Re: [ozmidwifery] Midwifery in East Timor
Hi Margaret : I would be interested in assisting in some way! Please contact me at [EMAIL PROTECTED] marilyn - Original Message - From: Margaret Aggar To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 18, 2005 9:34 PM Subject: [ozmidwifery] Midwifery in East Timor Dear All, I am a Midwife and Childbirth Educator working on the Central Coast of NSW. I went to East Timor in May, after hearing that their mortality rate is 100 times that of Australia! Only 10% of the women birth with a trained professional present. Many birth alone, or with an untrained relative or friend. There are village women who assist with births in the remote villages. One village I visited was a 9 hourbus trip from Dili (just 180 kms away). I have been asked to provide some training for these women in the remote villages so that they are able to better care for these women and reduce the poor outcomes, and to be able to recognise problems during the pregnancy so that they can be moved into Dili before birth. I am working on a training package at present, which will need to be translated into Tetum. The training will take place at a Clinic in Dili where there are about 60 births / month. I also need to become more fluent in their language - Tetum. I will return to East Timor either later this year, or early next year. This is a voluntary venture, and the training will be provided free of charge for the village women, with accomodation included. I will be looking for sponsorship for this as well as resources for these women to use in their villages at the completion of the training. It is anticipated that this will be on-going, with maybe two trips / year to check and see how they are going and provide more training. There are 5 women interested in the training at present. If there is anyone who may have an interest in assisting with this training, or assisting in some way, or would like to know more, please contact me via email. Regards, Margaret Send instant messages to your online friends http://au.messenger.yahoo.com
Re: [ozmidwifery] Success!!!
excellent and so well done. marilyn - Original Message - From: Maternity Ward Mareeba Hospital To: ozmidwifery@acegraphics.com.au Sent: Friday, June 10, 2005 5:52 PM Subject: [ozmidwifery] Success!!! It is now official as it is in todays Cairns Post and no doubt it will be on the news sometime. MAREEBA MATERNITY IS NOW TO BE A PILOT SITE IN QLD FOR A LOW RISK FREESTANDING BIRTH CENTRE. Thanks to the brilliant work done by the staff, the women, the community and MC, ACMI etc. Apparantly we can start 1 July. Policies are being madly written and all sort of paperwork produced as we will be under a microscope for a long time. Apart from that we have had 3 babies this week, multis who were in too good a labour to risk transferring, 3 very happy mums to birth in their own community. Cheers Judy***This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.Any unauthorised use, alteration, disclosure, distribution or review of this email is prohibited. It may be subject to a statutory duty of confidentiality if it relates to health service matters.If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone or by return email. You should also delete this email and destroy any hard copies produced.***
Re: [ozmidwifery] face presentation
a face presentation cannotbirth when the mentum or chin is posterior, unless of course the baby rotates so that the mentum is anterior then depending on the sacrum of the woman, the baby can birth vaginally. It just depends how firmly the baby is in a mentum posterior position. marilyn - Original Message - From: Nikki Macfarlane To: ozmidwifery@acegraphics.com.au Sent: Monday, June 06, 2005 11:03 PM Subject: Re: [ozmidwifery] face presentation Perhaps mechanical delivery is not possible, but certainly a mother birthing a baby herself is possible even when the baby is presenting face first. There was an excellent photo diary on the web last year but was removed after a few weeks. I had printed off the photos and they are just beautiful. I guess when a person calls a birth a mechanical delivery they are not going to see many things that happen as nature intended, or is that just my bias? Nikki Macfarlane www.childbirthinternational.com
Re: [ozmidwifery] vulval varices
Lindsay: I don't know if there is any evidence on this, I have only anecdotal info: I have seen vulval varices on several homebirth clients in the USA. First thoughts were in alignment with Foote. However at least 2 of the women stated they had them during previous births and all went well which in deed it did. What was also reassuring was the advice of other midwives who were attending homebirths who stated it was not uncommon to see vulval varices and they in fact were not a problem during birth. Midwifery Today archives might have some info. marilyn - Original Message - From: Lindsay Kennedy To: ozmidwifery@acegraphics.com.au Sent: Monday, June 06, 2005 3:14 AM Subject: [ozmidwifery] vulval varices Hi I am doing some research into varicose veins for an assignment. According to Foote (1960), it is possible that extensive vulval varices could rupture during birth and cause fatal hemorrhage. Does anyone know anything about this subject? It is the only bit of research I found that said this. But there is very little info on vulval varices at all. Cheers Lindsay No virus found in this outgoing message.Checked by AVG Anti-Virus.Version: 7.0.323 / Virus Database: 267.6.2 - Release Date: 4/06/2005
Re: [ozmidwifery] gastric washes
I had only known of a gastric lavage being done once when I worked in California and that was to a baby who had swallowed a tummy full of blood birthing through an abruption (apgars of 8 and 9, c/s birth). In his case it seemed quite reasonable though perhaps also unnecessary. It seems to be quite a common practice here though and at one time seems to have been done routinely at birth (there is a check point for it on the care path header). The usual scenario seems to be a mucousy baby who is positing amniotic fluid during the first 24 to 48 hours often after a rapid (5 to 15 min) second stage. My practice to reassure the parents that the fluid will pass through and all will be well, which it is if given half a chance, but often the next shift someone has lavaged the baby. It seems at one time the gastric aspirate was cultured for GBS? (also still on the care path header). The practice had not even registered in my consciousness until working here. marilyn - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, June 06, 2005 1:17 AM Subject: Re: [ozmidwifery] gastric washes Hi all, Need your help finding references/articles on gastric washes for neonates, also any first hand observations or thoughts. I've just returned from a week in Adelaide doing a postpartum placement and was amazed to see so many gastric washes being done. When I queried the practice and asked for protocols and policies to look at, I was told that 'we've been doing them for 30 years and they work'. To hell with best practice and evidence!! Any comments would be welcomed, 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.
Re: [ozmidwifery] gastric washes
Hi Sue: I found this one on pubmed after entering: neonates AND gastric lavage. marilyn Eur J Pediatr. 1999 Apr;158(4):315-7. Related Articles, Links Is gastric lavage needed in neonates with meconium-stained amniotic fluid? Narchi H, Kulaylat N. Saudi Aramco - Al-Hasa Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Mubarraz, Saudi Arabia. [EMAIL PROTECTED] We compared the incidence of complications from meconium-containing gastric fluid in a group of neonates born with meconium-stained amniotic fluid (MSAF) who did not routinely have gastric lavage prior to feeds, versus a group who had elective gastric lavage before the first feed. In the first group, 275 neonates born with MSAF were fed without prior gastric lavage. While 13 developed feeding problems, the other 262 infants (95%) who did not undergo routine gastric lavage remained free of later feeding difficulties or secondary meconium aspiration. In the second group, all 227 neonates with MSAF had elective gastric lavage performed after birth. All remained free of later feeding difficulties or secondary meconium aspiration. CONCLUSION: Our data suggest that gastric lavage is not necessary in most neonates born with meconium-stained amniotic fluid, regardless of the thickness of the meconium-stained fluid, as no complications from meconium-containing gastric fluid were observed. Publication Types: a.. Clinical Trial b.. Randomized Controlled Trial - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, June 06, 2005 1:17 AM Subject: Re: [ozmidwifery] gastric washes Hi all, Need your help finding references/articles on gastric washes for neonates, also any first hand observations or thoughts. I've just returned from a week in Adelaide doing a postpartum placement and was amazed to see so many gastric washes being done. When I queried the practice and asked for protocols and policies to look at, I was told that 'we've been doing them for 30 years and they work'. To hell with best practice and evidence!! Any comments would be welcomed, Sue -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. --production.springer.de-OnlineResources-Logos-springerlink.gif
Re: [ozmidwifery] vulval varices
Lindsay: there are some articles and reviews on pubmed. I entered "vulval varicosities" AND birth and got nothing but I did get 3 articles whenI deleted "AND birth". If you then go to the related articles button you will get some interesting papers. I've pasted one below on vulval varicosities in pregnancy. It seems despite the appearance and discomfort of vulval varices they do not pose a threat or risk to the mother and if they bleed can be controlled with pressure. However, little research has been done. marilyn Rev Fr Gynecol Obstet. 1991 Feb 25;86(2 Pt 2):184-6. Related Articles, Links [Vulvar varicosity and pregnancy][Article in French]Marhic C.Poorly recognised, despite being common, in particular during pregnancy and above all in multipara, this familial condition falls within the context of venous disease in general. Slight during a first pregnancy, vulval varicosities develop all the earlier and are larger as the number of pregnancies increases. They cause discomfort, heaviness in the pubic region, sometimes pruritus or even pain, which is most often relieved by lying flat. Complications, which are uncommon, may give rise to exacerbation of the clinical symptoms described above in relation with a notable increase in size and, more rarely, traumatic ruptures which respond to compression. They disappear completely post-partum. Often poorly tolerated during successive pregnancies, the symptoms of vulval varicosities of pregnancy are significantly relieved by phlebotonic agents.PMID: 1767171 [PubMed - indexed for MEDLINE] - Original Message - From: Lindsay Kennedy To: ozmidwifery@acegraphics.com.au Sent: Monday, June 06, 2005 3:14 AM Subject: [ozmidwifery] vulval varices Hi I am doing some research into varicose veins for an assignment. According to Foote (1960), it is possible that extensive vulval varices could rupture during birth and cause fatal hemorrhage. Does anyone know anything about this subject? It is the only bit of research I found that said this. But there is very little info on vulval varices at all. Cheers Lindsay No virus found in this outgoing message.Checked by AVG Anti-Virus.Version: 7.0.323 / Virus Database: 267.6.2 - Release Date: 4/06/2005
[ozmidwifery] icm program
Just thought i'd let you all know that 2 of the founders of Seattle Midwifery School are presenting at the ICM on Monday 25th July:Suzy Myers as below and Joanne Myers-Cieko as per the conference (I'll send another email). marilyn From Lay to Licensed: A Tale of Two Midwives Practicing in Seattle, Washington and Vancouver, B.C. Suzy Myers, L.M., C.P.M., M.P.H. and Lee Saxell, R.M., M.A. Using our own experiences over the past twenty-five years, this presentation will illustrate the parallel development of direct-entry midwifery in British Columbia, and Washington State, neighboring jurisdictions on either side of the Canadian U.S. border. The authors first met in 1982. Both were practicing home birth midwives and activists in the effort to advance the development of professional midwifery in their respective jurisdictions. At that time Washington State had a licensing law enabling direct-entry midwives legal status and a fledgling midwifery school co-founded by one of the authors. British Columbia had no legal status for midwives, but a dedicated and savvy group of midwives had organized a professional association, the Midwives Association of British Columbia, with a goal to secure legalization. Subsequently, the Washington midwives helped the British Columbia midwives organize a midwifery education program, and the British Columbia midwives helped the Washington midwives launch their professional association. An alliance was forged. Today, B.C. is one of 5 Canadian provinces that have legalized midwifery and integrated registered midwives into the provincial health care system, which includes salary, access to hospital practice, consultation and education programs. Across the border, Washington midwives continue to practice legally, but face many challenges. This paper will contrast our histories, victories, struggles, and realities in todays complex health care environment in North America. Word count: 245 - Original Message - From: Kirsten Lerstrøm To: ozmidwifery@acegraphics.com.au Sent: Tuesday, May 31, 2005 6:59 AM Subject: RE: [ozmidwifery] MidResearch Hi Denise Quite a lot of research has been done, but it is extremely difficult to deciffer, which is good enough to be referenced - exactly what was the study purpose (corresponding to the conclusion?), treatment of data, analyzing comparable issues etc. Go to the Cochrane Library and check some of the abstracts listed there and also check eventual comments from other sources. One of the most famous and wellknown studies in this matter are Eksmyr's three studies during the 1980's - first one in order to provide documentation on the improvement of outcomes, when organizing all births at a central large unit - he didn't find the documentation, so the sencond study was launched, this time including a larger and transnational field - Sweden and Finland, again it couldn't be proved that a large centralised hospital setting was better than smal cliniques, so a Scandinavian study was launched - same conclusion as before. Unfortunately these studies are not accesible via Cochrane. Eksmyr 1986 Eksmyr R. Two geographically defined populations with different organization of medical care - Cause-specific analysis of early neonatal deaths. Acta Pediatrica Scandinavia 1986;75:10-16. Links Then i 1997 Ole Olsen and MD Jewel did a meta study on home vs hospitals births - http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000352/frame.html Look at the comments, as most studies compare mortality, which really isn't the most intersting perspective in this matter (very few deaths) but rather a question of interventions and the women's percieved quality of care. On Cochrane today I found this project description to be published next year, unfortunately, but includes contact details if that will be a help: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004667/frame.html [Protocol]Midwifery-led versus other models of care delivery for childbearing women MHatem, EDHodnett, DDevane, WDFraser, JSandall, HSoltani Note in the background section of this protocol, the authors state: Available experimental studies suggest some benefit for women intending to give birth within midwifery-led models of care compared with similar risk women who intend giving birth within traditional or other models of care (Hodnett 2003). Lower rates of intrapartum analgesia and augmentation of labour and increased mobility during labour have been reported (Hodnett 2003). In addition, non-experimental evidence suggests rates of spontaneous vaginal deliveries are higher, rates of caesarean section, episiotomy
[ozmidwifery] icm part 2
Ok so this is the abstract for Jo Anne Myers-Cieko's presentation on Monday 25th July. marilyn: This is the story of a midwife whose career began with the unlawful and highly political act of attending home births in when the state did not recognize midwives. And of a mother who had her first baby at home in 1976 with this midwife and her extraordinary colleagues. With a vision for radically transforming maternity care by making midwifery care available to all childbearing women, these two women joined forces with other midwifery activists to establish an independent midwifery school, lobby for new laws, create state and national professional associations, launch midwife-owned birth centers, and organize consumer advocates. Nearly thirty years later, they recall their trials and tribulations, share funny stories and joyful moments and reveal their hopes and fears as they contemplate the future of midwifery and childbirth in America.
Re: [ozmidwifery] re epidural top ups and iv cannulation
a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps? marilyn - Original Message - From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just wanted to share our experience. The move away from an epidural that required top ups in labour to infusion pumps came about when the midwives refused to perform the topups or push a bolus down the epidural line manually. We insisted on the anaesthetists doing this task as they were responsible for the integrity of the line and most certainly for its placement. Our anaesthetists got sick of returning again and again to do this and researched an alternative for themselves that we were happy to work with. In our setting a midwife will assist the anaesthetist with equipment required for epidural insertion, however she never ever pushes any fluids down the line manually. Priming the line is all done by the anaesthetist, he/she connects all lines, filter and tubing to a syringe and together they check the settings on the syringe driver and turn it on. Works for us, women have the analgesia they request, midwives turn the pump off when second stage is noted and many women push their infant actively- although there is still a high number of instrumental births Cheers Alesa Alesa Koziol Clinical Midwifery Educator Melbourne Find local movie times and trailers on Yahoo! Movies. http://au.movies.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- Internal Virus Database is out-of-date. Checked by AVG Anti-Virus. Version: 7.0.308 / Virus Database: 266.11.5 - Release Date: 4/05/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 266.11.14
Re: [ozmidwifery] re epidural top ups and iv cannulation
The USA website has a lot of info on the issue of antibiotic resistance which i think is very interesting. I actually bought a book on Streptococcus when I was in the states because I felt there was a whole lot of misinformation running around (that didn't seem to fit with my biology background)and that well intentioned people were taking risks with a potentially very dangerous organism. The book is called Streptococcal infections clinical aspects, microbiology, and molecular pathogenesis edited by Dennis L. Stevens and Edward L. Kaplan. Published by Oxford University Press in 2000. In brief my understanding on antibiotic resistance and Streptococcus agalactiae (GBS) is that it remains sensitive to beta lactam antibacterials which is penicillin, the problem can be for those allergic to penicillins because there is, as you said, resistance to the cephalosporins and erythromycins, so for those who are allergic the CDC suggests sensitivities done on the 35 to 37 week low vaginal swabs. I think unfortunately this testing is not done here (at least not in FNQ) just the m/c/s on the booking in urine. Interesting too is that the doses of antibiotics recommended on the web sites (both the USA CDC site and the Belgian one) are 2X the amount used up here!! It is always reported that women receiving the AB's have an increased incidence of vaginal thrush afterwards. This has not been supported by the evidence except that women with high colonisation of GBS vaginally also report high incidence of thrush prior to administration of abs, so when this is accounted for there is no increased incidence of thrush. The other concern regarding AB resistance is with the enterococcal organisms such as E.coli and Enterobacter which also cause sepsis in neonates: apparentally some resistance is showing up: there is a discussion on the CDC website. All in all I think this is an organism we can't become blase about, who knows why it emerged as potential neonatal pathogen in the 70's and 80's but there is no denying that antibiotic prophylaxis has made a huge impact on neonatal morbidity attributed to it. Similarly, I agree Jenny, as midwives we must not become cavalier re administering antibiotics the danger of course being anaphylactic reactions, are we prepared to respond? are we staffed accordingly? marilyn - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, May 23, 2005 6:37 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation Agree Marilyn. I have seen a baby develop GBS. He was a normal birth at term, good Apgars. No prolonged ROM. Became ill very quickly (within one hour of birth), profound apneas brady's, collapsed died with 24 hours of birth. A big contributing factor to his death was delay in starting him on AB's. The tricky thing with newborns is that they don't always become febrile in response to infection, even a severe one. More likely a drop in temp. This case was many years ago a baby presenting like that now would be given AB's immediately until proven otherwise. GBS has an incidence of 1:1000 and good midwifery care will detect a sick or becoming sick infant. I wonder about the issue of antibiotic resistance, although this is less likely with Penicillin than the broad spectrums. WHO have big concerns about antibiotic resistance. 30% is a lot of women and babies. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, May 24, 2005 3:09 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation What your describing is the risk based protocol vs the culture based one. UNfortunately the recent evidence shows more babies were missed using the risk based protocol that the culture based one. This is all covered on the web sites posted. Whenever you practice prophylactic treatments you are going to be treating some people unnecessarily it's the nature of the beast!! We don't have the test(tests) to positively identify those mthers who have a 100% chance of their babies becoming septic with GBS. And yes it does become a pathogen again we don't know all the triggers that make it change from being normal flora. Of course women refuse the antibiotics and I personally have never known anyone who has had a baby become ill or die from GBS disease. And I have attended births at home and in hospital with women who have refused the antibiotics(after testing positive) or who birthed before the iv could be set up and we simply watched the baby closely especially taking temp's 4/24 for 48 hours and regularly for the first week. However, if you read the web sites you must become aware that thinking you can pick who will have a sick baby from health status of the mother can be risky and erroneous. Though I have to say I would
Re: [ozmidwifery] GBS
Exactly 20to 30% of otherwise healthy women will test positive for GBS by either urine culture or lvs at 37/40 wks: we have no way of knowing which GBS positive women will have a GBS septic baby and, in fact most GBS positive women wont!! Somehow some women who are gbs positive transmit immunity to their baby or themselves and others don't which is why the antibiotics ordered are for GBS prophylaxis not illness. As Mary said we are not treating an illness. Check out the GBS guidelines at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5111a1.htm . marilyn - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 11:29 PM Subject: [ozmidwifery] GBS GBS is part of the normal flora of a large number of women. It causes some difficulty to some babies but not to all babies, even those that are colonized. Colonization does not mean illness. MM GBS is not normal. What is the cut-off point for midwifery care scope of Px? -- 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] IV epidural
Exactly!! To be licensed as an independent midwife in Washington i had to be able to cannulate (I was stunned that this wasn't expected here): it's emergency skills if you don't have them you shouldn't be practicing independently, plus suturing plus other emergency skills: exactly how can you manage a PPH completely without cannulation skills. Yes supporting the mother and assessment of progress are definetly core skills but without these other skills a midwife is surely flatfooted and dangerous at least out of hospital. The epidural top up skills are just really who is going to do it skills as opposed to theseother emergency skills. As far as GBS positive: we managed GBS positive women at home: they were given a detailed informed consent and if they consented to IV antibiotics then their GP (or our GP consultant) wrote the order and we administered the antibioticsIV at home (yes we carried adrenaline/epinephrine in case of anaphylactic rx and we were very thorough re hx of allergies), it did give us practice with cannulation skills but also allowed women who would otherwise have to birth in hospital to birth at home. Never had a complication due to the antibiotics. It was definetly a community standard in Seattle not so though in Santa Cruz, California there we followed the risk basedprotocol (no testing urine or 37 week lvs for GBS)and so would have transferred to the hospital any women at risk via the protocol. We took annual cannulation workshops as well as annual neonatal resusc workshops. marilyn - Original Message - From: Maternity Ward Mareeba Hospital To: ozmidwifery@acegraphics.com.au Sent: Friday, May 20, 2005 9:25 PM Subject: [ozmidwifery] IV epidural In my opinion IV cannulation is a basic skill that all midwives should have. How do you manage a PPH?? And yes you do keep in practice by cannulating for IV antibiotics, etc - so when you need to cannulate in an emergency you can!! I know which of these skills (epidural top-up IV cannulation) I consider more valuable. I work in a small rural hospital where we don't have doctors on site all the time - it can be 1/2 hour from when you call them to when they arrive. 1/2 hour waiting for an IV in an emergency would be terrible. (And doctors do epidural top-ups here - not midwives) Maybe this is different from major hospitals - but it seems odd to me that you have doctors available to cannulate, but not to do epidural top-ups. Something is very warped in this thinking. Jacky***This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.Any unauthorised use, alteration, disclosure, distribution or review of this email is prohibited. It may be subject to a statutory duty of confidentiality if it relates to health service matters.If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone or by return email. You should also delete this email and destroy any hard copies produced.***
Re: [ozmidwifery] Re: Epidural top-ups
With our epidurals post c/s we use pcea's which are quite different and easier to manage re adding more drugs than the epidural syringe type plunger used for top-ups in birth suite (at least for me). I had never seen these plunger type things before coming to oz so i don't knowwhere they exist elsewhere: have heard from a colleague in Ontario, Canada that they also have the plungers and if the midwives are attending a women in labour who has requested an epidural then the midwives do the care after an ob consult (they do caseload independent practice in home, hospital, and birth centre with ob nurses for the ob's and gp's in the hospitals). In the hospitals I had trransferred to in washington and california they had used pcea's in labour ward set up by the anaesthetist but monitored by the ob nurse even if ordered by us in consult with an ob. marilyn - Original Message - From: Barbara Stokes To: ozmidwifery@acegraphics.com.au Sent: Thursday, May 19, 2005 4:57 PM Subject: [ozmidwifery] Re: Epidural top-ups It is rare that at Parkes we use epidurals during labour, but I am supportive of mothers having epidural for elective caesareans. This is where we use epidural top-ups, in the first 24 hours or less. Therefore we need policies to cover as our midwifery care includes adequate pain relief post Caesar. We do not have the doctor at the hospital, or if he is he may be in emergency, I dont need our mother in pain to have to wait til he comes to the unit. Thankyou to those who have helped with information. Barbara, Parkes NSW
Re: [ozmidwifery] Epidural top-up Policy
