Re: [ozmidwifery] birth and mental health
HI Sue Recently worked with a woman who has been on Lithium for many years. Pregnant with her first and on advice had chosen to remain on this throughout pregnancy and also chose not to breastfeed and quite happy with this decision as she wanted to stay 'stable normal' (her words). Following birth we kept a close eye on the infant for any signs of toxicity- there were none and they went home after an uneventful hospital stay.When I last caught up with five weeks after birth, she was really pleased with her whole pregnancy/birthing/parenting (so far) experience. Especially pleased with her ability to care for her infant as she had severe doubts about this prior to birth. Reflecting on her experience I see many areas where I would have made different choices, but was once again was reminded that the journey truly is for each woman to make her own Cheers (and congratulations) Alesa Alesa Koziol Clinical Midwifery Educator Melbourne - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, January 03, 2007 6:03 PM Subject: [ozmidwifery] birth and mental health Hi, Do any of you have stories relating to the use of Lexapro and Lithium (two different women) and birth - particularly homebirths. Would appreciate any feedback re outcomes and neonatal well being. Also how the women manage their medication both pre and post birth. As usual there is a lot of info out thereand a lot of it conflicting, Thanks, Sue -- 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] Premature birth risks of loop diathermy
Womb cell op 'raises birth risk' The most common operation to remove abnormal cervical cells raises the risk of giving birth early, experts say. A study of 5,000 Australian women found when a heated wire, loop diathermy, was used the risk rose substantially. Young women should not automatically have diathermy, the British Journal of Obstetrics and Gynaecology (BJOG) says. UK experts said abandoning the treatment could mean up to 1,500 fewer premature births a year - and they said doctors should consider alternatives. Last year, more than 3.3 million women in the UK underwent screening, and just over 1% of these had clear changes in the cells lining the cervix. Women need to know about the risks involved and discuss alternative treatments with their gynaecologist, before going ahead with a procedure that increases the risk of pre-term birth Phil Steer BJOG Women with severe changes in these cells are at higher risk of going on to develop cervical cancer at some point, and are often referred to hospital to have them removed. Increased risk There are three main ways of doing this, two of which - cone biopsy and loop diathermy - can remove relatively large amounts of tissue from the cervix. Cone biopsy is now used only rarely in the UK. The third - called laser ablation - destroys just the abnormal surface cells. While other studies have already made a link between loop diathermy and premature birth, the Australian research, from Melbourne University and Royal Women's Hospital in Australia, is the largest yet. It found that having had abnormal cells, regardless of the method of removal, increased the risk of having a premature baby, but having either loop diathermy or cone biopsy raised that risk even further. Only the laser ablation technique - in the UK more commonly used on women with very mild cell changes - did not increase the chance of a premature baby. Babies born prematurely - before 37 weeks pregnancy - are at increased risk of a variety of health problems. Practical problems The researchers said that doctors should consider using alternatives to loop diathermy in women of childbearing age, and that women should be made fully aware of the risks before undergoing the procedure. Phil Steer, editor of the BJOG said: Women need to know about the risks involved and discuss alternative treatments with their gynaecologist, before going ahead with a procedure that increases the risk of pre-term birth. Dr Margaret Cruickshank, a senior lecturer in obstetrics and gynaecology at Aberdeen University, said that the vast majority of UK women with abnormal cells currently received diathermy rather than ablation. She said there would be huge practical difficulties and expense involved in hospitals abandoning it. The key thing appears to be the volume of tissue removed, and we need to find out in more detail the relationship between this and the risk of preterm birth. She said that the main advantage of diathermy was that it produced a sample of tissue which could be removed and analysed in the laboratory to make sure a cancer had not been missed, whereas ablation destroyed the tissue. Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6227555.stm Published: 2007/01/03 11:57:27 GMT © BBC MMVII news_logo.gif Description: GIF image
Re: [ozmidwifery] birth and mental health
Thanks Alesa. Can you share the thoughts you had about what other choices you know to be available to women on Lithium? Particluarly interested in breastfeeding ... The woman I am seeing has no issues about her ability to cope with motherhood and is very well supported - just trying to work through the options re place of birth, level of back-up, breastfeeding - if so would comp feeding or milk banking be necessary/beneficial? Thankyou, Sue HI Sue Recently worked with a woman who has been on Lithium for many years. Pregnant with her first and on advice had chosen to remain on this throughout pregnancy and also chose not to breastfeed and quite happy with this decision as she wanted to stay 'stable normal' (her words). Following birth we kept a close eye on the infant for any signs of toxicity- there were none and they went home after an uneventful hospital stay.When I last caught up with five weeks after birth, she was really pleased with her whole pregnancy/birthing/parenting (so far) experience. Especially pleased with her ability to care for her infant as she had severe doubts about this prior to birth. Reflecting on her experience I see many areas where I would have made different choices, but was once again was reminded that the journey truly is for each woman to make her own Cheers (and congratulations) Alesa Alesa Koziol Clinical Midwifery Educator Melbourne - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, January 03, 2007 6:03 PM Subject: [ozmidwifery] birth and mental health Hi, Do any of you have stories relating to the use of Lexapro and Lithium (two different women) and birth - particularly homebirths. Would appreciate any feedback re outcomes and neonatal well being. Also how the women manage their medication both pre and post birth. As usual there is a lot of info out thereand a lot of it conflicting, Thanks, Sue -- 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. __ NOD32 1.1454 (20060321) Information __ This message was checked by NOD32 antivirus system. http://www.nod32.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Premature birth risks of loop diathermy
