinking well but had a few small vomits, and next UA showed small ketones and SG 1.030, but was still drinking
 well and ctx remained strong and regular so didnt want to put in a cannula. VE at 1130 showed an anterior lip, still a bit thick. Wasnt able to wee again after that but head was well down.      Was actively pushing with some ctx at 0100 with signs of full dilatation (nice purple line!) Contractions really started to drop off, became about 4minutely and only about 20secs of good strength. Mum getting quite tired at this stage but more focussed and excited than earlier. At this point I did put up some fluids as I thought with the ctx dropping off combined with her fatigue she might need some hydration. She pushed babe up to on view (birth stool) but made little more progress over next 20mins or so. Fluids running in flat out but no sign of increased ctx. Babes HR started to drop to around 80 which at first had good recovery , so I wasn't too worried but after a while were staying there
 for a minute or so each time before climbing back to 100. At this point with encouragement she managed to push bub up to almost crowning and that was the last of the contractions!!! Obviously not easy to get FH at this stage but was quite low and staying there. She had not much strength left as she had done much of the work without help of ctx.      With a few position changes she got a little more head out but then seemed to only move millimeter by millimetercolour was ok eventually after what seemed like 10 minutes I managed to push the peri back to get a chin...then nothing no ctx...mum managed to push a little and I got her to move from kneeling to standing then one leg up on bedstill nothing... went onto bed and there was some movement with maternal effort (the last of it!) the body birthed over almost three minutes, it was a pretty tight fit with the shoulders coming
 in the lateral position, when a shoulder appeared I gave it a push with two fingers to the anterior it moved just a little into the oblique but then was finally out far enough for me to get a little finger under the arm and finally managed to get her out!  Apgars 7 and 10. but as it was so slow and there were no ctx to assist with her being a big bub too, It was a bit hairy for a little while. Lucky she didnt have big enough ears or they might have ended up a little stretched!! LOL.  Second stage was only 1hr 45min but I felt it was just way too slow birthing that head and those shoulders! Perhaps I should have been more trusting?? I hesitated in calling the Doc after an hour of pushing cause was on view at this stage and I thought he would have been too late by the time he came in. Probably would  have been better to have him on standby just in case, I suppose. I just felt quite helpless and know that things ended up quite stressful for everyone in the
 room. I think I would have prefered to deal with a shoulder dystocia at least then I would have had a practiced sequence of events to go through!!     Thought she might get away without a tear as birthed sooo slowly but peri went with the shoulders, 2nd degree peri tear (no too big) and a anterior labial that wasnt too bad either.(thank goodness, was after 3am by then, that time of night where you see double!) Did have synto at birth but needed to get her to squat to get placenta and had a constant trickle and (surprise surprise) a relaxed uterus, which was fine after another shot of Syntometrine (450 loss).     My feelings are I probably should have been a little more pro active in getting

Re: [ozmidwifery] No Contractions

[Andrea Robertson]

Hi  Di,

Just a point on fluids in labour - if a woman is overloaded with 
fluid (via a drip) her system,  vasopressin (antidiuretic hormone) 
will kick in to stop her body being flooded with fluid.  This hormone 
is produced from the same source as oxytocin (posterior putuitary 
glad).  Perhaps this was why the contractions dropped off.


Why not let the woman herself dictate what she was drinking?  As a 
rough guide, about 1 cup of fluid  per hour is often suggested.  The 
ketones in her urine (unless they are alarmingly high) are a sign 
that her body is working well and mobilising her fat stores to give 
her energy etc for labour.


I agree that the "rest and be thankful" stage is often misunderstood 
- if a woman is lucky enough to get a break, especially in a strong 
labour, then she should not be robbed of it!  I deliberately put this 
stage on the new Birth Day panels that I developed for teaching about 
second stage, because it is often

glossed over in classes and women don't know about it.

It is fantastic that you are seeking answers to these questions - 
that's the best way to learn - from experience!