I think we need to be united in what we do too but we do also need to be able to identify what is a nursing skill and what is a midwifery skill. Just because a skill is a nursing skill doesn't mean it isn't delivered with compassionate care. We have to stop deprecating nursing but neverthless identify what we are doing. marilyn - Original Message - From: Andrea Quanchi To: ozmidwifery@acegraphics.com.au Sent: Thursday, May 19, 2005 7:25 PM Subject: Re: [ozmidwifery] Epidural top-up Policy Well as many of you know I would consider myself a very experienced and woman friendly midwife. I also live in the real world and some, (not many I grant you who are lucky or smart enough, to find/have continuity of midwife care through pregnancy and birth) women have epidurals during labour.If we restricted epidurals to only women who were birthing in hospitals where there was an anaeasthetic team on site it would only be a very small number of places in metro or regional centres and NONE in rural settings. Now I can already hear you say that so what the women dont need them anyway. I agree that women who have known midwives rarely if at all need them but the reality is that all women dont have known midwives. So Justine et.al. keep fighting the good fight that we all know is happening and know that we appreciate what you are doing more than you probably are told or realise but be careful that you dont undermine what it is we are doing while waiting for the system to be changed. I do give epidural top ups to women in labour who are for what ever reason having an epidural. I dont consider it a nursing skill. I AM a midwife, caring for a woman in labour and it is a midwifery skill that is required for the care of that woman. My refusing to top up the epidural will not reflect on her opinion of epidurals but in her opinion of midwives as it will cause any extensive delay in the top up occurring. She already knows that the epidural took her pain away, and believe me when the anaesthetist left he will have told her to let the midwife know when you need a top up and she will see the midwife as the cause of the delay in maintaining her relief if she declines to give the top up. We need to change the attitude of women before they get to this stage not try and do it in labour with women you hardly know.That doesnt mean I am going about promoting epidurals. I dont promote LUSCS either but I still believe a woman having a LUSCS deserves a midwife or else the theatre nurses could just grab the baby and send it back to the ward. I find the whole thing frustrating but we need to be united in supporting each other and not alienating part of the group by undermining what it is they are needing to do to do their job to the best of their ability in the situation they find themselves.With respectAndrea QuanchiOn 20/05/2005, at 8:24 AM, Sally-Anne Brown wrote: Exactly - well said Justine congrats on your wonderful baby news.Why the midwifery profession proports and has come to to provide the care usually done by ananaesthetic team(in OT)is beyond my comprehension really. It is a continuum of the doctor-handmaiden stuff.The care of a woman having an epidural in my (limited) experienceis usuallyattended by only one other health professional - andthat is ananaesthetic team or have other professional arms also agreed to do this as well ?In a world where some ob's think we might not even have vaginal births in the next cple of generations ( National media from one of the Ob's attending the RANZCOG conference in Hobart 2005).. one has to wonder what other handmaiden roles the ob's, anaesthetists and obstetricians will come up with next, that will be pushed onto midwives and perhaps even taken up !!! This surely has to ring alarm bells when it comes to the legal, ethical and professional considerations of how and why midwives have adopted the practices of another health professional's scope of practice.If an anesthetic is provided,into the spine - surely the anaesthetist is responsible for the care of that person whilst under the anaesthetic ? One thing is for sure, we all know whothese trained epidural specialists would try to be blame - if something went wrongOn another note, as an advocate for one-to-one midwifery care with a known midwife, my observation is with the emergence of someprimary models of midwifery care, there is a common theme of enormouspressure fromthe medicos to have these models also take onthe(ir) medical ways. I have noticed in some position descriptions and accreditation competency standards for midwives,that in the name of 'safety' etc we maybe inadvertentlyswaying to the powerof our medical colleagues as we take on
Re: [ozmidwifery] Epidural top-up Policy
Title: Re: [ozmidwifery] Epidural top-up Policy I can't agree about the iv insertion either. How can any midwife practice independently if she can't insert an iv. And it is too a nursing skill in most of the world. If Australian nurses are not inserting iv's now what were they doing 30 years ago? Definetly inserting IV's. marilyn - Original Message - From: Jenny Cameron To: ozmidwifery@acegraphics.com.au Sent: Thursday, May 19, 2005 7:33 PM Subject: Re: [ozmidwifery] Epidural top-up Policy Well said Justine For the first 3-4 years of my midwifery experience epidurals were not an option for women where I worked. OK they are now but it is not the role of a midwife to top them up. I believe topping up is the job of the anaesthetist, the same as inserting IV's is not a midwifery role ( or a nursing one for that matter). This all about dumping the scut work on to women. Tasks like topping up are the housework of health care; too menial for docs to do, same with IV insertion. Prostaglandin gel insertion is now housework , the newness has faded so now the drudge (midwife) can do that. Am I too cynical...no, a midwife with both feet on the ground. Cheers, see you all in Brisbane. Jenny Jennifer Cameron FRCNA FACMPO Box 1465Howard Springs NT 0835 0419 528 717 - Original Message - From: Justine Caines To: OzMid List Sent: Thursday, May 19, 2005 9:37 PM Subject: Re: [ozmidwifery] Epidural top-up Policy Dear Lisa and AllYou seem to have missed my point. I did not advocate against women choosing an epidural, I said the use of epidurals should not be within a midwifery scope of practice and I stand by that. I find it insane when a fraction of midwives actually work as midwives and yet we yell and scram to keep supporting all the obstetric who ha. Don't worry all that stuff is very safe. I agree every womanneeds a midwife, regardless (but topping up the epidural is not being a midwife)As to who should do it, yes let the Drs go for it, it's their domain! If midwives determined what was and wasn't midwifery then we would have real changein this country NOW.We will never see midwifery practiced fully while there is such support for an obstetric model with all its trappings. The balance is so severely skewed it is time to get realand establish what is midwifery and the right of healthy women to access it exclusively.With less than .2 of 1% of women being able to be cared for by a known midwifeand yet women being able to demand epidurals, social inductions, and elec c/s Iknow where the work needs to be done.As a woman I have paid $14,000 for homebirths, with not a cent in return. Yet Ipay for the 30% rebate for privately insured women to have the works. Something has to give.I really believe midwifery on the whole to be with well women with only an emotional and supportive role for women accessing medical care and intervention.Just because 80% of women currently receive intervention and many blindly ask forit doesnt mean its right, or that they are informed. Most women are told an epidural cant harm the baby!! How can we say women really want/need an epidural when 99% of them are forced to share their most intimate moment with a stranger and nearly as many of them cant even use warm water immersion and they are in a system that sets them up for failure (pelvis too small, big baby, unreal labour time frames etc etc!).What we know is that where midwives form a relationship with women the use of drugs is slashed. In our local unitEpidurals are hard to obtain and consequently 2 are done each year, what makes these women different to the city womenwhere it is peddled??Hope this clarifies Justine Internal Virus Database is out-of-date.Checked by AVG Anti-Virus.Version: 7.0.308 / Virus Database: 266.11.5 - Release Date: 4/05/2005
Re: [ozmidwifery] Re: cannulation
Exactly! perhaps it falls into the category of health care provider skill, just one we all need. marilyn - Original Message - From: Barbara Stokes To: ozmidwifery@acegraphics.com.au Sent: Friday, May 20, 2005 5:34 AM Subject: [ozmidwifery] Re: cannulation It would be great not to need cannulation skills, but in a small rural hospital we deal with general patients, doctor not on site. Trauma, acute chest pains etc all need cannulas to commence life saving treatment. Is no-one doing IV antibiotics for group B strep positive mothers in labour? By doing these ourselves, we keep the doctors away. Barbara
Re: [ozmidwifery] re epidural top ups
LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps: I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps? marilyn - Original Message - From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just wanted to share our experience. The move away from anepidural that required top ups in labour to infusion pumps came about when the midwives refused to perform the topups or push a bolus down the epidural line manually. We insisted on the anaesthetists doing this task as they were responsible for the integrity of the line and most certainly for its placement. Our anaesthetists got sick of returning again and again to do this and researched an alternative for themselves that we were happy to work with. In our setting a midwife will assist the anaesthetist with equipment required for epidural insertion, however she never everpushes any fluids down the line manually. Priming the line is all done by the anaesthetist, he/she connects all lines, filterand tubing to a syringe and together they check the settings on the syringe driver and turn it on. Works for us, women have the analgesia they request, midwives turn the pump off when second stage is noted and many women push their infant actively- although there is still a high number of instrumental births Cheers Alesa Alesa KoziolClinical Midwifery EducatorMelbourne
Re: [ozmidwifery] Breastfeeding
I think what gets up my nose with regards to this issue is the implication that at the individual level a mother's ease with birth and breastfeeding necessarily makes the woman a great or better mother. While I don't think the numbers have yet been crunched at a population level (probably because we can't think of what what parameters/indices we should measure to measure great or better mothering) I too would not be surprised if there was not at the very least a strong association with normal birth and normal breastfeeding and better mothering. I am certainly a strong advocate for both normal birth and breastfeeding. However, any of us who have worked in birth suite and maternity wards and in the community must know that on an individual level normal birth and breastfeeding ability and/or success do not a mother make whether she be great, fantastic or simply good enough. There is no denying it (they) is (are) part of the equation, but just a part and in some situations very clearly overriden by other factors. I can only speak for myself, and I do, it is not the promotion of either the normality of breastfeeding or normal birth (both of which I advocate for strongly myself) that creates the heat but the over simplification of what makes a great, good, or good enough mother. marilyn - Original Message - From: Denise Fisher [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, May 18, 2005 5:22 PM Subject: Re: [ozmidwifery] Breastfeeding Breastfeeding doesn't often come up on this list, but when it does it causes heated discussions - I don't understand why as a very reasonable advocate of the normal, healthy way to feed a baby I feel so threatened each time I post. :-\ Does having a normal birth, followed by a normal breastfeeding relationship make a woman a better mother?? I wouldn't be surprised if, when big numbers are crunched, that that is what statistically comes out of the computer, while also accepting that you can't apply statistics to individuals. Whether we like it or not we are driven by hormones over which we have no control - all of our loving relationships are heavily influenced by the hormones that are floating around us at the time. That's why normal birthing is so important (read Michel Odent, plus heaps of others now), and why breastfeeding is also incredibly important to the ability to mother and form secure attachments. Please don't get personally slighted over that statement - I'm not saying that all is lost for the mother and baby who don't experience normal - but when you're starting from the abnormal, it takes greater effort to get everything back to normal. Denise Hynd's support for normal birthing to ultimately support breastfeeding is definitely addressing one of the barriers to successful breastfeeding. However, there are still a lot of midwives and doctors who set the mother up for failure of breastfeeding because of mismanagement, despite their wonderful birth experience. Lieve will support me when I mention the very, very poor breastfeeding rates in The Netherlands despite home birthing. It's not a natural follow-on - it's another essential skill that a good midwife must learn about and acquire and then share with her clients. Yes there are barriers to breastfeeding that are beyond our immediate control, but one of the biggest barriers is the uneducated health professional. We're improving, and because of that I feel that some of the social barriers are being knocked down by confidently breastfeeding mothers - more women breastfeed in public without giving it a second thought; more mothers seek a place to pump at work, or lobby for closer childcare. It's happening, but only because these women start out with self-confidence, and that's where the assumption of breastfeeding as normal, and facilitating normal establishment of breastfeeding by knowledgeable midwives is the key. Self-confidence in an ability to birth naturally is just as important as self-confidence to feed their baby naturally. Introducing doubt needlessly to either process destroys self-confidence. Denise *** Denise Fisher Health e-Learning http://www.health-e-learning.com [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.
Re: [ozmidwifery] Epidural top-up Policy
Title: Re: [ozmidwifery] Epidural top-up Policy Dear Justine and all: With respect, if midwives in Australia stop doing things like epidural top ups etc., you will see the introduction of the obstetric or labour and delivery nurse this is her/his domain in places where she/he exists, not the doctor's domain: the doctor orders the epidural, the anaesthetist inserts it, the nurse tops it up. Fortunately or unfortunately in Australia, we do not have ob or ld nurses and so this falls into the midwife's domain. It is just one of the many hats midwives wear and so one of the many skills midwives have. Unless we are to go back to task orientated care in birthing suites(rather than attempting 1 to 1 care)then most of us have to learn these skills. Umm... never thought I'd be supporting skilling midwives in epidural top-ups(which is a nursing skill and NOT an advanced practice midwifery skill)but there you go, not sure how great the alternative would be here especially in the current climate of cost cutting, shifting, and shortages of staff. marilyn - Original Message - From: Justine Caines To: OzMid List Sent: Thursday, May 19, 2005 5:07 AM Subject: Re: [ozmidwifery] Epidural top-up Policy Dear Lisa and AllYou seem to have missed my point. I did not advocate against women choosing an epidural, I said the use of epidurals should not be within a midwifery scope of practice and I stand by that. I find it insane when a fraction of midwives actually work as midwives and yet we yell and scram to keep supporting all the obstetric who ha. Don't worry all that stuff is very safe. I agree every womanneeds a midwife, regardless (but topping up the epidural is not being a midwife)As to who should do it, yes let the Drs go for it, it's their domain! If midwives determined what was and wasn't midwifery then we would have real changein this country NOW.We will never see midwifery practiced fully while there is such support for an obstetric model with all its trappings. The balance is so severely skewed it is time to get realand establish what is midwifery and the right of healthy women to access it exclusively.With less than .2 of 1% of women being able to be cared for by a known midwifeand yet women being able to demand epidurals, social inductions, and elec c/s Iknow where the work needs to be done.As a woman I have paid $14,000 for homebirths, with not a cent in return. Yet Ipay for the 30% rebate for privately insured women to have the works. Something has to give.I really believe midwifery on the whole to be with well women with only an emotional and supportive role for women accessing medical care and intervention.Just because 80% of women currently receive intervention and many blindly ask forit doesnt mean its right, or that they are informed. Most women are told an epidural cant harm the baby!! How can we say women really want/need an epidural when 99% of them are forced to share their most intimate moment with a stranger and nearly as many of them cant even use warm water immersion and they are in a system that sets them up for failure (pelvis too small, big baby, unreal labour time frames etc etc!).What we know is that where midwives form a relationship with women the use of drugs is slashed. In our local unitEpidurals are hard to obtain and consequently 2 are done each year, what makes these women different to the city womenwhere it is peddled??Hope this clarifies Justine
Re: [ozmidwifery] FW: Breastfeeding
Title: Re: [ozmidwifery] FW: Breastfeeding Thank you Kerreen and Carina. It seems to me that despite the BFHI about 10 to 20 % of women within our maternity system will and do have problems with breastfeeding. I appreciate that only 1 % may have truly insurmountable difficulties neverthless these other women are a significant part of our population and their situation must be respected and supported. For some of us women, breastfeeding is ridiculously easy, even a deliciously sensual experience but, dare I say this, this doesn't make us(or at least me) better mothers, just as for some of us, despite the culture, birth is easy or at least some of us would birth normally upside down in the back of a bus: does this make us better mothers? I think not. It is simply just how some of us are and incidently just how some of us are not. Isn't it clear that forcing agendas down anyones throat creates a back lash? Aren't we in the middle of one? There are miriad reasons for all of this not the least of which is our culture but also genetics, physiology, socialisation to name a few. I do get truly tired of the habit of blaming women, categorising them for being "dramatic" etc., in a general way when they a simply part of a system they have been conditioned to accept. Believe it or not not all of us were conditioned this way and so for some of us it is far easier to step outside the system, in fact for some of us it is the only way we can be!! Again it doesn't make us better only different and adds to the richness and diversity of the palate as well as the menu of skills we must possess as midwives to facillitate as much breastfeeding success as possible. marilyn - Original Message - From: Carina To: ozmidwifery@acegraphics.com.au Sent: Wednesday, May 18, 2005 4:20 AM Subject: Re: [ozmidwifery] FW: Breastfeeding Dear Denise,My point is that there is a group of women who do not fit this mould and that it is dangerous to assume that women who are having problems with breastfeeding are doing so because of the fragmented medical model of maternity care. I can see how some problems are exacerbated by the fragmented care model, but to make generalised statements is dangerous. I am also well aware of the Baby Friendly Hospital Initiative and am in full support.Carina BrownOn 18/5/05 8:13 PM, "Denise Hynd" [EMAIL PROTECTED] wrote: Dear CarinaThe World Health Organisation and most research shows that the problems that most woemn in our culture have are down to misinformation and disempowering management.That is why their is the Baby Freindly Hospital Initiative !However anyone who has had expereince or an understanding of contiuity of care by a known midwife knows that what is even more effective support of the overwhelming majority (98%+) of women's iniate abilities to nurture their babies as they need including breastfeeding after brithing them the way that they need is for the woman to have this care!!That is why I who was a convenor of BFHI in WA am now actively involved with Maternity Coalition to give women the opportunity to choose this model of maternity care.The current problems of birthing , breastfeeding and mothering are a reflection of the fragmented medical model of care imposed on them!!Denise Hynd"Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled." Linda Hes - Original Message - From: Denise Fisher mailto:[EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, May 18, 2005 3:32 PMSubject: Re: [ozmidwifery] FW: BreastfeedingHi CarinaYou've brought up some points that are good food for thought. It was a tragedy the day that milk banks were closed in Australia due to the scare with HIV, despite pasteurisation easily killing HIV (I wonder why sperm banks weren't also closed??). I note that a new bank is opening in WA and perhaps one in Melbourne. I wish them success.The incidence of physiological inability to breastfeed is somewhere in the order of 1 - 2 per 100 women. I don't believe with an incidence at this level that it warrants we guard everything we say to every woman. And then there's that really fascinating topic of 'guilt'. Can you induce guilt in someone? - maybe, if they really are guilty. However I don't feel guilty about something I have no control over. For example if I had no uterus I wouldn't feel guilty that I'm not adding to Australia's population, no matter how much Mr Howard exhorts me to. If I had no breasts or my breasts were not functional I would not feel guilty that I'm not breastfeeding regardless of how many people told me it
Re: [ozmidwifery] Quote
absolutely, me too! marilyn - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, May 16, 2005 1:50 AM Subject: Re: [ozmidwifery] Quote ME TOO!!! Sue I am amazed to have been a midwife from the era in which women marched in the streets, demanding normal births without medication, to a time when they expect an epidural as soon as it is allowed in labor, even planning elective cesareans and giving up the gift of birthing their children altogether. **Katherine Jensen** __ NOD32 1.1075 (20050423) Information __ This message was checked by NOD32 antivirus system. http://www.nod32.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Iron infusion
Hi Sue: It seems to me that iron infusions are often advised for anyone who has a Hb less than 100, antenatally/postnatally asymptomatic/symptomatic and blood transfusions for postnates with Hb's less than 80 or 90 depending on the doctor because again the woman maybe asymptomatic. Also regardless of iron stores etc.. I am not saying this isn't appropriate treatment for some women but often seems like over treatment to me. It seems like iron supplementation and vitamin C should be sufficient for this woman, interested to see what others think. marilyn - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, May 16, 2005 1:49 AM Subject: [ozmidwifery] Iron infusion Hi, Not too sure if this isn't part of the same thread about 'dramatic' women,. What do any of you know about the risks/benefits of iron infusions after a PPH? Hb @ 5 weeks is 91, but mother active, walking, good milk supply (always), happy... Anyway, she's been advised by a medico to have an iron infusion and I can find very little in any of my Obs or midwifery texts. Looking forward to your wise responses, 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.
Re: [ozmidwifery] Re:physios
Thanks for that Belinda as I also attended brilliant antenatal classes led by a physio in the '70's. Small country hospitals that had a physio even part-time were offering antenatal classes long before midwives were. I am not sure why physios picked up antenatal classes on the breath of the natural childbirth movement of the time maybe it was because of women like Elizabeth Noble and Elizabeth Bing. marilyn - Original Message - From: Belinda Maier [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, May 05, 2005 9:46 PM Subject: [ozmidwifery] Re:physios - Can I just caution blanket statements against professions. 15years ago it was in antenatal classes led by a physio that I learnt and became passionate about active drug free birth and breastfeeding. I worked hard and achieved everything I wanted for my birth with the very sound advice and joyful learning she gave us as a group. the hospital I birth at had never seen birth plan before and the midwives asked if they could keep it. I recently complained about a midwife 'educating' women about the benefits of a neat cut compared to a mutilating tear (words powerful enough to elicit agreement I think!) in antenatal classes. Thereare good and bad in all professions, including midwifery medicine physio etc lets not exclude or vilify the whole in case we lose the good ones. all of us working to increase women's choices experiences and decrease intervention etc need support Belinda -- 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] HAPPY INTERNATIONAL MIDWIVES DAY!
Denise and all who are interested: I have the Shamamas cd: yes i got it on the Farm in '99. It may be possible to buy one from the various Farm websites or even Ina May's website not sure? Of course I could prolly get some child of mine or someone elses to burn it and make copies if there are no longer any available. The songs on the CD are: 1. We who believe in freedom 2. humble yourself 3. circle 'round 4. Witches 5.Bold Women And the Shamamas are the Farm Midwives: Ina May, Sharon, Deborah, Pam, and one more marvelous women whose name has slipped me. I will play the cd later today and try to identify the tune, I am not musically gifted or talented so that may be a challenge. marilyn - Original Message - From: Denise Hynd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, May 05, 2005 5:41 AM Subject: Re: [ozmidwifery] HAPPY INTERNATIONAL MIDWIVES DAY! Lieve Do you know the tune for this song?? Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. Linda Hes - Original Message - From: Lieve Huybrechts [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, May 05, 2005 3:22 PM Subject: RE: [ozmidwifery] HAPPY INTERNATIONAL MIDWIVES DAY! Also my best wishes for all the midwives and wise women on earth, from the past, the present and the futur. Let us make a strong circle to care for mother and child and the futur of the world. Let us sing together and let the world know we are there and women are strong. Two days ago Sarah Wickham was with the flemish midwives to teach about her 'sacred cycles'. She is also a good singer and made together with others some good and funny songs. Singing makes people happy, connected and strong. Here is one of their songs. bold women! This song was taught to us by the brave, bold and wise midwives and women at The Farm Midwifery Center in Summertown, Tennessee. I am a bold woman I am such a brave bold woman Walking right into the dragon's mouth alone I am a brave woman I am such a brave bold woman Seeking love and beauty I go on my own I go on my own Seeking love and beauty On my quest I go No matter what may happen I know I will grow Yes I will grow I am a bold woman! http://www.withwoman.co.uk/contents/art/funnysongs.html From a happy midwife Lieve Lieve Huybrechts Vroedvrouw 0477/740853 -Oorspronkelijk bericht- Van: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Namens Andrea Robertson Verzonden: donderdag 5 mei 2005 1:14 Aan: ozmidwifery@acegraphics.com.au Onderwerp: [ozmidwifery] HAPPY INTERNATIONAL MIDWIVES DAY! Hello everyone, I hope that today is a special one for all you midwives - one where you can celebrate everything that you do for women and babies and give yourselves a pat on the back for your hard work and dedication. We all appreciate what you do and hope that you can take part in some appropriate celebrations. Here's to midwives - united, strong, essential advocates and carers for pregnant and birthing women. We salute you! Andrea and the Birth International team - Andrea Robertson Birth International * ACE Graphics * Associates in Childbirth Education e-mail: [EMAIL PROTECTED] web: www.birthinternational.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.308 / Virus Database: 266.11.3 - Release Date: 3/05/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.308 / Virus Database: 266.11.3 - Release Date: 3/05/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.308 / Virus Database: 266.11.3 - Release Date: 3/05/2005 -- 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] Antenatal Screening/Informed Choice Agreement. Vitamin D supps.