Hello wise women, Does anyone know the probability of having a pre-term birth or miscarriage in women who have previously undergone a LLETZ procedure? I asked an ob at our hospital and couldn't get a straight answer. Ta Tiff :-) BBC NEWS Womb cell op 'raises birth risk' The most common operation to remove abnormal cervical cells raises the risk of giving birth early, experts say. A study of 5,000 Australian women found when a heated wire, loop diathermy, was used the risk rose substantially. Young women should not automatically have diathermy, the British Journal of Obstetrics and Gynaecology (BJOG) says. UK experts said abandoning the treatment could mean up to 1,500 fewer premature births a year - and they said doctors should consider alternatives. Last year, more than 3.3 million women in the UK underwent screening, and just over 1% of these had clear changes in the cells lining the cervix. Women need to know about the risks involved and discuss alternative treatments with their gynaecologist, before going ahead with a procedure that increases the risk of pre-term birth Phil Steer BJOG Women with severe changes in these cells are at higher risk of going on to develop cervical cancer at some point, and are often referred to hospital to have them removed. Increased risk There are three main ways of doing this, two of which - cone biopsy and loop diathermy - can remove relatively large amounts of tissue from the cervix. Cone biopsy is now used only rarely in the UK. The third - called laser ablation - destroys just the abnormal surface cells. While other studies have already made a link between loop diathermy and premature birth, the Australian research, from Melbourne University and Royal Women's Hospital in Australia, is the largest yet. It found that having had abnormal cells, regardless of the method of removal, increased the risk of having a premature baby, but having either loop diathermy or cone biopsy raised that risk even further. Only the laser ablation technique - in the UK more commonly used on women with very mild cell changes - did not increase the chance of a premature baby. Babies born prematurely - before 37 weeks pregnancy - are at increased risk of a variety of health problems. Practical problems The researchers said that doctors should consider using alternatives to loop diathermy in women of childbearing age, and that women should be made fully aware of the risks before undergoing the procedure. Phil Steer, editor of the BJOG said: Women need to know about the risks involved and discuss alternative treatments with their gynaecologist, before going ahead with a procedure that increases the risk of pre-term birth. Dr Margaret Cruickshank, a senior lecturer in obstetrics and gynaecology at Aberdeen University, said that the vast majority of UK women with abnormal cells currently received diathermy rather than ablation. She said there would be huge practical difficulties and expense involved in hospitals abandoning it. The key thing appears to be the volume of tissue removed, and we need to find out in more detail the relationship between this and the risk of preterm birth. She said that the main advantage of diathermy was that it produced a sample of tissue which could be removed and analysed in the laboratory to make sure a cancer had not been missed, whereas ablation destroyed the tissue. Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6227555.stm Published: 2007/01/03 11:57:27 GMT C BBC MMVII image001.gif Description: GIF image
Re: [ozmidwifery] birth and mental health
Sue, I was a psych nurse for 13 years b4 doing midwifery, and did have a bit to do with women with mood disorders, before , and after birth, especially while working in the community. Their moods tend to be harder to control with the influence of the fluctuating hormones. Lithium, i think from memory is contraindicated in the first trimester due to increased risk of fetal cardiac abnormality. I met a psychiatrist that works out of rooms attached to the melbourne clinic whose entire practice seemed to be made up with women with mood disorders b4 , during and after pregnancy. His approach was to make sure they had been well controlled and stable for at least 12 months b4 getting pregnant, but would advise them to not breastfeed and put them on a mood stabiliser and a monophasic oral contraceptive. This was a lot to do with being able to get their mood under control i think rather than due to contraindications with breastfeeding. If not managed carefully, It does seem from my experience that women with bipolar affective disorder do either go extremely up or extremely down relatively soon after birth. I was case manager for a woman with a severe unipolar disorder(major depressive illness) after she had a baby. She was returned to her normal medications(one of the tricyclic antidepressants) after delivering and was advised she would not be able to breastfeed due to the array of ill effects it would have on her baby. She breastfed anyway, and i never saw any of the ill effects in her son even though she was on a massive dose. The specialists looking after her son were all happy with how he was and amazed that he had no ill effects because of how badly the warnings regarding that med was. She was on such a huge dose, if any baby was to get ill effects it would have been him. The big problem i can see about changing medications to breastfeed is that quite often with mood disorders, u are very lucky to find a medication that controls their mood well, it is not very common that u would find another medication that controls it as well. I must admit that although i worked in psych for quite a while, i am now studying natural therapies and i am believing more my feeling that mediactions aren't the way to go, because really(for example) - depression isn't caused by a deficiency in prozac!!! please excuse if this is a bit jumbly , I'm in the middle of a night shift run, and my brain is acting accordingly cos it's daylight! Belinda