Warm regards,

Andrea

At 07:24 PM 5/10/2006, you wrote:

Hi Wise women,
Just want to throw this out there for comments/suggestions. Had a 
birth the other night that was a bit worrying at the time. Good 
outcome lovely 4200g baby girl. Mum (primip) had SROM at clinic 
visit at 830 am then went home and established at about 1630, came 
in contracting moderately at 1900hrs was 4-5cm , I took over her 
care at 2000hrs. Lovely very motivated mum, well read and attended 
classes, well supported by partner and mum and mum in law and 
sister. Ctx hotted up to 3-4 minutely and stronger, was drinking 
well but had a few small vomits, and next UA showed small ketones 
and SG 1.030, but was still drinking well and ctx remained strong 
and regular so didnt want to put in a cannula. VE at 1130 showed an 
anterior lip, still a bit thick. Wasnt able to wee again after that 
but head was well down.


Was actively pushing with some ctx at 0100 with signs of full 
dilatation (nice purple line!) Contractions really started to drop 
off, became about 4minutely and only about 20secs of good strength. 
Mum getting quite tired at this stage but more focussed and excited 
than earlier. At this point I did put up some fluids as I thought 
with the ctx dropping off combined with her fatigue she might need 
some hydration. She pushed babe up to on view (birth stool) but made 
little more progress over next 20mins or so. Fluids running in flat 
out but no sign of increased ctx. Babes HR started to drop to around 
80 which at first had good recovery , so I wasn't too worried but 
after a while were staying there for a minute or so each time before 
climbing back to 100. At this point with encouragement she managed 
to push bub up to almost crowning and that was the last of the 
contractions!!! Obviously not easy to get FH at this stage but was 
quite low and staying there. She had not much strength left as she 
had done much of the work without help of ctx.


With a few position changes she got a little more head out but then 
seemed to only move millimeter by millimetercolour was ok 
eventually after what seemed like 10 minutes I managed to push the 
peri back to get a chin...then nothing no ctx...mum managed to push 
a little and I got her to move from kneeling to standing then one 
leg up on bedstill nothing... went onto bed and there was some 
movement with maternal effort (the last of it!) the body birthed 
over almost three minutes, it was a pretty tight fit with the 
shoulders coming in the lateral position, when a shoulder appeared I 
gave it a push with two fingers to the anterior it moved just a 
little into the oblique but then was finally out far enough for me 
to get a little finger under the arm and finally managed to get her 
out!  Apgars 7 and 10. but as it was so slow and there were no ctx 
to assist with her being a big bub too, It was a bit hairy for a 
little while. Lucky she didnt have big enough ears or they might 
have ended up a little stretched!! LOL.  Second stage was only 1hr 
45min but I felt it was just way too slow birthing that head and 
those shoulders! Perhaps I should have been more trusting?? I 
hesitated in calling the Doc after an hour of pushing cause was on 
view at this stage and I thought he would have been too late by the 
time he came in. Probably would  have been better to have him on 
standby just in case, I suppose. I just felt quite helpless and know 
that things ended up quite stressful for everyone in the room. I 
think I would have prefered to deal with a shoulder dystocia at 
least then I would have had a practiced sequence of events to go through!!


Thought she might get away without a tear as birthed sooo slowly but 
peri went with the shoulders, 2nd degree peri tear (no too big) and 
a anterior labial that wasnt too bad either.(thank goodness, was 
after 

RE: [ozmidwifery] No Contractions

[Grant and Louise McLeod]

I'm not that old ! early 40something
but when I did midi we called it the "rest and be thankful stage" . It seemed to go out of fashion! with "quick get the synto up".
Now women ( if they're not private and have a doctor hovering) again have that little rest and then get on with it.
 
Louise
rural NSW
 
 
[EMAIL PROTECTED]
---Original Message---
 

From: ozmidwifery@acegraphics.com.au
Date: 10/06/06 09:02:53
To: ozmidwifery@acegraphics.com.au
Subject: RE: [ozmidwifery] No Contractions
 
 
Mary M said:
 
  "I am old enough to remember doctors saying "turn her on her side and give
her a rest, Sis", in a time when IV fluids, synto drip and epidurals were
available but not used so aggressively."
 