I hopeI don't sound too rude but it highlights exactly why I am not practicing independently at the moment. Australian midwives do not have a mandate to be independent practitioners; I simply cannot imagine not being able to order path tests for the women I am caring for, not being able to order my own emergency drugs etc.. We are dependent on GP/Obs to do this for us and dependent on their records in case of transfer ahh!! sorry just had a couple of wines!! marilyn - Original Message - From: Sally Westbury To: ozmidwifery@acegraphics.com.au Sent: Friday, April 29, 2005 5:37 PM Subject: RE: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps. Hi Gaye, It is an interesting question about antenatal testing. I ask all my clients are booked into a hospital as a backup. They are booked through antenatal clinics or GP/Obs or Obstetricians. There is a problem with getting this booking in done properly. As a midwife in WA I cannot order path tests, this is of course done by the doctors and it is their responsibility to provide results to the local hospital. I cannot book people into the hospital, this is the doctors responsibility also. Some of the doctors are great and provide copies of blood tests to me so that I can put them in my/clients antenatal records so that it is easy for hospital transfer situations. Other doctors are not so cooperative and will not provide them to me and make it difficult, even though the woman has a right to have copies, for the woman to have a copy. In these instances I trust what is passed on to me by the woman, hope the doctor follows up on anything abnormal and ask the woman to remind the doctor to provide copies for the hospitals records in case of transfer. Sometime the doctors do this, sometimes they dont. Sometimes the offical result documents are in some doctors surgery files only and not accessible in the middle of the night when a transfer has happened. Having said this I have had a client that declined all blood tests, due to her own personal belief systems. It is her right. I did speak with her about why these test are done and clearly documented in my antenatal notes the discussion and we both signed the notes. Um did that help clarify anything??? Sally Westbury Hi All, Just hoping some of you wonderful Homebirth midwives out there can enlighten my ignorance regarding what "routine" antenatal investigations you order for or recommend to your clients, as part of your initial consultation. Is there a standard guideline that you must adhere to?(Apart from the "National Midwifery Guidelines for Consultation and Referral", that is). Or is it only up to the individual practitioner and his/her client to discuss and come to an agreement about what tests she will have and when she must go to hospital? My reason for asking is the vague responses to our enquiries we recently encountered when a planned homebirth client presented to hospital for delivery. There was no accompanying antenatal record so we thought it feasible to ask basic questions of the client and her midwife such as blood group, last Hb, etc because it was no longer a normal situation. Is it probable these tests weren't done, because she was hitherto a normal, healthy woman with the right to choose what invasive procedures she had? Sorry to sound stupid but I'm used to the Obstetrician/G.P. who orders every test the lab has ever done and then some, you know - like the questionable Hep C and HIV without prior counselling, but I won't go there! I've done a couple of Web searches re the evidence (and lack of), and cost-effectiveness of the regular antenatal screen blood tests (I think I read it cost Medicare some $48 million dollars back in 1997), but wanted to know what you guys are practicing out there. On another tack, I just read this gem in an excerpt from a policy statement by The American Academy of Paediatricians: "Vitamin D drops containing 200iu should be given to all breastfed infants starting in the first two months of life" Gartner LM et al "Breastfeeding and the use of Human Milk" Pediatrics 2005 Feb; 115: 496-506. Alaskans born in the middle of winter perhaps? I think our NICU give daily Pentavite from about Day 5, but surely, if there is some sun exposure this routine administration shouldn't be necessary? Do different skin colours absorb it from sunlight at different rates, such as black skin slower, perhaps? Any Lactation Consultants able to comment here please? Cheers, Gaye :)
Re: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps.
I totally agree Kim with everything you have said. I need to know how these limitations to practice autonomously have arisen and why it seems to be accepted. marilyn - Original Message - From: Kim Stead To: ozmidwifery@acegraphics.com.au Sent: Saturday, April 30, 2005 7:33 AM Subject: Re: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps. Hi Marilyn. I totally understand where you are coming frombut just to play devil's advocate..who is to care for these women who have made educated choices to birth their babiesin a setting they believe to be safer than the hospital? Someone has to do it (and it's not me at the moment either!!!). I know it's not ideal and at times,very scarry notto be able to offer the full servicebut someone has to step up to the mark and provide this service and notcontinue to be bullied by this god forsakengovernment. Some of these women will birth unattended and do. If I were to ever have any more children (cross my legs as I write!!!),I'd have them at home. I'd like to think I could find a midwife to support me and can understand the ones whocontinue to birth unattended after exhausting all options to find midwifery or should I say 'woman-centred' care. The hospital setting is a frighting place for those who are 'birth educated'. Just thinking out loud. Kim. ---Original Message--- From: ozmidwifery@acegraphics.com.au Date: 04/30/05 22:55:50 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps. I hopeI don't sound too rude but it highlights exactly why I am not practicing independently at the moment. Australian midwives do not have a mandate to be independent practitioners; I simply cannot imagine not being able to order path tests for the women I am caring for, not being able to order my own emergency drugs etc.. We are dependent on GP/Obs to do this for us and dependent on their records in case of transfer ahh!! sorry just had a couple of wines!! marilyn - Original Message - From: Sally Westbury To: ozmidwifery@acegraphics.com.au Sent: Friday, April 29, 2005 5:37 PM Subject: RE: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps. Hi Gaye, It is an interesting question about antenatal testing. I ask all my clients are booked into a hospital as a backup. They are booked through antenatal clinics or GP/Obs or Obstetricians. There is a problem with getting this booking in done properly. As a midwife in WA I cannot order path tests, this is of course done by the doctors and it is their responsibility to provide results to the local hospital. I cannot book people into the hospital, this is the doctors responsibility also. Some of the doctors are great and provide copies of blood tests to me so that I can put them in my/clients antenatal records so that it is easy for hospital transfer situations. Other doctors are not so cooperative and will not provide them to me and make it difficult, even though the woman has a right to have copies, for the woman to have a copy. In these instances I trust what is passed on to me by the woman, hope the doctor follows up on anything abnormal and ask the woman to remind the doctor to provide copies for the hospitals records in case of transfer. Sometime the doctors do this, sometimes they dont. Sometimes the offical result documents are in some doctors surgery files only and not accessible in the middle of the night when a transfer has happened. Having said this I have had a client that declined all blood tests, due to her own personal belief systems. It is her right. I did speak with her about why these test are done and clearly documented in my antenatal notes the discussion and we both signed the notes. Um did that help clarify anything??? Sally Westbury Hi All, Just hoping some of you wonderful Homebirth midwives out there can enlighten my ignorance regarding what "routine" antenatal investigations you order for or recommend to your clients, as part of your
Re: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps.
Hi: I am not yet a lactation consultant but I am a midwife who lived in the USA until 2002. There are a number of factors involved here re the vitamin D drops. I am assuming this is in response to an increase in the prevalence of rickets in babies and young children. I will list them below. Yes it does seem like an overreaction but I think it fits into the public health mantra of treating all rather than missing some. Coming from Norwegian heritage I remember a childhood of drinking my daily dose of cod liver oil in sunny far north qld, yes I do have strong bones and teeth. Anyway theseare some ofthe possible reasons for this response that I can think of: 1. Increasing numbers of americans covering up completely to avoid sun exposure a strong belief that there is no "good" exposure. 2. asignificant group of americans who cover up for religious and social reasons. 3. the sun IS a lot weaker, trust me. 4. yes different skin pigmentations do let is more or less light: the fairer you are theless sun you need to make vit D (or get sun burned)and unless you are eating a diet rich in fatty deep ocean fish or ocean dwelling sea mammals (whales, sea lions, etc..) you will be deficient hence the scandanavian use of cod liver oil: an oldy but a goody. Eskimoes in Alaska would prolly be those least likely to need supplements unless of course they are living on Mc Donalds. 5. When it gets cold many people are reluctant to give baby a sun bath in direct sun and that far from the equator indirect sun is not that efficient...it can be cold 9 mnths of the year...the reverse of here! Because of this normal supermaket milk has been supplemented with vit D for decades as has baby formula. If a mother is confident of her diet and her sun exposure and her babies then no supplement would be necessary of course. I don't think there are supplement police...yet. marilyn - Original Message - From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, April 29, 2005 10:44 AM Subject: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps. Hi All, Just hoping some of you wonderful Homebirth midwives out there can enlighten my ignorance regarding what "routine" antenatal investigations you order for or recommend to your clients, as part of your initial consultation. Is there a standard guideline that you must adhere to?(Apart from the "National Midwifery Guidelines for Consultation and Referral", that is). Or is it only up to the individual practitioner and his/her client to discuss and come to an agreement about what tests she will have and when she must go to hospital? My reason for asking is the vague responses to our enquiries we recently encountered when a planned homebirth client presented to hospital for delivery. There was no accompanying antenatal record so we thought it feasible to ask basic questions of the client and her midwife such as blood group, last Hb, etc because it was no longer a normal situation. Is it probable these tests weren't done, because she was hitherto a normal, healthy woman with the right to choose what invasive procedures she had? Sorry to sound stupid but I'm used to the Obstetrician/G.P. who orders every test the lab has ever done and then some, you know - like the questionable Hep C and HIV without prior counselling, but I won't go there! I've done a couple of Web searches re the evidence (and lack of), and cost-effectiveness of the regular antenatal screen blood tests (I think I read it cost Medicare some $48 million dollars back in 1997), but wanted to know what you guys are practicing out there. On another tack, I just read this gem in an excerpt from a policy statement by The American Academy of Paediatricians: "Vitamin D drops containing 200iu should be given to all breastfed infants starting in the first two months of life" Gartner LM et al "Breastfeeding and the use of Human Milk" Pediatrics 2005 Feb; 115: 496-506. Alaskans born in the middle of winter perhaps? I think our NICU give daily Pentavite from about Day 5, but surely, if there is some sun exposure this routine administration shouldn't be necessary? Do different skin colours absorb it from sunlight at different rates, such as black skin slower, perhaps? Any Lactation Consultants able to comment here please? Cheers, Gaye :)
Re: [ozmidwifery] implanon and breastfeeding
No they both coexist. Implanon being iseerted in the arm and i think its life in oz is 2 yrs or maybe 3yrs (need to reread the pamphlett from Family Planning), there was one in the USA called Norplant which lasted 5yrs. Mirena is the IUD which is implanted with progesterone and also a very ngood option. marilyn - Original Message - From: Kim Stead To: ozmidwifery@acegraphics.com.au Sent: Monday, March 21, 2005 9:20 PM Subject: Re: [ozmidwifery] implanon and breastfeeding Just out of curiosity Is implanon theone you get inserted in your arm? What is it's recommended life? Has this replaced the Mireana (IUD)? Kiwi Kim ---Original Message--- From: ozmidwifery@acegraphics.com.au Date: 03/22/05 15:55:09 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] implanon and breastfeeding BTW is implanon now approved in Australia for breastfeeding mothers?? I was told it was. It didn't affect my milk supply. I had it inserted at 8 weeks, and removed after a year (due to intolerable side-effects!) Kate
Re: [ozmidwifery] implanon and breastfeeding
wow! where does that 10 % risk of uterine puncture come from - insertion technique? One of my daughters uses the Mirena and after years of painful periods with the other IUD is very thrilled with the Mirena, she also cannot use other hormonal contraceptives, but thought the Mirena was worth trying as the progesterone is thought to act only locally on the uterine lining and not be systemic. apparently this is so as she has experienced only good side effects. marilyn - Original Message - From: Kate /or Nick To: ozmidwifery@acegraphics.com.au Sent: Monday, March 21, 2005 9:41 PM Subject: Re: [ozmidwifery] implanon and breastfeeding Yes it was in my arm. LIfe is 3 years. I gave it a year before I decided to have it removed due to side effects (very long, frequent,heavy menses. I washaving a 10-12 day period, a 3 day gap, andother 10-12 day perioda 5 day gap and then the cycle began again. Certainly very effective contraception!) In my case, once it was removed, the Mirena was recommended. But my gyn gave me a 10% risk of uterine puncture, which made me decide against it. Oral contraceptives are not an option for me, which is serously narrowing the choices. That vasectomy is looking good! Kate - Original Message - From: Kim Stead To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 22, 2005 3:50 PM Subject: Re: [ozmidwifery] implanon and breastfeeding Just out of curiosity Is implanon theone you get inserted in your arm? What is it's recommended life? Has this replaced the Mireana (IUD)? Kiwi Kim ---Original Message--- From: ozmidwifery@acegraphics.com.au Date: 03/22/05 15:55:09 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] implanon and breastfeeding BTW is implanon now approved in Australia for breastfeeding mothers?? I was told it was. It didn't affect my milk supply. I had it inserted at 8 weeks, and removed after a year (due to intolerable side-effects!) Kate
Re: [ozmidwifery] one umbilical artery
Hi Mary: A 2 vessel cord is associated with some syndromes and some kidney anomalies not all of which are problems. Have had one baby with a 2 vessel cord lovely birth centre birth no u/s during pregnancy so no suspicions prior to birth. Another mum did have u/s and 2 vessels cord was picked up along with some other heart and kidney potential problems so she did have a lovely hospital birth and baby was also just fine though watched very closely for a while. I will do a quick search in a moment, currently in between cyclone watches. marilyn - Original Message - From: Alice Morgan [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 08, 2005 5:59 AM Subject: RE: [ozmidwifery] one umbilical artery Hi Mary, I have heard from a sonographer that babies with only one kidney, or with kidney problems often only have one umbilical artery and one umbilical vein. I'm not sure what evidence there is to back this up though (the baby in question did have only the two vessels and one kidney). Alice Morgan From: Mary Murphy [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: list ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] one umbilical artery Date: Tue, 8 Mar 2005 20:23:51 +0800 Does anyone have any experience with babies with one umbilical artery one vein? I would appreciate stories and research. thanks, MM _ Want three months FREE dial-up access? http://ad.au.doubleclick.net/clk;14155953;10925630;c?http://www1.optusnet.com.au/offers/phoneandnet/?tas=hotmailtag -- 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] one umbilical artery
Here is another article Mary: J Matern Fetal Med. 2001 Feb;10(1):59-63. Related Articles, Links Perinatal outcome following fetal single umbilical artery diagnosis.Pierce BT, Dance VD, Wagner RK, Apodaca CC, Nielsen PE, Calhoun BC.Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington 98431, USA. [EMAIL PROTECTED]OBJECTIVE: We report the frequency of associated congenital abnormalities in fetuses with a single umbilical artery as well as the sensitivity, specificity, positive predictive value and negative predictive value of ultrasound for detecting these abnormalities. We also report the pregnancy outcome of fetuses complicated by single umbilical artery, both isolated and with other congenital anomalies. METHODS: All pregnancies complicated by fetal single umbilical artery from 1995 to 1999 were identified. A retrospective chart review was performed on both the prenatal records and the ultrasound records of these pregnancies, determining the nature and incidence of other congenital abnormalities. Delivery data were collected to include gestational age at delivery, Apgar score, birth weight, mode of delivery, fetal gender and any complications. RESULTS: Ninety-two pregnancies were identified with a fetal single umbilical artery, of which outcome data were available for 65. Forty-eight (74%) cases were identified as isolated single umbilical artery. Seventeen (26%) cases had other congenital abnormalities. High-resolution ultrasound had 100% sensitivity and specificity for identifying single umbilical artery and an 85% sensitivity and 98% specificity for detecting other congenital abnormalities. Compared to isolated single umbilical artery, pregnancies complicated by single umbilical artery with other abnormalities had a statistically significantly increased rate of fetal aneuploidy, lower birth weight, preterm delivery and Cesarean delivery. CONCLUSION: Pregnancies complicated by fetal single umbilical artery, especially when associated with other congenital abnormalities, are at increased risk for adverse pregnancy outcome.PMID: 11332422 [PubMed - indexed for MEDLINE] - Original Message - From: Mary Murphy To: list Sent: Tuesday, March 08, 2005 4:23 AM Subject: [ozmidwifery] one umbilical artery Does anyone have any experience with babies with one umbilical artery one vein? I would appreciate stories and research. thanks, MM
Re: [ozmidwifery] Preconception care?
Ditto: likewise it was a big part of our education and practice in the USA. marilyn - Original Message - From: Callum Kirsten To: ozmidwifery@acegraphics.com.au Sent: Friday, March 04, 2005 5:33 PM Subject: Re: [ozmidwifery] Preconception care? I'm with Kim, in NZ we were taught pre conception care as part of our uni course. It was also a part of our scope of practise, i am 2nd year at uniSA and have yet to see anything done on it here though. Kirsten ~~~start life with a midwife~~~ - Original Message - From: Kim Stead To: ozmidwifery@acegraphics.com.au Sent: Saturday, March 05, 2005 9:02 AM Subject: Re: [ozmidwifery] Preconception care? Hi Julie I haven't got much time to chat at the moment but I do believepre-conception care is part of our practice shouldwe be able to access women at this time.It's important to discuss the importance of a healthy body prior to conception - especially things such as diabetes control, listeria, toxoplasmosis, family histories (spina bifida comes to mind and increased folic acid) etc. There's quitea few other things that I discuss (not that many women make contact prior to conception). Must run for now.I look forward to other's perceptions on this topic. Kiwi Kim ---Original Message--- From: ozmidwifery@acegraphics.com.au Date: 03/05/05 09:58:28 To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Preconception care? Hello all you wonderful, wise people. I was wondering what your thoughts are on midwives providing preconception care. Is it in our scope of practice as we are told at university or does our role really only beginning in the antenatal period? If we are involved, what are we telling couples other than to take folic acid supplements and have sex in the middle of the menstrual cycle. I am beginning my final year of Midwifery at Flinders University and would like to explore and research this area further. Cheers, Julie Garratt (champion Ozmid lurker and learnerJ
Re: [ozmidwifery] newborn bath
I totally agree with you Megan and Denise. For most of us up here (Cairns) teaching the parents how to bath their baby is showing them that water immersion is actually OK and they take it from there. Of course there are the safety messages about hot water and not leaving baby alone in the bath etc.. Babies do get bathed a lot up here especially in summer when the humidity is so high and so a lot of time is spent on keeping baby cool discussions. It is pleasing to see on home visits that mum and dad are taking baby into the shower or bath with them. I remain surprised at how much fear there is around babies and water, so my main message is reassurance. Of course I love water myself. marilyn - Original Message - From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, March 03, 2005 1:39 AM Subject: Re: [ozmidwifery] newborn bath I have to agree there. My memories of my husband and I being taught how to bath our first child (6 yrs ago) are embarassing. I hadn't ever bathed a baby before, but to be told that today we will take you down and teach you how, it clearly was a messge that we weren't capable. Then the instructions on doing the head first, blah, blah, blah. My poor deprived fourth child, if it wasn't for the school and kindy show and tell bathing a baby sessions, he wouldn't have known what baths were. I know I'm being highly critical here, and I realise some parents will want to be shown, but really??? I also have a problem with the idea that these babies have to be bathed at all. Babies smell just beautiful all on their own, the Johnson and Johnson smell just gets in the way of this, not to mention the sensitivity these tiny new darlings are dealing with. Providing women with an option and explaining that not bathing their baby all the time is perfectly fine too. and, Yes, I know that water emmersion is lovely and relaxing, but thats not about washing them. anyway, my two bits worth, cheers Megan -- -- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Denise Hynd Sent: Thursday, 3 March 2005 7:33 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] newborn bath I find the whole idea of teaching an adult woman HOW to bath the most cherished person in her life a reflection of our patriachial attitude and approach to women, birth parenting. and another step along the path to disempowered parenting or re-enforcing the need for outside experts in deciding how respond to your child Perhaps supporting a woman to bath her child as she can in her home in her way is a little more respectful? Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. - Linda Hes This message was sent through MyMail http://www.mymail.com.au -- 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] MORE ACTIVE MANGAEMENT
Needless to say the procedure is not done very often and always the preferred place would be a hospital and under analgesia if not anaesthetic. If it where done at home it would always be with the consultation of a backup obstetrician by telephone. However as I said it was a required skill at least in simulation for graduation. As in Sue's case many independent midwives there do work in rural and remote locations where despite all efforts actual transfer times can be greater than 1 hour usually due to weather. This expectation has been around since at least the 1970's and in some states such as Washington where midwifery never became illegal, since 1917. As always the procedure would only be done when the risks of not doing it outweigh the risks of doing it in that particular location. A friend of mine who has attended over 2,000 births in the Seattle area since 1981 has performed the procedure once in that time, successfully with the mother and baby being able to remain at home albeit with the midwife sleeping over. Obviously litigation risks have also changed in the last 30 years and also at least in Seattle so has the transfer transport facillitation. I have heard several descriptions from midwives in the Washington-Oregon corridor who have done the procedure at least once and successfully. As with Sue many of these midwives were originally trained and educated by docs who were still attending homebirths through the 1970's, consequently they were taught many procedures that were not part of the hospital repertoire. Others have taken placements in developing countries (from Jamaica to the Phillipines) in charity hospitals where this (manual uterine exploration without anaesthetic) unfortunately is standard procedure even after the placenta has delivered, I am not sure but I actually think this was standard obstetric practice in the USA through the 1970's and maybe why it was also included as part of midwifery practice. Contrary to Australian perceptions of both nursing and midwifery in the USA and Canada, Nurses and Midwives there have provided basic care in many frontier outposts for a long time, it isn't all LA and NY though even there nurse practitioners and midwives practice. To be honest Australia seems much more litigation minded than the USA at least to me. Intervention is actually much more routine here and for public hospitals the c/s rate is almost 10% higher, I am comparing Washington, Oregon and California with Queensland. You also have to be aware that where midwives work in the USA whether it is in or out of hospital they do work with the authority of at least a nurse practitioner in Australia. An obstetric nurse would never do an MROP but neither would she catch a baby, a midwife would only do an MROP with consultation with an OB and would certainly step aside if one were available where she was attending a woman. Of course if a midwife performed the procedure inappropriately and especially if the mother was harmed she could expect to have her licence suspended if not revoked. Nurse Midwives in the USA can and do perform procedures and have prescription priveleges that are certainly part of the GP's scope of practice here. I am surprised at the number of retained placentas I have become aware of since working here and the associated extreme blood loss (approaching 2L), what was a truly rare occurrence for me is actually quite common in a hospital at least much more common that I expected. Since I didn't work in the hospital there except on occassions of transfer, I can't really compare the hospital systems, so their MROP rates in hospital may actually be similar. marilyn - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 01, 2005 4:59 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Hello Marilyn I am surprised that litigation- mad America sanctioned midwives performing MROP. If the placenta is difficult to remove manual removal may result in death from shock as well as haemorrhage. Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 01, 2005 2:24 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Jenny: I know that what you say is Australian practice and if i were attending homebirths here I would always transfer rather than do a manual removal of either a partially detached placenta or retained products however it wasn't considered outside of a midwife's scope of practice in the USA where I practised (california and washington state), in fact it was required by state law that i be capable of carrying out this procedure. The exact procedure is detailed in Varney's Midwifery third edition, p. 843, Chap 68. Most certaily considered part of the midwife's scope of practice. I would suggest
Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Jenny: I know that what you say is Australian practice and if i were attending homebirths here I would always transfer rather than do a manual removal of either a partially detached placenta or retained products however it wasn't considered outside of a midwife's scope of practice in the USA where I practised (california and washington state), in fact it was required by state law that i be capable of carrying out this procedure. The exact procedure is detailed in Varney's Midwifery third edition, p. 843, Chap 68. Most certaily considered part of the midwife's scope of practice. I would suggest that any birth attendant practicing in an out of hospital setting should at least know what to do and have practiced the procedure just in case which is what Sue was saying is her situation. I have never actually done the procedure myself but was knowledgeable of it, tested on it with simulation (as it is NOT something you practice on someone) and aware when it is necessary. Definetely quite different than removing a placenta trapped in the vaginal vault, the os, or lower segment. marilyn - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, February 27, 2005 9:00 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Manual removal of a separated placenta is different to manual removal of a placenta still attached to the uterine wall. Removing a separated placenta from the os or lower segment is not difficult but it is uncomfortable for the woman. Manually detaching a placenta from the uterine wall is barbaric and traumatic and should not be carried out unless under adequate anaesthetic and fluid replacement. Granted a partially separated placenta is a high risk situation as bleeding will continue until separation. Although this is an emergency we would better to summon help and use bi-manual compression to slow/stop the bleeding until assistance arrives. If you are performing true manual removal of the placenta and membranes (ie partially separated placenta ) as a midwife you are practising outside your scope of practice. Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, February 28, 2005 7:31 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Hi Sue, I was taught that if doing a manual removal would effectively save the woman's life, then that was the best option. Obviously a risk vs benefit type of situation. The doctor I trained with did the occasional manual removal at home rather than the time challenging option of transferring, and always with the woman's cooperation. I work rurally, and sometimes the speed of the bleed and the distance from hospital would equal real damage to the woman. As I said in my posting, I have not had to perform a manual removal, but I can and would if it was a life saving procedure. I thought the hospital acted very dangerously by delaying many aspects of their management of the PPH I witnessed last year, and that all up, a manual removal there and then would have been the quickest and safest option. Instead the woman went on to lose much more blood over another 40 minutes or so until in theatre, and then faced the choice of transfusion. I found that management very scary. I have witnessed one manual removal in a hospital on the delivery bed after the cord tugging GP/Obs broke the cord whilst trying to extract the placenta (after a forceps delivery). He simply went straight in after the placenta and delivered it quite quickly. The woman was not too perturbed!! (and hadn't had any drugs either). So I guess it's a matter of training, attitude, access and appropriateness - all to be assessed in a very short time frame if a real bleed is occurring. Sue I am a bit confused here - can you please explain how you do manual removal in the home situation? Surely this is too dangerous a procedure to do at home? Thanks Sue - Original Message - *From:* Marilyn Kleidon mailto:[EMAIL PROTECTED] *To:* ozmidwifery@acegraphics.com.au mailto:ozmidwifery@acegraphics.com.au *Sent:* Monday, February 28, 2005 1:34 PM *Subject:* Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Totally agree Sue. I was taught manual removal too and exactly the same re when to apply gentle but firm CCT. However, for a manual removal at home you do need maternal cooperation and did have one incidence in Seattle where we had to transfer for prolonged moderate/heavy blood loss that just would not settle and uterus that kept getting boggy. Para 3 with several years between each of the births, third birth being precipitous, placenta delivered easily (dirty duncan if you know what I mean
Re: [ozmidwifery] ACTIVE Vs EXPECT MAGMT
I think the other reason which tag teams on this one is the prevalence of malaria and resultant loss of rbc and hence anaemia. There are also other parasitic diseases coexisting chronically which also lead to a depletion of rbc. From reading the Hinchinbrook trial I was under the impression that syntometrine was more stable than syntocinon at room temperature especially temps greater than 25 celsius. Or is that misoprostol tabs (which of course are stable), but I think that is the reason given for research protocolsfor misoprostol and pph. marilyn - Original Message - From: Maternity Ward Mareeba Hospital To: ozmidwifery@acegraphics.com.au Sent: Monday, February 28, 2005 5:03 AM Subject: Re: [ozmidwifery] ACTIVE Vs EXPECT MAGMT Just a comment on why so many PPH deaths in underdeveloped countries. At a symposium I went to in Saudi Arabia many years ago one of the speakers was an African Dr. His subject was anemia in the underprivelaged and he spoke of how severely anaemic many of the women are. As a result PPH is more quickly devastating than in a woman with a normal (or nearly normal) Hb level. Cheers Judy [EMAIL PROTECTED] 02/28/05 07:05am Hi everyone. Back on the list and great topics abound !!I wrote a critical analysis last yr on active vs expectant management formaglobal perspective. Interestingly the infamous Hinchinbrook trial didacknowledge the type of labours. However there were significantdiscrepancies in my observation of the methodology eg: the confidence ofmidwives to support expectant management and no record of home births.I have personally noted a large no of women having a pph following activemanagement (according to the 500 defn) but also following induction oflabour , particularly withg syntocinon. In some areas such as homebirththese drugs are never used for IOL, in addition to countries like Germanywhere I have heard of acupuncture now being offerred for IOL in the hospitalsetting.There are 2 main issues with PPH. The global maternal mortality rate isapprox 600, 000 women die a year (of reported deaths). Over 90% of thesedeaths are in developing countries and largely due to PPH. Drugs like syntoare viewed by some authors as problematic as many tropical areas cannotrefridgerate and therefore cannot use synto. There is move afoot to look atother methods that do not require refridgeration. One begs the question,why so many deaths ? Is it related to the various experiences of managmentby TBA's who attend to most of the births ? Is it related to the factthousands of women spend days in labour and on their own ? Is itdehydration ? Malnutrition ? The list goes on... It certainly isrelated to a poor level of care and pathetic govt priorities in my view, tonot ensure as many women as possible have pregnancy birth and postpartumcare.In my view this is where the true crisis of PPH lies.Having said that. There is no global or even national standardisedmeasurement of loss (process), nor is there an agreed global standardiseddefinition of pph as many of you have so aptly pointed out.Certainly I think there is need for further research comparing the activeand expectant magmt techniques where there is no confidence bias, thatincorporates accurate defns of labour type also. Even a RCT looking at IOLwith synto vs No IOL of women 39-42 weeks and comparing their loss could besignificant.Thanks Sue for your insights on your practice and the wonderful knowledge ofJohn's wisdom. In my experience I always keep arnica and the australian bushflower essences on hand and discovered through my kinesiology practice aboutten yrs ago the need for a woman to have a homeopathic known as UstilagoMaidus twice antentally and three times in the immediate postpartum.I have then seen it used on three more occasions and would not hesitate tohave it on hand, particularly for remote rural areas.On another note, I have also noted that pph is common for women who have aprecipitous labour. Often these women appear to be in shock after the highof a beautiful, sometimes intense or furious labour.On an emotional and spiritual reflection of practice, I have also noted itis not uncommon for women who have experienced abuse to have a very veryfast or very very long labour also. And a pph. It is afterall the essenceof the life/death paradigm and I try to remain aware of this particularly ifthe dissasociation and trauma of unrecognised abuse arises in labour. Ithink it is important when a pph is not obviously drug induced or activelyinduced, we are alert to what the 'triggers' of the emotion around a pphcould be.Again, another reason highlighting the importance of one-to-one midwiferycare.Also a comment re the G10 P9 woman - I would consider assessing the wishesof the woman, the previous history, the
Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Totally agree Sue. I was taught manual removal too and exactly the same re when to apply gentle but firm CCT. However, for a manual removal at home you do need maternal cooperation and did have one incidence in Seattle where we had to transfer for prolonged moderate/heavy blood loss that just would not settle and uterus that kept getting boggy. Para 3 with several years between each of the births, third birth being precipitous, placenta delivered easily (dirty duncan if you know what I mean) physiologically but bleeding would not subside and mum kept soaking a pad in an hour, could not stand a hand going past the introitus and was happy to go to the hospital. Estimated blood loss was 1600mL including theatre, a pin head size piece of membrane was all they could find. Mum declined transfusion and was home the next day tired but happy. marilyn - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 24, 2005 11:59 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Hi, I would definitely treat this woman like all others and assume physiological 3rd stage is sufficient. I have never actively managed a 3rd stage, and have given syntometrine 3 times only after placentas were born - all in my early days of homebirth. I always prefer to; a) make sure women are well hydrated going into 2nd stage so they can tolerate volume loss b) if bleeding is serious go into deliver placenta mode I always catch and therefore can measure blood loss at a glance I engage the mother first and tell her she's bleeding and that I need her to focus and deliver her placenta I always give herbs as a first line of attack- shepherd's purse has always been my first choice I would rub up a ctxn, add an ice pack to her uterus if one available Then with her assistance pushing I would apply cord traction and see if the placenta would come Repeat this maybe twice Then contemplate manual removal if necessary (not had to yet...) I have managed 5 large haemorrhages (over 1.5 litres measured) in this manner and have not had to transfer anyone yet.(I have a haemoglobinometer with which I can measure Hbs on the spot over the next few weeks if necessary..) This management regime was taught to me by John Stevenson and always seems to work.Up until very recently, I have always worked alone. Isn't it interesting all the different ways we'd handle this depending on our personal experiences? By the way, late last year I witnessed the worst PPH I'd ever seen - mainly because of the management in the hospital (it was a hospital support not a homebirth), and with all the hands you could ever imagine -I'd say too many - the woman was severley depleted. Drips in etc etc but too much too late. A cord pulling midwife, and then no acknowledgement of when she needed help (irrespective of my pleas) plus she underestimated the blood loss by more than 100% (she thought 600ml, and it was measured by weight (? accuracy) to be more like 1400ml) and then the woman was taken to theatre - more time, more blood, why not a manual removal then and there?? Aaaah. Expect no PPH but stay on your toes ...always my motto. Sue - Original Message - From: leanne wynne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 24, 2005 2:43 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Hi All, I would be interested to hear from any experienced homebirth midwives how they would care for a woman who is a G10P9 if she chose to birth at home. She has had all normal, quick births so far. Would you use active management of third stage because she is a grand multip or would you still encourage a physiological third stage?? Leanne. From: Marilyn Kleidon [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Date: Thu, 24 Feb 2005 16:55:56 -0800 Excellent point. I do think the 500mL definition for PPH is spurious. Having been educated by a homebirth midwifery school I have to say we were not concerned when the blood loss was less than 1000mL as most of our 3rd stages were physiological. Very occassionally we did use oxytocin for management of 3rd stage usually when the woman had a history of PPH greater than 1000mL or retained products etc.. However we were well versed in the Cochrane studies and aware of that evidence so we had a high degree of caution shall I say. We did carry 40 units of pitocin and also ergometrine both vials and tabs to births as well as herbal remedies. Syntometrine does not seem to be available in the USA at least not where I was. That being said from what i have seen here postnatally, active management really decreases the postpartum blood loss in most women. I am currently doing the extended midwifery service and visiting
Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Fiona: I guess what I am meaning is the transition time from lochia that is moderate rubra to light serosa type loss, so not active fresh bleeding. I am also meaning the quality of the lochia in the second week. I was more familiar with women having a moderate serosa (pinkish brown)type loss at this time rather than women feeling comfortable wearing a panty liner after the first week due to only occassional spotting. marilyn - Original Message - From: Fiona Rumble To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 24, 2005 12:38 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Marilyn, could you please clarify what you mean by 'bleeding' in the post-partum. Are you refering to fresh blood loss or ongoing loss of lochia? I personally found no difference in the length of time I had a vaginal loss (similar to a period) with all three of my children- the first, definitely given injection as shoulder birthed, second have no idea, and third absolutely no intervention. I realise that every woman is an individual, however I have always 'bled' for 6 weeks or more, regardless of third stage management. Just curious as to what is the 'norm' ??? Thankyou, Fiona - Original Message - From: Marilyn Kleidon To: ozmidwifery@acegraphics.com.au Sent: Friday, February 25, 2005 10:55 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Excellent point. I do think the 500mLdefinition for PPH is spurious. Having been educated by a homebirth midwifery school I have to say we were not concerned when the blood loss was less than 1000mL as most of our 3rd stages were physiological. Very occassionally we did use oxytocin for management of 3rd stage usually when the woman had a history of PPH greater than 1000mL or retained products etc.. However we were well versed in the Cochrane studies and aware of that evidence so we had a high degree of caution shall I say. We did carry 40 units of pitocin and also ergometrine both vials and tabs to births as well as herbal remedies. Syntometrine does not seem to be available in the USA at least not where I was. That being saidfrom what i have seen here postnatally, active management really decreases the postpartum blood loss in most women. I am currently doing the extended midwifery service and visiting women in their home during the first 1 to 10 days and most seem to have almost finished bleeding by day 5, for most of the homebirth women I visited in the USA just from memory I would say they were almost finished by day 10. Both the American College of Nurse Midwives (ACNM) and the Midwives Alliance of North America (MANA) have been collecting stats for 5 to 10 years at least and must have good stats on this topic. I know it isn't Australian data but itmight be helpful. marilyn - Original Message - From: Jenny Cameron To: ozmidwifery@acegraphics.com.au Sent: Wednesday, February 23, 2005 3:51 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Good point Michelle. If we used 1000ml as PPH definition the stats would not look so appealing for active mgmt. Also as someone stated women having a physiological 3 stage tend to lose more in the first few hours after birth than those having active mgmt. As far as I am aware no-one has researched total postpartum (say in the first week) blood loss. Hb or Hct estimation is the best way of determining blood loss post partum but you need to have a pre-partum Hb/Hct as well. Jenny Jennifer Cameron FRCNA FACMProMid Professional Midwifery Education Service0419 528 717 - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Wednesday, February 23, 2005 10:34 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Ihaven't heard ofa study of this type beingb done. I find it interesting that the NSW policy (similar to many others) of PPH is over 500ml, and yet the WHO states that in healthy populations (ie not anaemic etc) up to 1000ml blood loss may be physiological. It isoften said that blood loss at birth is underestimated I wonder how many women have blood loss of over 500mland are fine due to the increased circulating blood volume in pregnancy. Cheers MichelleFiona Rumble [EMAIL PROTECTED] wrote: WITH REGARDS TO THE RESEARCH THAT SUBSTANTIATES THE CLAIMS THAT ACTIVE MANAGEMENT IS SAFER THAN PHYSIOLOGICAL MANGAEMENT
Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
I would make sure I had a good supply of oxytocics on hand even maybe have the syntocinon drawn up but unless she has a hx of PPH etc. I would not assume a PPH is destined to happen. Of course if the woman requested active management then that would be fine too. If the woman was confident to wait and see what happens I would be too. I would want to have a recent FBC available and IV fluids in my bag.And the woman totally informed of the increased risk of PPH especially if she were to have a preciptitous or prolonged labour. Definetly would be nice to have a 2nd midwife with me. LOve to hear what others say. marilyn - Original Message - From: leanne wynne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 24, 2005 2:43 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Hi All, I would be interested to hear from any experienced homebirth midwives how they would care for a woman who is a G10P9 if she chose to birth at home. She has had all normal, quick births so far. Would you use active management of third stage because she is a grand multip or would you still encourage a physiological third stage?? Leanne. From: Marilyn Kleidon [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Date: Thu, 24 Feb 2005 16:55:56 -0800 Excellent point. I do think the 500mL definition for PPH is spurious. Having been educated by a homebirth midwifery school I have to say we were not concerned when the blood loss was less than 1000mL as most of our 3rd stages were physiological. Very occassionally we did use oxytocin for management of 3rd stage usually when the woman had a history of PPH greater than 1000mL or retained products etc.. However we were well versed in the Cochrane studies and aware of that evidence so we had a high degree of caution shall I say. We did carry 40 units of pitocin and also ergometrine both vials and tabs to births as well as herbal remedies. Syntometrine does not seem to be available in the USA at least not where I was. That being said from what i have seen here postnatally, active management really decreases the postpartum blood loss in most women. I am currently doing the extended midwifery service and visiting women in their home during the first 1 to 10 days and most seem to have almost finished bleeding by day 5, for most of the homebirth women I visited in the USA just from memory I would say they were almost finished by day 10. Both the American College of Nurse Midwives (ACNM) and the Midwives Alliance of North America (MANA) have been collecting stats for 5 to 10 years at least and must have good stats on this topic. I know it isn't Australian data but itmight be helpful. marilyn - Original Message - From: Jenny Cameron To: ozmidwifery@acegraphics.com.au Sent: Wednesday, February 23, 2005 3:51 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Good point Michelle. If we used 1000ml as PPH definition the stats would not look so appealing for active mgmt. Also as someone stated women having a physiological 3 stage tend to lose more in the first few hours after birth than those having active mgmt. As far as I am aware no-one has researched total postpartum (say in the first week) blood loss. Hb or Hct estimation is the best way of determining blood loss post partum but you need to have a pre-partum Hb/Hct as well. Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Wednesday, February 23, 2005 10:34 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT I haven't heard of a study of this type beingb done. I find it interesting that the NSW policy (similar to many others) of PPH is over 500ml, and yet the WHO states that in healthy populations (ie not anaemic etc) up to 1000ml blood loss may be physiological. It is often said that blood loss at birth is underestimated I wonder how many women have blood loss of over 500ml and are fine due to the increased circulating blood volume in pregnancy. Cheers Michelle Fiona Rumble [EMAIL PROTECTED] wrote: WITH REGARDS TO THE RESEARCH THAT SUBSTANTIATES THE CLAIMS THAT ACTIVE MANAGEMENT IS SAFER THAN PHYSIOLOGICAL MANGAEMENT OF THIRD STAGE, DOES ANYONE KNOW IF THERE HAVE BEEN ANY STUDIES COMPARING PHYSIOLOGICAL WHOLE OF LABOUR AND BIRTH WITH ACTIVE MANAGEMENT OF THIRD STAGE FOLLOWING MANAGED LABOUR AND BIRTH I AM SURE THE RESULTS WOULD BE VERY DIFFERENT. JUST A THOUGHT. CHEERS FIONA --- - Find local movie times and trailers on Yahoo! Movies. Leanne Wynne Midwife in charge of Women's Business
Re: [ozmidwifery] DEM's
So, the state regulations must be different in SA than Qld and WA. The hospital would be more than happy for us to work with gyne patients it just isnot ok with the QNC and so we would not be covered by hospital insurance policies if we did and neither would the hospital iffor example we were involved in a court case and a gyne patient. marilyn - Original Message - From: shaz42 To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 17, 2005 1:59 AM Subject: Re: [ozmidwifery] DEM's I work in a private hospital casually in SA they allow me to work with the gyne patients and maternity patients. I also work at the women's and children's hospital in Adelaide and iam allowed to work with the neonatal patients in SCBU we cannot work in general wards unless we are registered nurses. - Original Message - From: Marilyn Kleidon To: ozmidwifery@acegraphics.com.au Sent: Friday, February 18, 2005 11:34 AM Subject: [ozmidwifery] DEM's We have been discussing restrictions on practice to Direct Entry Midwives can others tell us what the restrictions are state to state. I work in Qld and am restricted from working with gyne patients, others have said (Sadie) that in WA she is also restricted from working with gyne patients can others advise us what the situations are in NSW, SA, VIC, TAS, and NT? Thanks marilyn - Original Message - From: Mary Murphy To: list Sent: Wednesday, February 16, 2005 5:23 AM Subject: [ozmidwifery] Interesting The Art of Midwifery After 30 years of assisting mothers in labor at home and in the hospital, I have found some techniques that help empower mothers when they are pushing. In the beginning and at the time of birthing it is very relaxing and easy for some mothers to be on their side. If side-lying pushing does not seem to bring progress, then an upright position, preferably a standing squat or kneeling squat, can work well. Birth in a squatting position seems to encourage rapid expulsion and tearing, so I ask mothers to lean back in a semi-recline for the actual birth. I do use gentle perineal support, usually with a warm cloth and oil as needed. But when different positions have been tried and the fetal head is unable to come under the pubic arch, I encourage the mother to lie flat on her back with just a pillow under her head. I help her bring her legs up with the soles of her feet together. I wrap a towel around her feet and have her grasp the ends of the towel and pull as she pushes. This motion brings her legs back and the position causes a widening of the outlet, even more than squatting. The mother's elbows should be out and one should resist the urge to raise her upper body because this action seems to make the push less effective. Coaching the mother to "push the baby down and then up to the ceiling" seems to help as well. This position has saved many of my mothers from a c-section. I try to suggest it after the mother has tried any positions she prefers and before she becomes exhausted. I explain that, while it may seem to be a strange position, it may shorten the time needed to push the baby out. At the time of serious crowning, the towel can be abandoned and the mother may assume any position desired. It makes me sad when I see current writings that caution women to refrain from lying on their backs at any time during labor. We all know why women are told this, but we also know there are exceptions to everything. By the way, this position works with or without regional anesthesia, for those practicing in hospital settings where anesthesia is common. Mary Jo Terrill, RN, BSN, MSWSanta Barbara, California
Re: [ozmidwifery] epidural research
I still think it's all about marketing, isn't everything these days. I hate to be cynical and try to be sceptical... but I really think we are in a turf war with the obstetricians (not all of them but with their professional association aka AMA) and anaesthetists over normal women and normal labour and birth. Because the overall birth rate is low we have a smaller and smaller pool to divide up. So this research is used to convince normal healthy women to choose services they don't need. When we counter such arguments we need to be careful we don't fall into traps that further enable them to promote their product: pain free technological birth as safe as liposuction (name any plastic surgery that is now marketed as "cosmetic" surgery). We had TV shows that promote drastic surgery on otherwise normal people for superficial purposes. Please note just as there are many valid reasons for c/s and pain relief in labour there are many valid and life changing reasons for plastic surgery, we live in an amazing world, it is just that the marketeers are running rife and we have to be very careful... Just my opinion. marilyn - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 17, 2005 5:26 AM Subject: RE: [ozmidwifery] epidural research Dean and Jo wrote: I seriously question the validity of the research being done these days! I know what you mean Jo, and I seriously question some of the interpretation of research. Some of the medical profession take any studythat suits them and quote it as evidence based practice. Today I went to an inservice on CTG's and outcomes from a study done in Dublin were quoted - apparently the largest ever study on outcomes of CTG monitoring versus intermittent, involving over ten thousand women. I haven't heard of this study (has anyone else?) but it supported the use of continuous monitoring and supposedly didn't increase theircaesar rate.I find it hard tobelieve especially when they went on to talkabout the 50%-70% false positives for fetal distress withCTG's. Michelle -Original Message-From: [EMAIL PROTECTED] [mailtoo:[EMAIL PROTECTED] On Behalf Of Kylie CarberrySent: Thursday, February 17, 2005 10:13 AMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] epidural research Hi everyone, Just thought you all may be interested in a press release I found on the net and wanted to see what everyone thought. I just gave my first-time pregnant sister-in-law a run down the risks of epidurals as she was very quick to say she will request one (of course her OB encouraged her, saying if I was a woman I'd have oneneedless to say this made me cringe), what can I tell her about this new research. Early epidural does not raise c-section risk Last Updated: 2005-02-16 17:00:33 -0400 (Reuters Health) NEW YORK (Reuters Health) - Women in labor who need early pain relief need not fear that an epidural makes it more likely that they'll have to have a cesarean. Compared with intravenous narcotic pain control, new research shows, epidural pain control started in early labor does not increase the probability that women will undergo a c-section. Moreover, an early epidural seems to provide better pain control and may shorten the duration of labor. Previous reports have linked epidural analgesia with an elevated risk of cesarean delivery, but it is possible that this increased risk was due to related factors and not to the epidural per se, the researchers note in this week's New England Journal of Medicine. To determine if epidural pain control is an inherent risk factor for c-section, Dr. Cynthia A. Wong, from Northwestern University in Chicago, and colleagues assessed the outcomes of 750 pregnant women who received epidural pain control or intravenous hydromorphone started in the early stages of labor. In contrast to previous reports, the c-section rate in the epidural group was actually slightly lower than that seen in the comparison group: 17.8 versus 20.7 percent. There was evidence that epidural pain control hastened delivery. The time from the start of pain control until delivery was significantly shorter in the epidural group. In addition, epidural anesthesia was associated with significant improvements in pain and with better Apgar scores, the system used to evaluate infants in the first minutes of life. In a related editorial, Dr. William Camann, from Brigham and Women's Hospital in Boston, comments that for women who experience severe pain in early labor and desire pain control, the new
[ozmidwifery] Tsunami Relief Work
Hi all: I have copied this from the most recent Midwifery Today Enews. Gives us all a chance to do something perhaps. marilyn Aceh Midwifery Relief Update from Robin Lim February 2, 2005 Dear family, loved ones, In two days our "Mother/child survival" team will leave for Aceh. It has been a wild ride getting ready. The direct family members going along will be Wil, Deja, Thor and myself. Other team members include Ida Tanjung, Kelly, and Oded. We will join a group of 16 sanitation (well and out-house diggers) workers from Bali. We will travel from Medan to the West coast of Sumatra, to an area near Meulaboh, to a small area not on most maps called "Sama Tiga." There we will be setting up human resource services. My focus will be women and children (no surprise). The reports we had from this area yesterday said, "It's a lot worse than we imagined. The women are hiding, no matter how sick, hungry, pregnant or injured, they won't come out to seek medical aid, or food, or any help, as they culturally cannot have contact with male relief workers. Get over here, fast." These were the words of Christine, whose husband, Ngurah heads up the sanitation guys. Thor, by the way, will be digging those out-house holes. "Birth buckets" are the most important things will be bringing for the expectant women. The birth buckets contain high protein foods, rehydration fluids, a sarong (remember, they lost everything in the tsunami, including 80% or more of the population), veils (Muslim women will not come out unless their heads are covered), candles, a lighter, underwear, receiving blankets, baby clothing, cloth diapers, vitamins, herbs to prevent hemorrhage and Betadine for cleaning hands where there is no water. Looking at the first buckets we made up, I cried, knowing that if I had been given one of these buckets when I was a young mother-to-be, it would have been useful, and I would have been full of gratitude. Please read the rest of Robin's update. Feedback Kelly Dunn is a lay midwife working with two nongovernment organizations (NGOs). Yaysan Bumi Sehat (Healthy Mother Earth Foundation) had run a successful community cooperative clinic in the village of Nyuh Kuning. However, after the tsunami everything has been destroyed. Yayasan Bumi Sehat is a nonprofit organization (NPO) of community members, midwives, and doctors who help advocate for reproductive rights for low-income, marginalized, and displaced women and their children. They are now offering their services to the thousands of women who are birthing without any assistance or help. They offer free prenatal, postpartum and birth services. They also promote and educate natural family planning. Right now they are creating birth buckets to give birthing women in this area the basics for a birthing mom. They are getting some funding through IDEP (www.idepfoundation.org/), an NGO in Indonesia working directly with the people. Both these groups are well-known, and all their money is documented. Midwives and readers who want to give directly to these organizations can find more information at www.idepfoundation.org/Idep_partners.html. Kelly and all the people on her team are volunteers. It would be really wonderful to be able to help these people. I am doing everything I can from this side to help them raise funds. They are doing terrific work, and Kelly is now volunteering her time overseas. Heather Mauer, Executive DirectorThe Institute for Professional and Executive Development, Inc.Washington, DC 20004 Find local movie times and trailers on Yahoo! Movies.