 
Wow, doctors actually said that...you must be joshing us Mary!! In our place
the synto would be waved around
 
 
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RE: [ozmidwifery] No Contractions

[Lisa Gierke]

Mary M said: 

 "I am old enough to remember doctors saying "turn her on her side and give
her a rest, Sis", in a time when IV fluids, synto drip and epidurals were
available but not used so aggressively." 


Wow, doctors actually said that...you must be joshing us Mary!! In our place
the synto would be waved around 


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RE: [ozmidwifery] No Contractions

[Mary Murphy]

Di, It sounds as tho you managed a
difficult situation in the best way you knew, and that is all one can do. 
You are now seeking to learn from it and we will obviously give you tips based
on our experiences.  Don’t feel that you “should have “etc. 
Many midwifery authors in all kinds of natural birthing magazines like
Midwifery Today etc, have spoken about the “rest and recovery stage”
where the body needs to gather its strength for the final stage.  It
usually happens at the end of a demanding first stage and the woman showing signs
of tiredness. I am old enough to remember doctors saying “turn her on her
side and give her a rest, Sis”, in a time when IV fluids, synto drip and
epidurals were available but not used so aggressively.  At the transition
between the first and second stage in a primip, the  urge to push with
each contraction needs to be resisted for a little while and breathed through,
so that there is no pushing on a cervix that is not completely out of the way.
We often can’t reach that little bit at the back, but it is still there. We
talk of an anterior lip, but there can be a posterior one too.   The urge
to push is triggered by the baby putting pressure on the nerves, even tho there
is still a lip etc.  Pushing without contractions is not usually the most
productive thing, but as I said, you handled it the best way you knew how.remeber
the discussion on”undirected pushing”?  I am sure you will get
lots of tips which will help us all in our practice no matter where we are. Cheers,
MM

Re: [ozmidwifery] No Contractions

[Lisa Barrett]

Sounds to me like this woman needed rest and 
carbohydrates when she had a rim.   Her body was telling you she 
needed a rest before she could get this baby moving.  This may have 
prevented any stress on her or her baby.
You said::   

  !!! Obviously not easy to get FH at this stage 
  but was quite low and staying there. She had not much strength left as she had 
  done much of the work without help of ctx. 
   
   
  She shouldn't have had to push without any 
  contrations.
   
  Lisa Barrett
   

[ozmidwifery] Wound management

[BrendaManning]

Hi Wise women,

Is there any evidence based research re the drying of wounds perineal or 
abdominal with hairdryers ?
Effective or not ?
Question within the unit.
I will ask the skin-integrity specialist also.

Thanks
Brenda
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[ozmidwifery] No Contractions

[diane]

Hi Wise women,
Just want to throw this out there for 
comments/suggestions. Had a birth the other night that was a bit worrying at the 
time. Good outcome lovely 4200g baby girl. Mum (primip) had SROM at clinic 
visit at 830 am then went home and established at about 1630, came in 
contracting moderately at 1900hrs was 4-5cm , I took over her care at 2000hrs. 
Lovely very motivated mum, well read and attended classes, well supported by 
partner and mum and mum in law and sister. Ctx hotted up to 3-4 minutely and 
stronger, was drinking well but had a few small vomits, and next UA showed small 
ketones and SG 1.030, but was still drinking well and ctx remained strong and 
regular so didnt want to put in a cannula. VE at 1130 showed an anterior lip, 
still a bit thick. Wasnt able to wee again after that but head was well down. 

 
Was actively pushing with some ctx at 0100 with 
signs of full dilatation (nice purple line!) Contractions really started to drop 
off, became about 4minutely and only about 20secs of good strength. Mum getting 
quite tired at this stage but more focussed and excited than earlier. At this 
point I did put up some fluids as I thought with the ctx dropping off combined 
with her fatigue she might need some hydration. She pushed babe up to on view 
(birth stool) but made little more progress over next 20mins or so. Fluids 
running in flat out but no sign of increased ctx. Babes HR started to drop to 
around 80 which at first had good recovery , so I wasn't too worried but after a 
while were staying there for a minute or so each time before climbing back to 
100. At this point with encouragement she managed to push bub up to almost 
crowning and that was the last of the contractions!!! Obviously not easy to get 
FH at this stage but was quite low and staying there. She had not much strength 
left as she had done much of the work without help of ctx. 
 