Re: [ozmidwifery] Bach Mid
Well said Sadie, exactly my experience in Qld. It isn't that I wont work Gyne or any other general ward here, it is that the QNC forbids it as it is NOT what I am licensed to do as a DEM. There are only 2 of us here so we have had to make it perfectly clear it is not our preference. However it does make other staff unhappy when you can never be redeployed etc.. marilyn - Original Message - From: Sadie To: ozmidwifery@acegraphics.com.au Sent: Monday, February 14, 2005 5:54 PM Subject: Re: [ozmidwifery] Bach Mid Hi Tania, I am a direct entry midwife trained in the UK which is the same as your BMid course. I work in Perth, and even though I was an auxiliary nurse before training (no certification), I am not insured to do 'adult nursing' - that means I cannot relieve for meal breaks in emergency or work shifts in gynae or adult special care. It isn't because I don't want to, my WA registration forbids it. You need to be sure your registration and hospital is actually covering you for any tasks you perform outside your midwifery practice. There are 50 direct entry trained midwives here, and this applies to all of us. I also did 'general' placements in my 3 year training course, but that does not give you an RN certification. Cheers, Sadie - Original Message - From: Tania Laurie To: ozmidwifery@acegraphics.com.au Sent: Tuesday, February 15, 2005 11:57 AM Subject: Re: [ozmidwifery] Bach Mid Hi Kim I was interested in your comment about not being able to be relocated to other 'wards' - is that from your point of view or others'? I'm a current Bmidder at UniSA and in our first year, we did a 'general nursing' placement on a surgical wardto enhance confidence andskills in the areas of basic nursing (BP, TPR etc blah blah blah, changing dressings, catheters yadayada yada - you get the picture). When on mid placements, where some 'general' patients may also be, if 'mid' is quiet and I'm asked to care for these patients (even men), I'm more than happy to oblige. It can only enhance my knowledge and experience. As with yourself, I'm not anti-nurse, I just chose not to be one. I think if we are willing to do the extra bits to combat the myth that we can't do anything else, it can only help those who follow us and assist in changing the attitudes of those out there who are not so happy with the way mid education is going. In an ideal world, we wouldn't have to fight and argue so hard about our abilities and competence, but it's not an ideal world so I do the best I can with what I've got and take on just about anything! (within reason of course). Cheers Tania - Original Message - From: Kim Stead To: ozmidwifery@acegraphics.com.au Sent: Monday, February 14, 2005 6:55 PM Subject: [ozmidwifery] Bach Mid Hello again Marcia and others interested in this thread. Thanks for your intro Marcia. It's always nice to knowwho you are talking to. I guess I have become a bit guardedregarding my midwifery qualification as it's been atorturous road to find a supportive environment in which to practice. I live rurally - Gippsland to be precise. DE midwives are virtually unheard of in the rural areas and many are at a lossas to 'what to do with us' since we can't be relocated to otherwards - despite screaming out for midwifery staff. Some, like anything new, are veryresistant to change - mostly their own insecurities from what I can make out. Anyway, I arrived in Australia 18mths ago and applied at two hospitals for work - both turned me down because 1. I could not be relocated and 2. because they were 'too busy' training medical staff. I was also told that "I needed serious career advice if I thought I would ever be able to work in this country". That was from one individual but someone in a position who should have known better!!! You can imagine how that felt being a new, very enthusiastic graduate who had just sacrificed everything (family financesincluded)to survive the 3 year 'full-on' degree!! It was soul destroying to say the least and I now fully understand the term 'horizontal violence'! Fortunately for me - it just made me stronger and more determined! Why does this profession 'eat their young' instead of nuture them? I thought as midwives and as women - we were the nuturing
Re: [ozmidwifery] Uterine rupture Castor oil
I have definetly seen higher incidence of mec liq with births from women who have taken castor oil, but then they have all been postdates (well and truly and trying to avoid hospital inductions) and there is a higher incidence of mec liq with postdates babies anyway. I am sure there isn't a study but theoretically since it is such a powerful emetic wouldn't some of that pass to the baby too at least there is a possibility: I guess it depends on the exact chemical that stimulates the mother's bowel and if it can cross the placenta? Castor oil has been around a long time, even in the fifties it was still used for hospital inductions (I wasn't working then but mum was): the good old castor oil and orange juice cocktail but if you have ever taken (or been given as a child) castor oil for constipation you would NEVER use it lightly. Certainly in the same category as a methods of inductions for women with a prior caesarean birth. marilyn - Original Message - From: Sadie To: ozmidwifery@acegraphics.com.au Sent: Tuesday, February 15, 2005 5:53 AM Subject: [ozmidwifery] Uterine rupture Castor oil A woman at 39 weeks' gestation with a previous Cesarean delivery had severe abdominal pains and rupture of membranes shortly after ingesting 5 ml of castor oil. Forty-five minutes later, repetitive variable decelerations prompted a Cesarean delivery. At surgery, a portion of the umbilical cord was protruding from a 2-cm rupture of the lower transverse scar. Uterine rupture associated with castor oil ingestion. Sicuranza GB, Figueroa R.Journal of Maternal - Fetal Neonatal Medicine [NLM - MEDLINE].Feb 2003.Vol.13,Iss.2;pg.133 Cheers, Sadie
Re: [ozmidwifery] Uterine rupture Castor oil
I just did a pub med search on "castor oil"AND labour and got 4 hits, 2 which had abstracts which seem to contradict each other, marilyn: S Afr Med J. 1987 Apr 4;71(7):431-3. Related Articles, Links Meconium during labour--self-medication and other associations.Mitri F, Hofmeyr GJ, van Gelderen CJ.Prior to artificial rupture of membranes, 498 women were questioned about obstetric and social factors including self-medication during pregnancy. Caesarean section (P less than 0,01) and low Apgar scores (P less than 0,001) were significantly more common in pregnancies complicated by fetal meconium passage. Meconium passage was more common in women who had recently taken castor oil (P less than 0,01) and possibly herbal substances called 'sihlambezo' (trend P less than 0,2). Use of laxatives or enemas and other obstetric risk factors were not associated with meconium passage.PMID: 3563790 [PubMed - indexed for MEDLINE] Cochrane Database Syst Rev. 2001;(2):CD003099. Related Articles, Links Castor oil, bath and/or enema for cervical priming and induction of labour.Kelly AJ, Kavanagh J, Thomas J.Clinical Effectiveness Support Unit, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent's Park, London, UK, NW1 4RG. [EMAIL PROTECTED]BACKGROUND: Castor oil, a potent cathartic, is derived from the bean of the castor plant. Anecdotal reports, which date back to ancient Egypt have suggested the use of castor oil to stimulate labour. Castor oil has been widely used as a traditional method of initiating labour in midwifery practice. Its role in the initiation of labour is poorly understood and data examining its efficacy within a clinical trial are limited. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. OBJECTIVES: To determine the effects of castor oil or enemas for third trimester cervical ripening or induction of labour in comparison with other methods of cervical ripening or induction of labour. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. Last searched: November 2000. SELECTION CRITERIA: (1) clinical trials comparing castor oil, bath or enemas used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods; (2) random allocation to the treatment or control group; (3) adequate allocation concealment; (4) violations of allocated management not sufficient to materially affect conclusions; (5) clinically meaningful outcome measures reported; (6) data available for analysis according to the random allocation; (7) missing data insufficient to materially affect the conclusions. DATA COLLECTION AND ANALYSIS: A strategy has been developed to deal with the large volume and complexity of trial data relating to labour induction. This involves a two-stage method of data extraction. MAIN RESULTS: In the one included study of 100 women, which compared a single dose of castor oil versus no treatment, no difference was found between caesarean section rates (relative risk (RR) 2.31, 95% CI 0.77, 6.87). No data were presented on neonatal or maternal mortality or morbidity. There was no difference between either the rate of meconium stained liquor (RR 0.77, 95% CI 0.25,2.36) or Apgar score 7 at 5 minutes (RR 0.92, 95% CI 0.02,45.71) between the two groups. The number of participants was small hence only large differences in outcomes could have been detected. All women who ingested castor oil felt nauseous. REVIEWER'S CONCLUSIONS: The only trial included in this review attempts to address the role of castor oil as an induction agent. The trial was small and of poor methodological quality. Further research is needed to attempt to quantify the efficacy of castor oil as an induction agent.Publication Types: ReviewPMID: 11406076 [PubMed - indexed for MEDLINE] - Original Message - From: Sadie To: ozmidwifery@acegraphics.com.au Sent: Tuesday, February 15, 2005 5:53 AM Subject: [ozmidwifery] Uterine rupture Castor oil A woman at 39 weeks' gestation with a previous Cesarean delivery had severe abdominal pains and rupture of membranes shortly after ingesting 5 ml of castor oil. Forty-five minutes later, repetitive variable decelerations prompted a Cesarean delivery. At surgery, a portion of the umbilical cord was protruding from a 2-cm rupture of the lower transverse scar. Uterine rupture associated with castor oil ingestion. Sicuranza GB, Figueroa R.Journal of Maternal - Fetal Neonatal Medicine [NLM - MEDLINE].Feb 2003.Vol.13,Iss.2;pg.133 Cheers, Sadie
Re: [ozmidwifery] Telemetric?
I have had access to these for women before in Seattle, and thought they were excellent in circumstances were you were required to have continuous monitoring but the mum was ambulatory, however most staff here are not impressed by them primarily I expect because of cost but also because I do remember them mentiopning reliability. So, what is the machine to machine cost of a telemetric unit vs the regular one and maybe also does anyone have access to the case made to purchase one? I am thinking that some of our regularly used ctg's will need to be replaced sometime soon and maybe just maybe a case could be made to purchase one of these. Of course it is somewhat unfair if there is only one in the unit and if the cost were comparable then why not have all the ctg's with the telemetric option? Themodel used in Seattle could be hooked up to the bedside unit or read remotely, however that does require all ctg's having a central monitoring unit...umm! marilyn - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Friday, February 11, 2005 10:12 PM Subject: Re: [ozmidwifery] Telemetric? Á telemetric CTG is a cordless CTG. Mt Isa (Qld) had one (in 2000) and used it. More recently when I worked in Hobart in a private hospital, they had one.If you really have to have a CTG on, then these areway ahead of the tradition CTG. It allows the women to be mobile and the one in Hobart was water proof as well so they were able to use the shower and bath with it on. It had excellent reception - the birth suites were on the 3rd floor of the hospital and the CTG could still be picked up on the ground floor. I think they're actually safer in that you don't havecords there for the woman or others to trip up in. Cheers Michelle Kim Stead [EMAIL PROTECTED] wrote: You'll have to excuse my ignorance butt.. what is a telemetric CTG compared to the standard contraption? ---Original Message--- From: ozmidwifery@acegraphics.com.au Date: 02/12/05 15:39:09 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Student's support role well, ours doesn't which I think is a shame, so that's why I am asking. marilyn - Original Message - From: "shaz42" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 10, 2005 1:46 PM Subject: Re: [ozmidwifery] Student's support role mosthospitals have the telemetricctg available it is just the staff which dont tend to use this as it can be a bit fiddly. - Original Message - From: "Marilyn Kleidon" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, February 12, 2005 12:07 AM Subject: Re: [ozmidwifery] Student's support role Just a question of interest: how common are telemetric ctg's here in Australia?? marilyn - Original Message - From: "shaz42" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 10, 2005 2:01 AM Subject: Re: [ozmidwifery] Student's support role Kirsten as a newly qualified midwife who has supported women during birth when a student I wish you luck. You need to be very strong for both the woman and her partner in what she wants to get out of her birth. I suggest that when you are with the woman and her partner during the birth you act as her advocate and speak up for her but at the same time ensure that both the wom,an and the unborn baby are not in any danger from what you are suggesting. A woman will adopt a position which she feels comfortable and safe in. There are ways around monitoring such as intermittent monitoring of the fetus using Doppler or using the telemetric ctg instead of forcing the woman to lay on the bed. Good luck with your role as support person. You could try reading some of the birthing books that women read to find out positions act or speak to the midwives at the clinic when you attend with the wom
Re: [ozmidwifery] Student's support role
well, ours doesn't which I think is a shame, so that's why I am asking. marilyn - Original Message - From: shaz42 [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 10, 2005 1:46 PM Subject: Re: [ozmidwifery] Student's support role most hospitals have the telemetric ctg available it is just the staff which dont tend to use this as it can be a bit fiddly. - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, February 12, 2005 12:07 AM Subject: Re: [ozmidwifery] Student's support role Just a question of interest: how common are telemetric ctg's here in Australia?? marilyn - Original Message - From: shaz42 [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 10, 2005 2:01 AM Subject: Re: [ozmidwifery] Student's support role Kirsten as a newly qualified midwife who has supported women during birth when a student I wish you luck. You need to be very strong for both the woman and her partner in what she wants to get out of her birth. I suggest that when you are with the woman and her partner during the birth you act as her advocate and speak up for her but at the same time ensure that both the wom,an and the unborn baby are not in any danger from what you are suggesting. A woman will adopt a position which she feels comfortable and safe in. There are ways around monitoring such as intermittent monitoring of the fetus using Doppler or using the telemetric ctg instead of forcing the woman to lay on the bed. Good luck with your role as support person. You could try reading some of the birthing books that women read to find out positions act or speak to the midwives at the clinic when you attend with the woman they are a invaluable source of information. Enjoy your time as a student - Original Message - From: Kirsten Wohlt [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 10, 2005 9:17 AM Subject: [ozmidwifery] Student's support role Hi all, As a 2nd year BMid student with very limited experience of being present at births, I wonder if I may ask for some tips on how to support women in labour. I have attended only 3 births, and have contributed to some degree by being there to hold a woman's hand or bring her ice or a cool cloth, or speak an encouraging word - very much been working on the 'less is more' basis and being a quiet support presence. I have one woman now who is planning a VBAC and has some specific requests regarding my support role, but I don't know where to start, and I don't want to go in there feeling nervous and tense! Her first birth was long and painful, ending in an emergency c-section following a 'failed' induction. She remembers essentially lying in the bed the whole time, not walking around, and having several doses of pethadine. This time she wants to stay active and upright and would rather have limited/no drugs. She says that she knows she will not want to walk once she is in labour and wants her husband and I to be strong and 'make' her. She also wants me to think about ways to encourage her, or positions that may help. I don't have any idea how to start...any pointers? Articles, texts, experience? I will do web research and look through my uni texts, but I know there will be an awful lot out there - some pointers which will help refine the search would be really appreciated. Many thanks, Kirsten -- 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. -- 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] Student's support role
Just a question of interest: how common are telemetric ctg's here in Australia?? marilyn - Original Message - From: shaz42 [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 10, 2005 2:01 AM Subject: Re: [ozmidwifery] Student's support role Kirsten as a newly qualified midwife who has supported women during birth when a student I wish you luck. You need to be very strong for both the woman and her partner in what she wants to get out of her birth. I suggest that when you are with the woman and her partner during the birth you act as her advocate and speak up for her but at the same time ensure that both the wom,an and the unborn baby are not in any danger from what you are suggesting. A woman will adopt a position which she feels comfortable and safe in. There are ways around monitoring such as intermittent monitoring of the fetus using Doppler or using the telemetric ctg instead of forcing the woman to lay on the bed. Good luck with your role as support person. You could try reading some of the birthing books that women read to find out positions act or speak to the midwives at the clinic when you attend with the woman they are a invaluable source of information. Enjoy your time as a student - Original Message - From: Kirsten Wohlt [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 10, 2005 9:17 AM Subject: [ozmidwifery] Student's support role Hi all, As a 2nd year BMid student with very limited experience of being present at births, I wonder if I may ask for some tips on how to support women in labour. I have attended only 3 births, and have contributed to some degree by being there to hold a woman's hand or bring her ice or a cool cloth, or speak an encouraging word - very much been working on the 'less is more' basis and being a quiet support presence. I have one woman now who is planning a VBAC and has some specific requests regarding my support role, but I don't know where to start, and I don't want to go in there feeling nervous and tense! Her first birth was long and painful, ending in an emergency c-section following a 'failed' induction. She remembers essentially lying in the bed the whole time, not walking around, and having several doses of pethadine. This time she wants to stay active and upright and would rather have limited/no drugs. She says that she knows she will not want to walk once she is in labour and wants her husband and I to be strong and 'make' her. She also wants me to think about ways to encourage her, or positions that may help. I don't have any idea how to start...any pointers? Articles, texts, experience? I will do web research and look through my uni texts, but I know there will be an awful lot out there - some pointers which will help refine the search would be really appreciated. Many thanks, Kirsten -- 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] RE: SA maternity hospitals info
Title: Message how interesting, never seen or heard of this before. marilyn - Original Message - From: Sylvia Boutsalis To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 10, 2005 3:31 AM Subject: RE: [ozmidwifery] RE: SA maternity hospitals info Funny you should ask about the Roma Wheel, as hardly anyone uses them, anywhere! They were a bit of a fad for a while, but the size of it made it a bit cumbersome in the labour rooms!! Check www.romabirth.com for info. Regards and happy looking, Sylvia PS. I have info on joining NACE. However it is a bit outdated (from last year). Is it still valid? -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Julie ClarkeSent: Thursday, 10 February 2005 7:39 AMTo: ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] RE: SA maternity hospitals info Hi Sylvia, I have read your message with interest and I am wondering what a Roma Wheel is could you describe it for me please? Warm regards, Julie Julie Clarke CBE Independent Childbirth and Parenting Educator HypnoBirthing (R) Practitioner ACE Grad Dip Supervisor NACE Advanced Educator and Trainer NACE National Journal Editor Transition into Parenthood Sessions 9 Withybrook Place Sylvania NSW 2224 Telephone 9544 6441 Mobile: 0401 2655 30 email: [EMAIL PROTECTED] visit Julie's website: www.transitionintoparenthood.com.au From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Sylvia BoutsalisSent: Saturday, 5 February 2005 7:18 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] RE: SA maternity hospitals info Hi all, Is there a website that I can access info regarding maternity services in Adelaide. I'm compiling a file of hospitals and what they offer. I want it to be something like this (which I did in Switzerland where I studied Childbirth Education): Kantonspital Basel, Frauenklinik Schanzenstrasse 46, 4056 Basel Tel: (061) 325 9595 This is an open hospital and accepts all types of medical insurance. 4 birthing rooms. 4 to 5 midwives on duty day and night. Cannot have a private midwife of own choice. Can have private Gynaecologist from the hospital with 1st and 2nd class insurance. Gynaecologist on duty 24 hours. Complete flexibility on position for delivery. Paediatrician on duty during the day and on call at night. Rooming in accepted. If sharing a room, by agreement with room mate. Breastfeeding help is given by the hospital staff. If the baby needs special care this is managed in the hospital whenever possible. Available for use during birth: Birth stool, mat, ball, rope, bath, Roma Wheel, various medication for pain, homeopathic medication, massage, reflexology, epidural anaesthesia. Information evening: 1st Tuesday of every month at 19:00 in the Horsaal. Any offers would be greatly appreciated. I actually visited all 7 hospitals (in Switzerland) and got detailed info from them about epidurals, C-Sections, birth rates etc. Thanks in advance Sylvia Boutsalis Adelaide Childbirth Educator Infant Massage Instructor
Re: [ozmidwifery] baby knows breats photo
Thank you so much Jo I think it is brilliant. marilyn - Original Message - From: Dean Jo To: ozmidwifery@acegraphics.com.au Sent: Tuesday, January 25, 2005 4:54 PM Subject: [ozmidwifery] baby knows breats photo This seems to be generating a great deal of interest and so I hope it is living up to peoples expectations! Actually, it is a cunning plan for you all to hand over your private email addresses.haw haw ha ha!! ( that was meant to be a sinister laugh that didnt quite work!) For those of you still interested, the pic is of a bub under 12months that is next to a statue of a bust of a woman. The second pic is bub sucking on the bust of the bust! Cheers Jo --Internal Virus Database is out-of-date.Checked by AVG Anti-Virus.Version: 7.0.300 / Virus Database: 265.6.5 - Release Date: 12/26/2004
Re: [ozmidwifery] attachments
I would love this too , Jo. [EMAIL PROTECTED] thanks marilyn - Original Message - From: Wendy Taberer To: ozmidwifery@acegraphics.com.au Sent: Tuesday, January 25, 2005 5:23 AM Subject: RE: [ozmidwifery] attachments Hi Jo, I too would love to see this photo. [EMAIL PROTECTED] Thanks From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Dean JoSent: 24 January 2005 07:44To: ozmidwifery@acegraphics.com.auCc: [EMAIL PROTECTED]Subject: [ozmidwifery] attachments I have a marvelous picture related to breast feeding and would like to share it with people, can this list accept JPEG attachmenst? Cheers Jo Bainbridge ---Outgoing mail is certified Virus Free.Checked by AVG anti-virus system (http://www.grisoft.com).Version: 6.0.836 / Virus Database: 569 - Release Date: 1/16/2005
Re: [ozmidwifery] Breast reduction site
I took the time to visit this site this morning and it is wonderful. marilyn - Original Message - From: Alesa Koziol To: ozmidwifery@acegraphics.com.au Sent: Tuesday, January 18, 2005 5:35 AM Subject: Re: [ozmidwifery] Breast reduction site Thanks Di, havent come across this site before, have just had a quick skim through but it seems like a great resource Cheers Alesa Alesa KoziolClinical Midwifery EducatorMelbourne There is a great website for women with breast reductions who wish to BF. www.bfar.org Cheers Di
Re: [ozmidwifery] Breast reduction
Dear Barb: What I have found is that the women themselves who have had breast reduction surgery when they come back for a second baby often don't want to repeat what happened the first time and so many choose to bottle feed. I think many do have unrealistic expectations and with early discharge even with follow up at home it isn't long enough to get a good supply established. I think we need to consider that at the very least breast physiology has been disrupted and this may lead to to a delay in the milk coming inand getting out which is the critical issue. I do know of one woman I worked with in California who went onto successfully fully breastfeed for at least 18 months, however it took 3 weeks for her milk to flow (it came in as usual but she was really engorged as the milk had no way at first to get out and baby was literally starving) and 6 weeks before she could stop comping, after the initial drama the baby thrived. This woman had 2 homebirth midwives plus a cattilion of lactation consultants in Santa Cruz looking out for her and she was incredibly zealous and dedicated in her endeavours. Finally the milk ducts re-grew/reconnected in any case her milk was able to flow. What I believe would have helped (hindsight is so cool)is: 1. Antenatal breast preparation: antenatal _expression_ of colostrum if possible: if this happenes I think your away, however I don't know if anyone has done this with this group of women. 2. If you don't want to feed formula then have your own supply (collected from friends?)of donor breast milk to feed baby until your supply is established, otherwise accept that baby will need formula feeds. 3. Have a support group of informed lactation consultants/ABA counsellors who will help you through the hurdles. 4. Accept that except for really rare instances (I personally don't know of any) your supply will not be established in the first week or even first 2 weeks. I hope this helps. Probably we need some protocols worked up I will check if our Lactation group have any. cheers marilyn - Original Message - From: Barb Glare To: ozmidwifery@acegraphics.com.au Sent: Monday, January 17, 2005 3:44 AM Subject: [ozmidwifery] Breast reduction Hi, does anyone have protocols at their place of work for working with mothers who have had breast reduction surgery and wish to breastfeed? Some mothers have reported that the staff have had very negative opinions of the mother's ability to breastfeed after a breast reduction, and have been happy to share those opinions with the mother. The mothers, whilst realising it may not be easy or possible to exclusively breastfeed are reporting that these opinions have left them feeling very discouraged, and have really knocked their confidence. They feel their attemps are not valued or appreciated. Any suggestions?
Re: [ozmidwifery] Birth Centre
Hi Jan and all: I'll go back to Andrea's issue with the gas and pethidine being on the menu why is this "* A natural birth is encouraged with hot showers, baths and hot packs, but if you want there is the gas or needle for pain (hard to believe this one!) offered in a birth centre? marilyn - Original Message - From: Jan Robinson To: ozmidwifery@acegraphics.com.au Sent: Sunday, January 16, 2005 3:39 AM Subject: Re: [ozmidwifery] Birth Centre Hi DiThere was a Birth Centre Network NSW wholly funded by NSW Health a few years ago, but not sure that it is still functional. I can remember a concern of the network at the time that no women from disadvantaged groups ever used the existing birth centres so a lovely little pamphlet was designed and distributed (courtesy of NSW Health) that attempted to define the birth centre concept and explain the advantages to women who used them.cover page was titled ...Birthing Place for All Womenpic of baby inserted hereBIRTH CENTRESinside was What is a birth centre?*A place to have your baby away from Labour Ward but still part of the hospital*In a birth centre each room has a double bed, chair, curtains and nice furnishings*The midwives of the birth centre will see you right through your nate-natal care, labour and after birth*A doctor will be called if problems arise*Medicare covers costs for birth centre careWhy use a birth centre?*You have your baby your way* It's a relaxed, friendly atmosphere* You can have your own support - whoever you want* A natural birth is encouraged with hot showers, baths and hot packs, but if you want there is the gas or needle for pain (hard to believe this one!)* Cultrural practices are respected and encouragedWho can use a birth centre?Almost all women can use a birth centre, but you may need to book in earlyWho will I see?Usually the midwives are femaleYou may be able to have shared care with a general pracftitioner, obstetrician or private midiwfe People to talk to there followed the local birth centres and Social work department contact detaiils as well as aboriginal medical service.Lots of work went into developing this pamphlet and as far as I can remember no feedback data was ever collected or the success of it's dissemination evaluated. Shame about that.If you really want a good definition of a Natural BIrth Centre - here is the one I like best .A Natural Birth Centre is* a safe, home-like place to have your baby.* managed by midwives who are specialists in natural birth* for women who plan to have their baby naturally.* located in (or near) a public maternity hospital that facilitates medical referral if necessaryThe Birth Centre midwives provide care for low-risk women throughout pregnancy, labour, birth and afterwards.The Birth Centre education program aims to empower women and their support people with a unique understanding of pregnancy and birth knowledge that facilitates participation in decision making related to the birth of their baby. I don't think any of the so called Birth Centres can say they adhere to all the above criteria. I would like to hear from any who think they do.I would like to see the development of Natural Birth Centres attached to each and every public hospital in the country. There would need to be a transfer of staff out into Community Midwifery programs ... The Community premises would become the Natural Birth Centres of the future and the focal point for women who wish to arrange for a home birth as well. Midwives who see their career pathway as becoming specialist in natural births do not rotate through labour and delivery suites and commit themselves to community services and forming partnerships with women rather than be placed on the rotating roster within a maternity unit.This is something that needs discussion at national level - perhaps put on the ACMI executive agenda. CheersJanJan Robinson Independent Midwife PractitionerNational Coordinator Australian Society of Independent Midwives8 Robin Crescent South Hurstville NSW 2221 Phone/Fax: 02 9546 4350e-mail address: [EMAIL PROTECTED] website: www.midwiferyeducation.com.auOn 16 Jan, 2005, at 10:43, Ken WArd wrote: The birth centre where I work offers midwife care throughout antenatal, intrapartum and post natal. We encourage non-drug use in labour, but do have gas and morphine. These are NEVER offered, and not given on first ask. It is between the midwife the woman and her supports when drugs are used, the vast majority do not even think about it. Nitros does not affect her choice for a water birth, but morphine does, she can labour in water. Iv therapy can be given to rehydrate if necessary, and ceased once a litre has been given. We have research based policies, and are
Re: [ozmidwifery] Triumphant birth for Caroline (Cas) McCullough!!
fantastic news, congratulations to Cas and her baby, Wayne and Lynne and Vicki. much love marilyn - Original Message - From: Jodie Miller [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, January 13, 2005 2:21 PM Subject: [ozmidwifery] Triumphant birth for Caroline (Cas) McCullough!! This is a quick note to all Cas's friends in birth reform. At 5.45 this am, Adam Samuel McCullough was roared into this world with the love and perseverence of mum Caroline and dad Wayne at Selangor Private Hospital near Maleny (Qld) with midwives Lynne and Vicki. After a lng pregnancy and a lng pre-labour he only took a rapid 5 hours (or so) to greet his parents. Naturally Cas and Wayne are ecstatic to have achieved a totally natural vaginal birth after two prior caesareans!! Please send your congratulations and support to: [EMAIL PROTECTED] Please feel free to pass on the news! -- 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] Clexane
Title: Clexane Hi Justine and all: I tried real hard to let this alone a wait for a while but just couldn't. I do think that a homebirth could be possibly contraindicated for this woman because of these cardiolipin antibodies coupled with her apparently needing anticoagulation theraapy. I have done a Pubmed search and googled andI think the results support my inclination. Elevated cardiolipin antibodies can be associated with a number of autoimmune disorders including autoimmune thrombocytopenia, antiphospolipid syndrome, systemic lupus, haemolytic anemia, non-traumatic thrombosis, and prior exposure to treponemal organisms (like syphilis and lyme disease to name a couple). They are associated (note, not causal) strongly with increased fetal damage and loss, thrombosis, stroke, PIH, IUGR and so on whcih is why a homebirth could be contraindicated. Treatment throughout pregnancy does involve close monitoring of various antibodies (not just the cardiolipin) and possible adjustments to the anticoagulant therapy. This I believe would necessitated care with an obstetrician or perinatologist competent and confident in this area apparently new research is happening all the time. There is a strong association with infertility research. It is also possible that this woman's condition maybe relatively benign (such as if she had a prior exposure to the infectious agents mentioned or just one of the otherwise healthy people with elevated levels) but only a thorough differential diagnosis and assessment would tease this out. None of this contraindicates concurrent 1-2-1 midwifery care which I believe would be essential for this woman. I have pasted below some info from a research site from the google search (search terms: "cardiolipin antibodies" AND pregnancy). As with just about everything these days there is controversy surrounding the various treatments. I hope this helps. marilyn Antigen:Cardiolipin is not, like most other autoantigens, a protein, but a phospholipid. Phospholipids are major components of membranes of living cells and of organelles within these cells. Cardiolipin is located in bacterial membranes, mitochondria, and chloroplasts.Cardiolipin is made up of two phosphatidic acid groups, each attached to a glyceride moiety by a phosphodiester bond, and joined by a central glycerol moiety. Antibodiesbind to the complex of cardiolipin and the cofactor ß2-GPI. Pharmacia assays are coated withpurified cardiolipin. Antibody specificity and prevalence: - Antiphospholipid syndrome (APS) (one of two laboratory criteria for the diagnosis of APS)- Stroke (7%), stroke in young patients (18%)- Pregnancy loss*: 3 or more consecutive pregnancy losses (15%), in 2nd or 3rd trimester (30%), with growth retardation and late loss (40%)- Secondary APS in SLE (10-15%)- Connective tissue diseases like SLE (44%), RA (4-49%), Scleroderma (25%), juvenile chronic arthritis (42%) (numbers of secondary APS included)- Infectious diseases like Lyme disease (32%), syphilis (75%), leprosy (67%), tuberculosis (53%) and some more (Q fever, AIDS)- Epilepsy (11%)- Healthy individuals (0-7.5%) *numbers refer to antiphospholipid antibodies in general Disease activity:High aCL levels are associated with increasing risk for thrombosis or fetal loss. Raised anticardiolipin antibody levels may be detected many years prior to the _expression_ of thrombosis or fetal loss. The risk for fetal loss increases from 6.5% (aCL negative) to 15.8% with aCL positivity. When is the measurement recommended?- Suspicion of antiphospholipid syndrome- Fetal loss- Stroke in young patients- Unexplained thrombosis- in discussion: migraine, epilepsy, chorea, heart valve disease, skin ulcers etc. Antibody isotypes:IgG is accepted as the most frequent and most important isotype in aCL detection but the measurement of IgM and IgA is recommended, too, otherwise some risk patients would be lost. The clinical association of different aCL isotypes is discussed controversially in the literature. References:Moris V, Mackworth-Young C (1996) Autoantibodies to phospholipids. In: Van Venrooij WJ, Maine RN (eds.) Manual of biological markers of disease, Kluwer Academic Publishers, Dordrecht Khamashta MA, Hughes GRV (1996) Phospholipid Autoantibodies - Cardiolipin. In: Peter JB, Shoenfeld Y (eds.) Autoantibodies, pp 624-629, Elsevier, Amsterdam Roubey RA (1999) Immunology of the antiphospholipid syndrome: antibodies, antigens, and autoimmune response. Thromb Haemost 82: 656-661 - Original Message - From: Justine Caines To: OzMid List Sent: Monday, December 20, 2004 8:51 PM Subject: [ozmidwifery] Clexane Dear AllThe message below came to me through the Homebirth Australia website.I would really appreciate your clinical wisdomJustineI had a homebirth with my first child in the UK in 2001.I would dearly like to have another homebirth here in Australia but I now have
Re: [ozmidwifery] Fwd: The risk that follows caesarean
This is the actual article from medscape: http://www.medscape.com/viewarticle/496128 Not nearly as alarmist as the smh version. marilyn - Original Message - From: Andrea Robertson [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, December 17, 2004 6:55 PM Subject: [ozmidwifery] Fwd: The risk that follows caesarean IN case any of your missed this. lots of mixed messages here! http://www.smh.com.au/news/National/The-risk-that-follows-caesarean/2004/12/16/1102787218025.html Regards, Andrea - Andrea Robertson Birth International * ACE Graphics * Associates in Childbirth Education e-mail: [EMAIL PROTECTED] web: www.birthinternational.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] feeds in 24 hrs?
Dear Maureen: For what it is worth I totally agree with all you've said. Very common scenarios. regards marilyn - Original Message - From: Ken WArd [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, December 15, 2004 11:21 PM Subject: RE: [ozmidwifery] feeds in 24 hrs? Ok I expect to get shot down, but here goes. A baby who is hungry, refusing the breast , no colostrum apparent, a stressed, crying mother who is considering bottle feeding. What's best? Keep on trying to attach a fighting baby, mum in tears or a comp feed, settle both for a sleep,and try again next feed? I have seen this, babies wake, eager for a feed, mum's had a rest, and is more relaxed. Baby attaches with little fuss. Then there's the baby who has lost weight, looks hungry, poor out-put. Mum needs her milk supply built-up. This requires good food, rest and a relaxed mum. Expressing pc helps, as does a comp to settle baby and eas4e mum's mind. My first 3 were all comped for the first couple of days, no confusion, no probs with attachment. I was more rested and it all went naturally. No allergies. No. 4 child, different story. I knew so much, this baby was going to be fully B/F. Ha. Fed on demand, problem was this baby didn't wake for feeds, I was of the she'll wake when she's hungry school. Three weeks later below birth weight, hardly weeing, no poos. She has dairy milk protein allergy I also attended a very interesting talk by a genetic counsellor from the NBST people. Certain enzymes require protein and if baby doest feed it can die. I forget all the details, but the info was on the net. I'm sure some one out there knows a lot more. I support BF. I would have loved to have fed for a couple of years. But I do feel that the all or nothing attitude sets women up to fail. I have seen babies who have been chronically under bf. Scrawny, whiney and constantly fiddling at the breast. Not sleeping well, tired looking. I will not comp a baby just because it's unsettled, I have read Maureen Minchin's books and attended her lectures and have done the LC course. Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of [EMAIL PROTECTED] Sent: Thursday, 16 December 2004 10:12 AM To: [EMAIL PROTECTED] Subject: RE: [ozmidwifery] feeds in 24 hrs? I will tell her if I believe all is well, but there are times when a baby genuinely needs comping. Maureen Hi Maureen and anyone else who could enlighten me on the above comment about there being times when a baby genuinely needs comping, Could you please be more specific ie, at what times would a baby genuinely need comping? Thanks Jayne -- 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] Re: feeds in 24 hours....
No Jo we don't do gastric lavages routinely anymore (not since I have been here at least in 2002). Though have known some midwives to do this on the ward to mucousy babies. This baby would have been suctioned on the peri and since he was vigorous no further tx was required. He wasn't mucousy either but had refused to feed immediately post birth but had fed well apparently on the night shift and had 3 apparently good feeds on my shift in the first 2 hours: well latched sucking and swallowing for 5 to 10 minutes at a time. I was feeling anxious about doing the BSL because I was anticipating an arguably normalresult in the 1.8 to 2.2 mmol/L range bub seemed stable but borderline jittery and to be honest mum was more concerned than I was. Good lesson in "listen to the mother" whocan often bewritten off as overly anxious. Anyway I am glad I listened to mum. Of course if this baby did have a good counterregulatory response going on then nothing needed to be done. From my understanding of the WHO document we just don't have the documentation on the truly normal range of BSL's, we also don't have really clear signs of abnormal symptoms at least until they become catastophic and you can't miss it. I mean "jittery" can mean different things to different people it is just not a very precise term but tachypnia, tachycardia, bradycardia, hypothermic etc. are clear as is low BSL. Fortunately or unfortunately i will have a lower toleranceof "jittery" for a while to come and can actually still understand the thought behind protocols that require routineBSL's (which seem to vary from 3/24 to 6/24 to random before feeds within the first 12 to 24 hrs) for babies at risk of hypoglycemia. I can imagine that those midwives and paediatricianswho work in intensive care nurseries and see the babies who are missed and have gone into comas etc. including those babies with unsuspected rare metabolic disorderscan see no harm in routine testing. I am just prolly overthinking this one for a while. marilyn - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Thursday, December 16, 2004 4:33 PM Subject: Re: [ozmidwifery] Re: feeds in 24 hours Marilyn Kleidon wrote: Thanks Tina: you've actually posted that before 'cause I had copied it and pasted it into my breastfeeding research file!! Found it when I went to copy it again!! I have read the whole thing a few times now and am somewhat reassured that the baby I referred to with a BSL of 0.6 mmol/L may have had a good counterregulatory response going on since he only had "soft" signs of hypoglycemia: some jitteryness and slightly increased irritability. Still unsure of why his BSL would be so low (even supposing mumhad zero colostrum)as his intrapartum stress could not be interpreted as intrapartum asphyxia in any way. I now have a high index of suspicion that mum may have actually been gestationally diabetic despite her reassuring/non-glucose impaired GTT. In which case it would be a transient hypoglycemia and the lab results should show hyperinsulinemia right? I hope so. I have been off since so i don't know if the hypoglycemia recurred which would be the case if baby had some rare metabolic disorder right? Sorry, thinking zebras now (instead of horses, when I hear galloping). regards marilynJust thinking about this... this baby was born into Mec, right? Was it policy to do a gastric lavage pre- first feed? If so, this could be why the BSL was so low...Jo.
Re: [ozmidwifery] feeds in 24 hrs?
I would think a baby generally needs comping when all is not well. This can present in a variety of ways at various times. Recently came on to special in HDU a young woman who had birthed over night (approximately 12 hours previously), spontaneous vaginal birth but pre-eclamptic in labour, Mg SO4 infusion etc.. Baby had birthed through mec liq but was vigorous with good apgars so was with mum and had fed on and off since the birth though not within the first couple of hours of birth as refused at this time. So, I assisted mum (she had lots of IV tubes etc..) with three attachments in the first couple of hours of my shift and became concerned as did mum with the increasing irritability (though only when not attached well to the breast) and slight (really very slight) jitteryness of the baby. Good temp maintenance, resps and HR. Unable to express colostrum when assisting with attachment. So, I recommended to mum we check baby's bsl and she agreed: 0.6 mmol I kid you not! Double checked (sample to path)as amongst other things baby did not seem symptomatic of such a low bsl. So baby straight to SCBU, comps and IV dextrose. It took the rest of the day shift for baby's bsl's to be close to 2.5mmol. We can only hope baby is neurologically fine. Baby had not appeared to have seizures. This is one baby (I think)who would have benefitted from 3/24 bsl's. Mum was not GDM though had had GTT due to family hx of diabetes and was NOT glucose impaired, normal weight at booking , baby 37+ weeks and around 3kg, first baby, young healthy mother. The only thing not normal was the sudden onset of pre-eclampsia in labour with really elevated lft's etc.. Despite this baby appeared to tolerate labour and birth well despite the mec liq. In hind-sight I would say the mec liq was actually an indication of the baby's stress and in this case would have been a reason to do 3/24 bsl's as well as the TPR's. Would just like to add that pre-eclampsia etc.. in labour is not necessarily a indicator as the mum and baby in the bed beside this mum had a very similar situation just no mec liq. That baby fed and slept all day shift and had colostrum dripping from lips and mum's nipples after feeds. Just wanted to say I can understand the 3/24 or similar protocols for bsl's especially after complicated births (even if the actual birth is spontaneous vaginal) as sometimes the signs and symptoms can be subtle and may be normalised through shift changes. Maybe I just feel bad I didn't rush the baby off for a bsl as soon as I came on or at least sooner than I did! marilyn - Original Message - From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, December 15, 2004 3:12 PM Subject: RE: [ozmidwifery] feeds in 24 hrs? I will tell her if I believe all is well, but there are times when a baby genuinely needs comping. Maureen Hi Maureen and anyone else who could enlighten me on the above comment about there being times when a baby genuinely needs comping, Could you please be more specific ie, at what times would a baby genuinely need comping? Thanks Jayne -- 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] Glucose Challenge Testing
Hi Abby: Firstly the other links provided should give you a good idea of the evidence around this test. Logistically though, if the mother wants to go ahead and have the test, the fasting should be no more than the normal overnight "fasting" in other words have a good meal around 8pm and schedule the first or fasting blood draw for 8am, then have the drink loaded with glucose and the further blood draws in 1 hr and 2 hrs. There should not be more than one sugary drink and it should be after the fasting blood draw. Whether or not to have this test is clearly debatable and despite its prevalence not evidence based at least not as a sole indicator for gestational diabetes, or risks of macrosomia, neonatal hypoglycemiaetc.. Also the effect of the test is debatable that is does it make any difference or improve outcomes? Enkin et al. makes good reading. Some people prefer to do random blood sugars using a glucometer, some in the morning before breakfast and others 2 hrs after a meal, the kind of "monitoring" a type 2 diabetic person might do when stabilising their blood sugars, and only proceed to a GTT if the resultsindicate. This is also briefly touched on by Enkin et al and not supported well by evidence either. cheers marilyn - Original Message - From: Abby and Toby To: [EMAIL PROTECTED] Sent: Tuesday, December 14, 2004 3:21 AM Subject: [ozmidwifery] Glucose Challenge Testing Hi, Couple of questions about this- 1) Is this application normal or necessary, the fasting for so long I mean - "My midwife wants me to have a glucose challenge test that involves 12 hours fasting then a blood test, drinking a sugary drink, 1hr later another blood test, drinking another drink and then another hour later another blood test." I have never heard of someonehaving to fast for that long beforehand?? Seems like a strange thing to ask a pregnant woman to do. Any insight would be great. 2) Does anyone have any info, links, research etc about the accuracy, relevance/importance, evidence etc for the glucose test? Thanksin advance. Love Abby (P.S. Still working on the `evidence` aboutcontrolled crying, nutrition etc)
Re: [ozmidwifery] Glucose Challenge Testing
Apologies to sally etc. I read "glucose tolerance test" and not "glucose challenge test". Your (at least mine) eye sees what it expects to see. It is my understanding that the "glucose challenge test" is even more debatable. marilyn - Original Message - From: Abby and Toby To: [EMAIL PROTECTED] Sent: Tuesday, December 14, 2004 3:21 AM Subject: [ozmidwifery] Glucose Challenge Testing Hi, Couple of questions about this- 1) Is this application normal or necessary, the fasting for so long I mean - "My midwife wants me to have a glucose challenge test that involves 12 hours fasting then a blood test, drinking a sugary drink, 1hr later another blood test, drinking another drink and then another hour later another blood test." I have never heard of someonehaving to fast for that long beforehand?? Seems like a strange thing to ask a pregnant woman to do. Any insight would be great. 2) Does anyone have any info, links, research etc about the accuracy, relevance/importance, evidence etc for the glucose test? Thanksin advance. Love Abby (P.S. Still working on the `evidence` aboutcontrolled crying, nutrition etc)
Re: [ozmidwifery] Rhogam product
Kristin: I do believe the anti-D WINROH products are thimerosol free, according to the product info sheet glycine is the preservative used. I am not at all familiar with Bayroh-d. Rhogam is just a brand of anti-d and does use thimerosol as a preservative, at least the last time I looked. I don't think you can get Rhogam in Australia at the moment. marilyn - Original Message - From: Kristin Beckedahl [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, December 10, 2004 12:31 AM Subject: [ozmidwifery] Rhogam product Dear List, In regards to the recent discussion on the RhoGAM product offered to Rh- women whilst pregnant (at 28/40 32??/40)...and the effects of potential mercury in these items on the unborn babe. Could somebody please confirm for me which product the mother needs to ensure the midwife offers her.. Is it BAYROH-D or WINRHO SDF...? Or if both, is one perferred over the other..? Many thanks, Kristin -- 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] Re: [MCVic] spiritual needs in pregnancy
Hi nicole: I couldn't resist doing a quick search on Pubmed using the terms pregnancy AND "spiritual needs" I came up with 3 journal articles which do appear to be commentories and also all more than 10 years old. The web site is: http://www.ncbi.nlm.nih.gov/entrez/query.fcgiand it is free. I then entered: pregnancy AND spirituality and got 37 hits with a few research articles at the very top. If you can't get into pubmed I can make a copy of the list of articles for you. You may need to expand the definition of research to include action research and various psychological and sociological research methodologies: you wont find any RCT's. marilyn Original Message - From: Nicole Carver To: [EMAIL PROTECTED] Cc: ozmid Sent: Sunday, November 28, 2004 2:32 AM Subject: [ozmidwifery] Re: [MCVic] spiritual needs in pregnancy Sorry guys, I meant haven't been able to find articles about spiritual needs. There's plenty about the other two. Nicole. - Original Message - From: Nicole Carver To: ozmid ; Maternity Coalition Sent: Sunday, November 28, 2004 9:30 PM Subject: [MCVic] spiritual needs in pregnancy Hi all, I am writing a thesis at the moment about women's needs in pregnancy. I am looking at physical, emotional and spiritual needs. I have not been able to find any research articles, only commentary on the subject. Can anyone point me towards some original research on this topic? Thanks, Nicole Carver. Yahoo! Groups Links To visit your group on the web, go to:http://au.groups.yahoo.com/group/MCVic/ To unsubscribe from this group, send an email to:[EMAIL PROTECTED] Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.