With a few position changes she got a little more 
head out but then seemed to only move millimeter by millimetercolour was 
ok eventually after what seemed like 10 minutes I managed to push the peri 
back to get a chin...then nothing no ctx...mum managed to push a little and I 
got her to move from kneeling to standing then one leg up on bedstill 
nothing... went onto bed and there was some movement with maternal effort (the 
last of it!) the body birthed over almost three minutes, it was a pretty tight 
fit with the shoulders coming in the lateral position, when a shoulder appeared 
I gave it a push with two fingers to the anterior it moved just a little into 
the oblique but then was finally out far enough for me to get a little finger 
under the arm and finally managed to get her out!  Apgars 7 and 10. but as 
it was so slow and there were no ctx to assist with her being a big bub too, It 
was a bit hairy for a little while. Lucky she didnt have big enough ears or they 
might have ended up a little stretched!! LOL.  Second stage was only 1hr 
45min but I felt it was just way too slow birthing that head and those 
shoulders! Perhaps I should have been more trusting?? I hesitated in calling the 
Doc after an hour of pushing cause was on view at this stage and I thought he 
would have been too late by the time he came in. Probably would  have been 
better to have him on standby just in case, I suppose. I just felt quite 
helpless and know that things ended up quite stressful for everyone in the room. 
I think I would have prefered to deal with a shoulder dystocia at least then I 
would have had a practiced sequence of events to go through!!
 
Thought she might get away without a tear as 
birthed sooo slowly but peri went with the shoulders, 2nd degree peri tear (no 
too big) and a anterior labial that wasnt too bad either.(thank goodness, was 
after 3am by then, that time of night where you see double!) Did have synto 
at birth but needed to get her to squat to get placenta and had a constant 
trickle and (surprise surprise) a relaxed uterus, which was fine after another 
shot of Syntometrine (450 loss).
 
My feelings are I probably should have been a 
little more pro active in getting the fluids up, maybe I erred on the non 
intervention side a little too long. Any other suggestions, how do you get a bub 
out with no Ctx and a tired mum? She did try nipple stimulation with little 
effect too.
Cheers
Di

Re: [ozmidwifery] FW: Headline - Birth rights for men

[Janet Fraser]

Yay for David!
J
- Original Message - 
From: "diane" <[EMAIL PROTECTED]>
To: 
Sent: Thursday, October 05, 2006 6:31 PM
Subject: Re: [ozmidwifery] FW: Headline - Birth rights for men


> the readers comments generated from this article are a great read, 
> everything from C/S to freebirth, wow!!!
> Di
> - Original Message - 
> From: <[EMAIL PROTECTED]>
> To: 
> Sent: Thursday, October 05, 2006 5:53 PM
> Subject: [ozmidwifery] FW: Headline - Birth rights for men
> 
> 
> > Congratulations to David Vernon and the college on "Men at Birth" - 
> > article
> > from the SMH attached
> >
> > 
> 
> 
> --
> This mailing list is sponsored by ACE Graphics.
> Visit  to subscribe or unsubscribe.
> 
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Re: [ozmidwifery] FW: Headline - Birth rights for men

[diane]

the readers comments generated from this article are a great read, 
everything from C/S to freebirth, wow!!!

Di
- Original Message - 
From: <[EMAIL PROTECTED]>

To: 
Sent: Thursday, October 05, 2006 5:53 PM
Subject: [ozmidwifery] FW: Headline - Birth rights for men


Congratulations to David Vernon and the college on "Men at Birth" - 
article

from the SMH attached





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[ozmidwifery] FW: Headline - Birth rights for men

[otwaygreens]

Congratulations to David Vernon and the college on "Men at Birth" - article
from the SMH attached 

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Dear sally brown,

You have been sent this article link by sally-anne brown courtesy of smh.com.au

Personal Message: 

Birth rights for men
Clive Hopkins
September 28, 2006 - 1:24PM

To view the entire article, click on: 
http://www.smh.com.au/articles/2006/09/28/1159337265439.html


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