Re: [ozmidwifery] Re: [MCVic] spiritual needs in pregnancy
Also Nicole: if you go to www.medscape.com you can run searches on both medscape and medline, I had most success here with pregnancyAND spirituality. The articles will be international though most (but not all) will be in US journals. I did notice a few from Australia though. marilyn - Original Message - From: Nicole Carver To: [EMAIL PROTECTED] Cc: ozmid Sent: Sunday, November 28, 2004 2:32 AM Subject: [ozmidwifery] Re: [MCVic] spiritual needs in pregnancy Sorry guys, I meant haven't been able to find articles about spiritual needs. There's plenty about the other two. Nicole. - Original Message - From: Nicole Carver To: ozmid ; Maternity Coalition Sent: Sunday, November 28, 2004 9:30 PM Subject: [MCVic] spiritual needs in pregnancy Hi all, I am writing a thesis at the moment about women's needs in pregnancy. I am looking at physical, emotional and spiritual needs. I have not been able to find any research articles, only commentary on the subject. Can anyone point me towards some original research on this topic? Thanks, Nicole Carver. Yahoo! Groups Links To visit your group on the web, go to:http://au.groups.yahoo.com/group/MCVic/ To unsubscribe from this group, send an email to:[EMAIL PROTECTED] Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.
Re: [ozmidwifery] ParvoB19
Thanks for that! marilyn - Original Message - From: Jenny Cameron To: [EMAIL PROTECTED] Sent: Friday, November 26, 2004 5:05 PM Subject: [ozmidwifery] ParvoB19 FYI http://www.obgynworld.com/international/obgynworld/reference/pdf/cpg119.pdf Jennifer Cameron FRCNA FACMProMid Professional Midwifery Education Service0419 528 717 btzhsepa.gifNetwork Blitz Bkgrd.gif
Re: [ozmidwifery] Breech birth question
Dear Abby: My own breech birth actually ended up pretty managed though it wasn't intended that way! My daughter was born 27 yrs ago this december 29 at Corinda maternity, Brisbane. I was seeing a Gp for my pregnancy as this was back in the day when Gp's attended births ie they did have hospital priveliges my Gp was Ann Mc bride in indooroopilly. When she palped me at around 36 weeks she suspected a breech baby and sent me for an u/s to check and she was right. So even then she wanted to schedule me for a c/s, but I said no, like why and explained that my mum was a midwife and had "delivered" (yes I used that term) many breech babies and that in my family it was not unusual my grandmother had "deliverd" 2 breech babies at home who were fine healthy men. Well she referred me to a doc in brisbane who was the "natural birth guru" at the time 1977: I can't remember his name. Anyway he attempted an ecv in his rooms I think in either Chapel Hill or maybe Woodside (no u/s, certainly no terbutaline and my 18 mnth old sitting beside me on the "table". Well my daughter would not turn. So that was that. But because she palped small (6 to 7 lb) he truly believed she was not yet due (i had "uncertain dates" due to breastfeeding and no period and no u/s but my own idea which turned out to be correct) and assured me even though he was going away over Christmas my baby would not come until the New year and he would be there then.. .well guess who was wrong? I came into labour in the afternoon of december 29 and my daughter was born by 8pm, delivered by his back upthe very technological Dr Yared who I believe still practices as an obgyn in Brisbane. Dr. Yared was not impressed to be "delivering" a breech baby at Corinda Matrernity (no operating theatre). The only redeeming feature of the birth was that it was vaginal. He arrived when i was 8cm, decided the breech was not engaged enough and insisted I push my baby down onto my cervix: everything I had been told NOT to do (by my mother, who to this day i wish was there, she did not take crap from doctors(or anyone)lightly), when I did not cooperate he had the midwife inject me with valium IV and I managed to observe my daughters birth from the ceiling. She was born very shortly after all of this, the doctor using forceps "to ach" which he explained to my husband meant he avoided the problem of sudden change in pressure by the too rapid delivery of the baby's head. She did come out pink and screaming for which i am greatful (he could have messed that up too), but I was really shaken and cried for a week (valium is NOT my drug of choice but then I am just a coffee and occasional beer person). I never saw him again. I was aware he wanted to hurry my birth because one of "his" women was coming off an induction at the Mater Hospital around 8 pm. Lucky woman if he didn't make it. This particular daughter did have some problems with drug abuse in adolescence andI do wonder if this valium interlude during her birth was linked at all. Who knows. She is fine now quite a delightful young woman. Like I said the only redeeming features of this birth were my lovely daughter and my intact uterus, which left me "low risk" enough to have a totally midwife led and definetly woman centred birth at an alternative birthing centre in 1981 in Chicago of all places. I only saw midwives or nurse practitioners for my healthcare for the next 21 years. marilyn - Original Message - From: Abby and Toby To: [EMAIL PROTECTED] Sent: Friday, November 26, 2004 6:37 PM Subject: Re: [ozmidwifery] Breech birth question Couple that with knowledge and common sense and you will cope with most midwifery situations including breech birth.marilyn Thanks for sharing Marilyn. I think that paragraph was pretty full on too..actually, I thought most of it was coming from a very "managed" and aggressive approach. Was your breech birth any different to your other births? It really interests me, the perspective of mothers birthing breech babies. I assume that most breech babies are "delivered" by c-section these days in hospitals and a lot of mothers believe this is the only way. Do you think that the high numbers of morbidity or injuryin breech birth statistics is because peope have not kept their hands and management out of the births? I wonder what the stats would be if there was a study done on completely natural breech births, not that stats tell everything, but it would be an interesting comparison of hospitals/home/managedto natural/ unmanaged. Love Abby- always thinking, always asking. lol.
Re: [ozmidwifery] Breech birth question
I would relish that! marilyn - Original Message - From: Kim Stead To: [EMAIL PROTECTED] Sent: Friday, November 26, 2004 1:38 PM Subject: Re: [ozmidwifery] Breech birth question Hi Marilyn and Abby Interesting topic guys. I thought, (with your permission of course), we could share this with Maggie Banks (breech birth guru) for her comments. I'm not sure when standing became vogue (well it's not really with the invent of C/S) but thought her comments would be interesting. What do you both think? Kiwi Kim. ---Original Message--- From: [EMAIL PROTECTED] Date: 11/27/04 08:13:27 To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] Breech birth question Hi Abby: I would expect this midwife was trained in breech birth management sometime ago probably by an ob in the 70's who was still delivering babies at home as they did in some parts of the US at this time. This midwife's address is Massachusetts. It seems like she is reacting to the relatively new idea to deliver breech babies standing/squatting/on a birthing stool. It seems to me that "standing to deliver" a breech baby came into vogue from the early 90's does anyone know when this started happening? I was more disturbed by this paragraph: 10. Now bring the mother's buttocks over the edge of the bed, keeping her legs supported by assistants. The baby's body will drop down, easily exposing the nape of the neck and usually both arms will come down as well. Keeping one hand on the mother's perineum, grasp the baby's feet witht he other hand and swing the body up and over onto the mother's abdomen. A towel or receiving blanket will help in holding on to slippery body. Just a "tad" to say the least more aggressive than most accounts of semi-reclining breech births I have read, seems quite dangerous to me, but I have only assisted with 2 vaginal breech births, one in the hospital (standing)and one at home (on a birth stool) and had one myself. I would be interested to read comments from midwives who haveattended breech births where the woman is semi-reclining. I think "fear" is a much maligned word in midwifery circles so i will use another word: caution. Couple that with knowledge and common sense and you will cope with most midwifery situations including breech birth. marilyn - Original Message - From: Abby and Toby To: [EMAIL PROTECTED] Sent: Friday, November 26, 2004 3:53 AM Subject: [ozmidwifery] Breech birth question Hi, Just reading about breech births and differences of opinions between caregivers. Came across this comment, on a homebirth midwifes page and found it kinda odd. I would expect it from some Obs and hospital staff,but not sure what to make of this. There are other things on the page that I think are weird eg. semi reclined position, do this, do that, I'm in charge kind of attitude, but this comment struck me as `fear`. 7. At this point the baby must be born quickly. STAY CALM! It is possible for the baby to suffocate if not born within 5 minutes. Note: Time seems to stand still when we are under stress. Have an assistant keep track of time. What will seem like twenty minutes to you will have probably have been two! http://www.moondragon.org/obgyn/pregnancy/breechhome.html Any midwives out there that have differing views on breech births. I realise that these days most women are encouraged to have c-sections, but thought some of you would supported women at breech births. I have learnt from a couple of wise women that the best way for women to birth a breech baby is just like any other baby, her way in her time. Love Abby (P.S. She also warns against the advocation of the squatting position, where as Michel Odent believes it should be insisted that women birth a breech baby squatting?? Any thoughts??)
Re: [ozmidwifery] Breech birth question
Hi Abby: I would expect this midwife was trained in breech birth management sometime ago probably by an ob in the 70's who was still delivering babies at home as they did in some parts of the US at this time. This midwife's address is Massachusetts. It seems like she is reacting to the relatively new idea to deliver breech babies standing/squatting/on a birthing stool. It seems to me that "standing to deliver" a breech baby came into vogue from the early 90's does anyone know when this started happening? I was more disturbed by this paragraph: 10. Now bring the mother's buttocks over the edge of the bed, keeping her legs supported by assistants. The baby's body will drop down, easily exposing the nape of the neck and usually both arms will come down as well. Keeping one hand on the mother's perineum, grasp the baby's feet witht he other hand and swing the body up and over onto the mother's abdomen. A towel or receiving blanket will help in holding on to slippery body. Just a "tad" to say the least more aggressive than most accounts of semi-reclining breech births I have read, seems quite dangerous to me, but I have only assisted with 2 vaginal breech births, one in the hospital (standing)and one at home (on a birth stool) and had one myself. I would be interested to read comments from midwives who haveattended breech births where the woman is semi-reclining. I think "fear" is a much maligned word in midwifery circles so i will use another word: caution. Couple that with knowledge and common sense and you will cope with most midwifery situations including breech birth. marilyn - Original Message - From: Abby and Toby To: [EMAIL PROTECTED] Sent: Friday, November 26, 2004 3:53 AM Subject: [ozmidwifery] Breech birth question Hi, Just reading about breech births and differences of opinions between caregivers. Came across this comment, on a homebirth midwifes page and found it kinda odd. I would expect it from some Obs and hospital staff,but not sure what to make of this. There are other things on the page that I think are weird eg. semi reclined position, do this, do that, I'm in charge kind of attitude, but this comment struck me as `fear`. 7. At this point the baby must be born quickly. STAY CALM! It is possible for the baby to suffocate if not born within 5 minutes. Note: Time seems to stand still when we are under stress. Have an assistant keep track of time. What will seem like twenty minutes to you will have probably have been two! http://www.moondragon.org/obgyn/pregnancy/breechhome.html Any midwives out there that have differing views on breech births. I realise that these days most women are encouraged to have c-sections, but thought some of you would supported women at breech births. I have learnt from a couple of wise women that the best way for women to birth a breech baby is just like any other baby, her way in her time. Love Abby (P.S. She also warns against the advocation of the squatting position, where as Michel Odent believes it should be insisted that women birth a breech baby squatting?? Any thoughts??)
Re: [ozmidwifery] terbutaline
Terbutline is a bronchial dialator but is also used to relax uterine muscle. it is definetly used in the USA to stop or even prevent uterine ctx's (like for example before an ECV is attempted). As homebirth midwives we also carried it in case we ever had someone with severe fetal distress who was not close to birthing and as such was an emergency transport. Of course it would only be administered in extreme situations and after consultation with the receiving doctor/hospital. Never ever had to use it but did carry it. marilyn - Original Message - From: ID AC Quanchi [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Sunday, November 21, 2004 2:09 PM Subject: [ozmidwifery] terbutaline Where does terbutaline fit in with all this? I have heard of them using it at RWH, but haven't seen it at my workplace. Nicole C Nicole, I am at home and so do not have access to a MIMS but I am sure you can check with your pharmacist but zisnt Terbutaline an asthma medication? Therefore its action may be similar to ventolin which we used for this purpose for years. All of these treatments are aiming for relaxation of smooth muscle and are not selective which smooth muscle they act on once they are in the blood stream hence the side effects you get to achieve the desired result on the muscle you want. To get enough ventolin to the bronchial tree in a severe asthma attack requires so much via neb ( or IV) that the person shakes viloently as all their smooth muscle is affected. Same in our situation we five the nifedipine or whatever until the smooth muscle of the uterus relaxes and hopefully gives up contracting but the woman will experience the effects of that much nifedipine on all her smooth muscles and needs to be supported ( and observed closely) until the effects subside Andrea Quanchi -- 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] Gentian Violet?
Because it is an old remedy many people think or assume it is herbal in origin, but it actually is of the heavy metal group of agents. If you are into colloidal silver and other treatments of this nature then it is effective, but as with other heavy metal agents there is a level of biotoxicity and retention in the system. As Joy said, Dr. Jack Newman's site does recommend it for thrush. I will look up what the metal is and post it later. There is a herb: Gentian lutea that is used but not for this (mouth ulcers and/or thrush). marilyn - Original Message - From: Pinky McKay [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Sunday, November 21, 2004 3:14 PM Subject: Re: [ozmidwifery] Gentian Violet? also be careful to use AQUEOUS gentian violet - if it has spirit in, it will burn Pinky www.pinky-mychild.com - Original Message - From: Nicole Carver [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, November 22, 2004 9:40 AM Subject: Re: [ozmidwifery] Gentian Violet? Gentian violet is very effective at treating thrush, particularly nipple thrush. I tend to use Daktarin gel for the baby. The concerns about carcinogenic effects of gentian violet have been deemed to be over reactive by many, and so some people prescribe gentian violet for mother and baby. If your sister is breastfeeding she needs to treat her nipples too, even if asymptomatic. Thomas Hale has a book, I think it is called medications and mothers milk or something like that(!) It is used by many lactation consultants, but it is difficult to purchase. Some people buy it from their vet! However, you have to be careful to get the correct strength. A lactation consultant can help with this. Nicole C - Original Message - From: Abby and Toby [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, November 22, 2004 8:28 AM Subject: [ozmidwifery] Gentian Violet? Hi, can anyone help me in locating info about the dangers of gentian violet? It was my understanding that in Oz we stopped recommending it quite some time ago because of some dangers?? My sister in America has been told to use it on her 4 week old daughter for thrush. Any info, especially online that I can access and email straight to her would be great. Please correct me if I'm wrong or if you have other ideas about the benefits etc. Thanks Love Abby -- 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. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Gentian Violet?
. 1991 Jun 3;154(11):782. No abstract available. PMID: 2046587 [PubMed - indexed for MEDLINE] 18: Sommer G, Happle R. Related Articles, Links [Necroses following the use of Pyoktanin] Hautarzt. 1977 Feb;28(2):92-3. German. PMID: 845034 [PubMed - indexed for MEDLINE] 19: Jensen PS, Holst E. Related Articles, Links [Oral candidosis. A review of the literature and a retrospective study of 91 patients] Ugeskr Laeger. 1969 Jul 17;131(29):1229-39. Danish. No abstract available. PMID: 5811512 [PubMed - indexed for MEDLINE] 20: Kim SJ, Koh DH, Park JS, Ahn HS, Choi JB, Kim YS. Related Articles, Links Hemorrhagic cystitis due to intravesical instillation of gentian violet completely recovered with conservative therapy. Yonsei Med J. 2003 Feb;44(1):163-5. PMID: 12619193 [PubMed - indexed for MEDLINE] - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, November 23, 2004 1:18 PM Subject: Re: [ozmidwifery] Gentian Violet? Because it is an old remedy many people think or assume it is herbal in origin, but it actually is of the heavy metal group of agents. If you are into colloidal silver and other treatments of this nature then it is effective, but as with other heavy metal agents there is a level of biotoxicity and retention in the system. As Joy said, Dr. Jack Newman's site does recommend it for thrush. I will look up what the metal is and post it later. There is a herb: Gentian lutea that is used but not for this (mouth ulcers and/or thrush). marilyn - Original Message - From: Pinky McKay [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Sunday, November 21, 2004 3:14 PM Subject: Re: [ozmidwifery] Gentian Violet? also be careful to use AQUEOUS gentian violet - if it has spirit in, it will burn Pinky www.pinky-mychild.com - Original Message - From: Nicole Carver [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, November 22, 2004 9:40 AM Subject: Re: [ozmidwifery] Gentian Violet? Gentian violet is very effective at treating thrush, particularly nipple thrush. I tend to use Daktarin gel for the baby. The concerns about carcinogenic effects of gentian violet have been deemed to be over reactive by many, and so some people prescribe gentian violet for mother and baby. If your sister is breastfeeding she needs to treat her nipples too, even if asymptomatic. Thomas Hale has a book, I think it is called medications and mothers milk or something like that(!) It is used by many lactation consultants, but it is difficult to purchase. Some people buy it from their vet! However, you have to be careful to get the correct strength. A lactation consultant can help with this. Nicole C - Original Message - From: Abby and Toby [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, November 22, 2004 8:28 AM Subject: [ozmidwifery] Gentian Violet? Hi, can anyone help me in locating info about the dangers of gentian violet? It was my understanding that in Oz we stopped recommending it quite some time ago because of some dangers?? My sister in America has been told to use it on her 4 week old daughter for thrush. Any info, especially online that I can access and email straight to her would be great. Please correct me if I'm wrong or if you have other ideas about the benefits etc. Thanks Love Abby -- 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. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. noabstract_d.gifabstract_d.giffulltext.gif
Re: [ozmidwifery] Gentian Violet?
. Additionally, the manufacture and distribution of herbal substances are not regulated in the United States, and no quality standards currently exist. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you. Please read the end user acknowledgement. - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, November 23, 2004 1:18 PM Subject: Re: [ozmidwifery] Gentian Violet? Because it is an old remedy many people think or assume it is herbal in origin, but it actually is of the heavy metal group of agents. If you are into colloidal silver and other treatments of this nature then it is effective, but as with other heavy metal agents there is a level of biotoxicity and retention in the system. As Joy said, Dr. Jack Newman's site does recommend it for thrush. I will look up what the metal is and post it later. There is a herb: Gentian lutea that is used but not for this (mouth ulcers and/or thrush). marilyn - Original Message - From: Pinky McKay [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Sunday, November 21, 2004 3:14 PM Subject: Re: [ozmidwifery] Gentian Violet? also be careful to use AQUEOUS gentian violet - if it has spirit in, it will burn Pinky www.pinky-mychild.com - Original Message - From: Nicole Carver [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, November 22, 2004 9:40 AM Subject: Re: [ozmidwifery] Gentian Violet? Gentian violet is very effective at treating thrush, particularly nipple thrush. I tend to use Daktarin gel for the baby. The concerns about carcinogenic effects of gentian violet have been deemed to be over reactive by many, and so some people prescribe gentian violet for mother and baby. If your sister is breastfeeding she needs to treat her nipples too, even if asymptomatic. Thomas Hale has a book, I think it is called medications and mothers milk or something like that(!) It is used by many lactation consultants, but it is difficult to purchase. Some people buy it from their vet! However, you have to be careful to get the correct strength. A lactation consultant can help with this. Nicole C - Original Message - From: Abby and Toby [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, November 22, 2004 8:28 AM Subject: [ozmidwifery] Gentian Violet? Hi, can anyone help me in locating info about the dangers of gentian violet? It was my understanding that in Oz we stopped recommending it quite some time ago because of some dangers?? My sister in America has been told to use it on her 4 week old daughter for thrush. Any info, especially online that I can access and email straight to her would be great. Please correct me if I'm wrong or if you have other ideas about the benefits etc. Thanks Love Abby -- 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. -- 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] gestational diabetes and antenatal ebm
Great study but not looking at what I am trying to find some research for. Does anyone have a copy of this article in The Practising Midwife 2001: Antenatal expression of colostrum. Pract Midwife. 2001 Apr;4(4):32-5. Review. No abstract available. PMID: 12026613 [PubMed - indexed for MEDLINE] - I would send a stamped self addressed envelope for a copy. thanks marilyn [EMAIL PROTECTED] Original Message - From: mh [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 11:10 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm They're not assigned to BF or AF. Just that if they're BF an d for some reason change their mind at any time during the (I think) 1st year, or use a comp etc, they use the one supplied which is unidentified (I think). You can look it up if you google TRiGR. I heard an inservice on it which didn't sound at all unethical. They are trying to promote BF but the fact of the metter is that in the real world the majority of mothers do comp with something at least once during their breastfeeding experience and many do wean to a bottle and formula. It is these they are trying to catch. Monica - Original Message - From: Nicole Carver [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 2:23 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Unfortunately, they seem to be signing people up before they have their babies, to be in a RCT between cow's milk and non-cow's milk based formulas. A bit dodgy ethically to me! Does anyone else know more about this? Nicole C - Original Message - From: Sandra J. Eales [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 2:00 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Marilyn There might not be much on expressing antenatally, but there is quite a bit of research on the increased risk of children developing type1 diabetes if they are exposed to cow's milk. In fact I heard just the other night on the news that there is a multi centre study going on - they were trying to recruit pregnant women or babies where one parent was diabetic.. hoping to follow 6000 kids. I don't recall the details of where it was being done though. Sandra - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 10:56 AM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Way to go Denise, I totally agree. However, am part of a working group for BFHI reaccreditation and was asked to find the evidence. So, I was just wondering if there was some that I had missed. marilyn - Original Message - From: Denise Fisher [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, November 16, 2004 3:41 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Hi Marilyn I won't swear to it but I don't know that there is any research out there on this practice. However to give newborns their own mother's milk is kinda natural and not really something that we need research to prove is a good thing do we? Wouldn't it be more to the point to ask those who are giving newborns something other than breastmilk to come up with the evidence to prove that what they are doing is not detrimental?? I'd like to see that ... could have them running around in circles for years trying to find anything to support that practice as opposed to giving mother's own colostrum. All you really need proof of is that expressing antenatally won't put a mother into preterm labor, which it won't and I'm sure you'll find plenty out there on that - then ensure that the mothers know how to store and transport their milk safely when the time comes. There's lots more than just giving breastmilk though that can stabilise the newborn's glucose levels quickly and efficiently - starting with undisturbed skin-to-skin on mother's chest from the moment of birthing. I really do implore everyone to think long and hard before scampering around trying to find research articles to prove what is normal and natural while practices using what is detrimental to birthing/breastfeeding/whatever continue without questioning. Please consider looking the perpetrators in the eye and saying First, do no harm! - your practice is not 'normal' - prove to me that it is doing no harm!! Cheers Denise *** Denise Fisher Health e-Learning http://www.health-e-learning.com [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
Re: [ozmidwifery] gestational diabetes and antenatal ebm
Thanks Sandra. I am surprised that there is no research on this as I have heard it recommended for years and have done so (recommended) myself. However, since it actually was a practice in the 50's and 60's and possibly the 70's as preparation of the breasts for breastfeeding along with nipple massage etc.. there actually seems to be a wealth of articles descrying (sp.) the idea. Just goes to prove it all keeps going around. Of course this isn't antenatal expressing for GDM mum's just antenatal expressing in general. You'd all be suprised at what does come up for antenatal expression but I actually wont go there... check it out yourself!! marilyn - Original Message - From: Sandra J. Eales [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, November 17, 2004 7:00 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Marilyn There might not be much on expressing antenatally, but there is quite a bit of research on the increased risk of children developing type1 diabetes if they are exposed to cow's milk. In fact I heard just the other night on the news that there is a multi centre study going on - they were trying to recruit pregnant women or babies where one parent was diabetic.. hoping to follow 6000 kids. I don't recall the details of where it was being done though. Sandra - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 10:56 AM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Way to go Denise, I totally agree. However, am part of a working group for BFHI reaccreditation and was asked to find the evidence. So, I was just wondering if there was some that I had missed. marilyn - Original Message - From: Denise Fisher [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, November 16, 2004 3:41 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Hi Marilyn I won't swear to it but I don't know that there is any research out there on this practice. However to give newborns their own mother's milk is kinda natural and not really something that we need research to prove is a good thing do we? Wouldn't it be more to the point to ask those who are giving newborns something other than breastmilk to come up with the evidence to prove that what they are doing is not detrimental?? I'd like to see that ... could have them running around in circles for years trying to find anything to support that practice as opposed to giving mother's own colostrum. All you really need proof of is that expressing antenatally won't put a mother into preterm labor, which it won't and I'm sure you'll find plenty out there on that - then ensure that the mothers know how to store and transport their milk safely when the time comes. There's lots more than just giving breastmilk though that can stabilise the newborn's glucose levels quickly and efficiently - starting with undisturbed skin-to-skin on mother's chest from the moment of birthing. I really do implore everyone to think long and hard before scampering around trying to find research articles to prove what is normal and natural while practices using what is detrimental to birthing/breastfeeding/whatever continue without questioning. Please consider looking the perpetrators in the eye and saying First, do no harm! - your practice is not 'normal' - prove to me that it is doing no harm!! Cheers Denise *** Denise Fisher Health e-Learning http://www.health-e-learning.com [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. -- 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] Here 'tis!!
Thank you for this jenny!! When will Queensland follow suite! marilyn - Original Message - From: Jenny Cameron To: [EMAIL PROTECTED] Sent: Wednesday, November 17, 2004 8:16 PM Subject: [ozmidwifery] Here 'tis!! http://www.nt.gov.au/health/news/2004/new_era_maternity_services.pdf Jennifer Cameron FRCNA FACMProMid Professional Midwifery Education Service0419 528 717 btzhsepa.gifNetwork Blitz Bkgrd.gif
Re: [ozmidwifery] Great News for NT Women
Title: Great News for NT Women Congratulations to all whop have worked so hard on this!! fantastic!! marilyn - Original Message - From: Justine Caines To: OzMid List ; MC NSW Branch Sent: Wednesday, November 17, 2004 8:33 AM Subject: [ozmidwifery] Great News for NT Women Dear AllIt seems that Maternity Coalition women and midwives have done it!Today the NT Health Minister, Toyne launched a comprehensive package of reform for NT maternity services and indemnity for Independent midwives (of which the NT Gov will cover). I cant attach the release and it is not yet on the website, but for those interested in looking later here is the linkhttp://www.nt.gov.au/ocm/media_releases/A good day for MC,A great day for NT women and midwives!!Thanks so much to Virginia Nock for a sterling effort of the last 18 months, it was her wonderful experience of homebirth and a known midwife that fuelled the passion.This is an example of how a national organisation who has developed respect and has some clout can support a branch to make great in-roads locally.Just shows when we tap all of our talents what we can do together!!Also very positive for the rest of the country, if Australias smallest jurisdiction can self insure private midwives then why not VIC, NSW etc.Champers tonight!JCJustine CainesNational President Maternity Coalition IncPO Box 105MERRIWA NSW 2329Ph: (02) 65482248Fax: (02)65482902Mob: 0408 210273E-Mail: [EMAIL PROTECTED]
Re: [ozmidwifery] Great News for NT Women
yes we do!! marilyn - Original Message - From: ID AC Quanchi [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, November 17, 2004 8:58 PM Subject: Re: [ozmidwifery] Great News for NT Women Oh you wonderful wonderful women. Now we just need the remainder of the mexican states to pull their fingers out and do the same thing Andrea Quanchi -- 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] gestational diabetes and antenatal ebm
Way to go Denise, I totally agree. However, am part of a working group for BFHI reaccreditation and was asked to find the evidence. So, I was just wondering if there was some that I had missed. marilyn - Original Message - From: Denise Fisher [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, November 16, 2004 3:41 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Hi Marilyn I won't swear to it but I don't know that there is any research out there on this practice. However to give newborns their own mother's milk is kinda natural and not really something that we need research to prove is a good thing do we? Wouldn't it be more to the point to ask those who are giving newborns something other than breastmilk to come up with the evidence to prove that what they are doing is not detrimental?? I'd like to see that ... could have them running around in circles for years trying to find anything to support that practice as opposed to giving mother's own colostrum. All you really need proof of is that expressing antenatally won't put a mother into preterm labor, which it won't and I'm sure you'll find plenty out there on that - then ensure that the mothers know how to store and transport their milk safely when the time comes. There's lots more than just giving breastmilk though that can stabilise the newborn's glucose levels quickly and efficiently - starting with undisturbed skin-to-skin on mother's chest from the moment of birthing. I really do implore everyone to think long and hard before scampering around trying to find research articles to prove what is normal and natural while practices using what is detrimental to birthing/breastfeeding/whatever continue without questioning. Please consider looking the perpetrators in the eye and saying First, do no harm! - your practice is not 'normal' - prove to me that it is doing no harm!! Cheers Denise *** Denise Fisher Health e-Learning http://www.health-e-learning.com [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] gestational diabetes and antenatal ebm
I remember some time ago one of the midwives on this list having a practice of having mothers with GDM express colostrum antenatally so it was available to feed the baby in the early postnatal period should the baby's BSLs be low. I have just been trying to search pubmed to find research on this practice and did not find any, can anyone help? Just need the evidence to change practice. thanks marilyn - Original Message - From: barbara glare chris bright To: [EMAIL PROTECTED] Sent: Monday, November 15, 2004 11:11 AM Subject: [ozmidwifery] Breastfeedng Calendars Hi, The Australian Breastfeeding Association's calendars are now available. This year they are in full colour, and look gorgeous. A fabulous way of promoting breastfeeding in your workplace, great gifts and just plain gorgeous to look at. They are only $15 plus $5 for postage (cheaper postage for multiples) You can order them by simply e-mailing me including the quantity and your address. And I'll invoice you. Or you can order via ABA's LRC website www.lrc.asn.au Warm Regards, Barb Barb GlareMum of Zac, 11, Daniel 9, Cassie 6 and Guan 1Breastfeeding counsellor ABA Warrnambool GroupDirector, Australian Breastfeeding Associatione-mail [EMAIL PROTECTED]www.abavic.asn.au
Re: [ozmidwifery] sodium
Hi there: This is quite complex and unusual, at least for me. I have done a google search for low sodium or hyponatremia AND neonates and came up with quite a list of info sources. Low sodium for a neonate can have severe consequences as it can lead to cerebral oedema and seizures. It seems to be associated with prematurity and the various medications used to treat asphyxia, apnea etc.. It can be reversed and the therapy is quite involved, I can't imagine that it could be done anywhere but in a NICU/SCBU as the fluid balance etc involved is delicate to say the least. Thus the mum would have to go to the baby and if she was also sick and in this case recovering from a c/s, then perhaps separation was unavoidable though regretable. I have copied a definition which is again technical: Hyponatremia Serum sodium under 120 mEq/L may produce seizures. Hyponatremia occurs in neonates with inappropriate antidiuretic hormone secretion syndrome, congenital adrenal hyperplasia, and those receiving hypo-osmolar formula. Inappropriate antidiuretic hormone secretion syndrome should be suspected in a neonate with decreased urinary output and high urinary osmolarity. I haven't found anything yet regarding treating or detecting it antenatally. You mentioned the mother having low sodium? Do you know why and was this therapeutically low? Did she have hyperemesis (often causes low potassium and corresponding high sodium), cyctic fibrosis (significant electrolyte imbalance), or was she taking any medications for hypertension? You said he was showing signs of distress leading to the c/s and needed resuscitation at birth (so apparently he was distressed) perhaps he was given medications to address the asphyxia which caused the low sodium levels? I would assume cord bloods were taken and if the baby was acidotic then its possible this could have led to an electrolyte imbalance but I am only guessing. I am probably hearing galloping and looking for zebras, anyone else got any ideas? marilyn - Original Message - From: cath wright [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, November 05, 2004 10:14 PM Subject: [ozmidwifery] sodium posted on behalf of di diddle (choices for childbirth) dear all, i am after some info on sodium levels in newborns. a friend recently had a baby by CS. apparently he got 'stuck' in 2nd stge then possibly showed signs of distress. when he was born he was resussitated had very low sodium levels due to the mothers low levels the doctors were concerned about possible brain damage. they didn't know how long he hadn't been breathing for. he was put in a humidy crib the mother didn't see him for 24 hours. i am wanting to know would they have not detected that he was not recieving oxygen well before the birth by observing his heart rate? how common is it for a mother to pass on these low sodium levels to their babys can it be detected during pregnancy? how would they have known that his sodium levels were so dangerously low at birth? what affect does low sodium levels have on a newborn? was it necessary to separate him for so long from his mother, if he needed sodium could the mother have had him while this was given? thankyou di diddle choices for childbirth -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. 5x5.jpg
Re: [ozmidwifery] Re:
It wasn't what I had ever done before either. In my previous life for Rh neg mum's at a homebirth we had baby's cord blood for blood group and a direct coombs and mum's blood for a kleihauer becke (indirect coombs). If bub was positive we just gave the anti-d and that was that unless of course mum declined. of course we also only offered the anti-d at sensitising events and/or at 28 weeks after the antibodies test at this time. Now the anti-D is being offered at 28 weeks and 34 weeks: couldbe the brandor new knowledge? marilyn - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, October 29, 2004 4:50 PM Subject: Re: [ozmidwifery] Re: Thats interesting Marilyn as I have never heard of this being done. Everywhere I have ever worked( not many institutions I admit) give the anti D and thats it. No follow up is done. What do other people do? How often after birth do you have to give a second dose? I can see more homework is needed to find out what is best practice. Andrea Quanchi On Saturday, October 30, 2004, at 08:15 , Marilyn Kleidon wrote: Yes there is. In the hospital up in FNQ at least, we do a FCAD (free circulating anti-D blood test) 48 hours after the anti-D is given (apparently this test was done 24 hrs after the previous brand of anti-D but this changed with WinRho to 48 hrs). If there is passive anti-D detected then no further anti-D is given if the test is negative in other words all of the antiD has been used up then another dose of antiD is given and yet another FCAD in a further 48 hrs. Of course this is after the regular postnatal dose of anti-D given as soon as the baby's blood group is identified (and if it is Rh positive). marilyn - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, October 28, 2004 1:37 AM Subject: Re: [ozmidwifery] Re: That was my point and so the woman was given a further dose of Anti D. Apparently the pathologist has followed up on the issue with CSL but I have not had the opportunity to talk to him yet Andrea On Tuesday, October 26, 2004, at 08:22 , JoFromOz wrote: Andrea Quanchi wrote: I had one case recently where pathology decided that there was enough remaining that anti D was not required after birth even though she had an rh +ve baby. That could be true, but who knows exactly how much (if any) rh+ blood got into mum's blood stream. Surely they can't be sure there are enough anti D antibodies to counteract the possible amount of foetal blood crossing? I would have thought there'd be a limit on how much of the rh+ blood could be combated by a certain number of antibodies. ? Jo -- 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. -- 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] Gary Ezzo
Great site Abby. marilyn - Original Message - From: Abby and Toby [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Saturday, October 30, 2004 1:04 AM Subject: Re: [ozmidwifery] Gary Ezzo been doing the right thing to let the baby cry for hours ... naturally nobody in the house has been getting any sleep and everyone is on edge!! Can anybody help me?Leanne. Hi Leanne, It makes me cringe and cry everytime I hear of another baby being tortured and a family being torn up because of this mans ridiculous teachings. There is a great site with heaps of info www.ezzo.info , I can't help out with a lactation consultant and ezzo has a dodgy way of making mothers believe that other professionals have no idea about child rearing. He uses brainwashing and cultish techniquesgrrr he makes me mad. All in the name of money! Hope you find some good info on that site. Love Abby -- 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] Re:
Yes there is. In the hospital up in FNQ at least, we do a FCAD (free circulating anti-D blood test) 48 hours after the anti-D is given (apparently this test was done 24 hrs after the previous brand of anti-D but this changed with WinRho to 48 hrs). If there is passive anti-D detected then no further anti-D is given if the test is negative in other words all of the antiD has been used up then another dose of antiD is given and yet another FCAD in a further 48 hrs. Of course this is after the regular postnatal dose of anti-D given as soon as the baby's blood group is identified (and if it is Rh positive). marilyn - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, October 28, 2004 1:37 AM Subject: Re: [ozmidwifery] Re: That was my point and so the woman was given a further dose of Anti D. Apparently the pathologist has followed up on the issue with CSL but I have not had the opportunity to talk to him yet Andrea On Tuesday, October 26, 2004, at 08:22 , JoFromOz wrote: Andrea Quanchi wrote: I had one case recently where pathology decided that there was enough remaining that anti D was not required after birth even though she had an rh +ve baby. That could be true, but who knows exactly how much (if any) rh+ blood got into mum's blood stream. Surely they can't be sure there are enough anti D antibodies to counteract the possible amount of foetal blood crossing? I would have thought there'd be a limit on how much of the rh+ blood could be combated by a certain number of antibodies. ? Jo -- 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] 2nd Stage of Labour
You know Sally, that is about the best description I have heard or read. I have tried to say the same thing and have used other bodily functions as an example (like thinking you need to poo and then having no doubt about it but I don't think that works as well as your scenario). marilyn - Original Message - From: Sally Westbury To: [EMAIL PROTECTED] Sent: Wednesday, October 27, 2004 6:56 AM Subject: RE: [ozmidwifery] 2nd Stage of Labour The analogy that I tell women is that being ready to push is like being ready to vomit. When you feel nauseous you are probably going to vomit some time. You know that it is coming but you are not actually doing it. When you feel like you want to push you know you are probably going to push soon but you are not actually doing it. (and probably not ready) When you vomit there is no stopping it. It is an overwhelming bodily fuction. When you are ready to push it is overwhelming and there is no stopping it. This analogy seems to help women. It is something that they can relate to. Sally Westbury Homebirth Midwife "It takes courage to remain a true advocate for women, challenging authority and sacrificing social and professional acceptance. It takes courage for a woman to choose a caregiver who will truly advocate for and empower her." -Judy Slome Cohain -Original Message-So, I guess what I'm really asking is - do you allow women to go with theirbodies and what they are feeling (which would be my instinct, rightly orwrongly who knows!) or wait for external signs that pushing 'ok'?CheersTania--
Re: [ozmidwifery] Re: anit-D
Sara Wickhams amazing and informative site is http://www.withwoman.co.uk/. marilyn - Original Message - From: Kristin Beckedahl To: [EMAIL PROTECTED] Sent: Monday, October 25, 2004 6:56 PM Subject: RE: [ozmidwifery] Re: anit-D Thanks for that info Marilyn! Could you direct me to the articles of Sara Wickham's you spoke of? Cheers, K. -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
Re: [ozmidwifery] Re:
Nicole: I think perhaps you are confusing giving anti-D prophylactically (usually given once at 28weeks if antibody negative and then again postnatally if the baby is Rh pos) with treating a possible sensitising event. When given prophylactically the life of the antibodies is thought to be around 12 weeks, theoretically should a sensitising event occur in this time period then these antibodies will take care of it. If the event were significant then perhaps another dose would be given with appropriate blood work (antibodies etc.. and FCAD). When treating a possibly sensitising event: when foetal blood cells would mix with maternal ones eliciting and immuune response and hence a memory in the mother's immune system which would make her sensitised then the time period is 3 days or 72hrs. This time period is not the life of the antibodies but the time interval within which the potentially sensitised person will NOT from antibodies, hence if the anti-D is given within this time period the anti-D will destroy the foetal blood cells before the mother's immune system can respond and form a memory. Potentially sensitising events include: spontaneous or intended abortion, placental abruption, small unnoticed placental bleeds, threatened miscarriage with or without observed bleeding, amniocentisis, ecv, birth, retained placenta, and similar events. Once a mother has been sensitised then that is it in the sense that future pregnancies will need to be monitored and antibody titres done to ensure the well being of the baby in the interests of preventing HDN if possible. There are many issues around anti-D not the least being that it is a blood product and thus a potential source of blood born contaminants/pathogens. I do believe to date the actual processing needed to produce these antibodies from sensitised donors has prevented the transmition of the blood born pathogens. Nevertheless the potential remains and we would be fools to ignore it, the scientific community certainly doesn't ignore it. Other issues have included the potential for these antibodies to cross the placenta and start destroying the baby's blood cells themselves. If this has happened I have not known it to be a significant issue: that is not the source of significant hemolysis or anaemia in neonates possibly because the supply is limited and not able to replicate itself. Another issue is the possibility for the antibodies to sensitise an Rh negative baby, again I don't think this has ever been recorded and to be honest doesn't make immunological sense to me but that doesn't mean it couldn't happen (I am not an immunologist). Anti-D has been given prophylactically in various communities around the world since the late 1960's and has been extremely effective in preventing HDN. As with all medications informed consent should be given. Have you visited Sara Wickham's site at http://www.withwoman.co.uk/. marilyn - Original Message - From: Nicole Carver [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, October 25, 2004 2:40 AM Subject: [ozmidwifery] Re: Hi Kristin, I have concerns about the reasoning behind the giving of anti D in pregnancy. It is apparently done because some women develop anti D antibodies without any obvious clinical events that can be treated with anti D when they occur. (Previously anti D was only given if there was an event whereby foetal cells could enter the maternal circulation). I can't understand how giving anti D twice in pregnancy can prevent antibody formation for the whole pregnancy, when after birth, it must be given within 72 hours to be effective. If the same period of action applies in pregnancy, wouldn't it have to be given every three days throughout the pregnancy? Perhaps someone can set me straight on this? The other thing I am concerned about is the wide scale use of a blood product on pregnant women. I feel certain that many women are not giving true informed consent to this. Kind regards, Nicole Carver. - Original Message - From: Kristin Beckedahl [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, October 25, 2004 6:52 PM Dear List, I have recently heard of the Anti-D that can be given during pregnancy (28weeks?) for the prevention of HDN... does anyone know how effective it is, and if it is safe...? Thanks, Kristin -- 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] Re:
I am assuming that a FCAD was done after the birth and if the presence of passively aquired antibodies was positive then it could be assumed that no further anti-D was required. How was this determined andrea? marilyn - Original Message - From: JoFromOz [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, October 26, 2004 3:22 AM Subject: Re: [ozmidwifery] Re: Andrea Quanchi wrote: I had one case recently where pathology decided that there was enough remaining that anti D was not required after birth even though she had an rh +ve baby. That could be true, but who knows exactly how much (if any) rh+ blood got into mum's blood stream. Surely they can't be sure there are enough anti D antibodies to counteract the possible amount of foetal blood crossing? I would have thought there'd be a limit on how much of the rh+ blood could be combated by a certain number of antibodies. ? Jo -- 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] Urgent Help Needed
Has the ABC been promoting this in other parts of Australia? I think I have heard of everything else George is doing this week except Tuesday night over here in FNQ, I do hope we're getting the same broadcast. All it says in the Weekend aus. Review is : Explores the issues, trends and personalities of contemporary Australian life. heres hoping marilyn - Original Message - From: Denise Hynd To: [EMAIL PROTECTED] Sent: Monday, October 25, 2004 6:31 AM Subject: Re: [ozmidwifery] Urgent Help Needed PS Lois is on ABCradio 720 in Perth in the morning promoting the segment of GNT tomorro nite she and others are in on ABC TV!! Denise Hynd "Never believe that a few caring people can't change the world. For, indeed, they are the only ones who ever have." Margaret Mead - Original Message - From: Denise Hynd To: [EMAIL PROTECTED] Sent: Monday, October 25, 2004 9:24 PM Subject: Re: [ozmidwifery] Urgent Help Needed Dear Jo Lois will be on ABC radio 720 in Perth only as far as I know on the Liam Bartlett show which is 9 -12 Denise Hynd "Never believe that a few caring people can't change the world. For, indeed, they are the only ones who ever have." Margaret Mead - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Monday, October 25, 2004 5:52 PM Subject: Re: [ozmidwifery] Urgent Help Needed Denise Hynd wrote: You can do thisby one of the following; * phone your local ABC TVstation and offer to speak as a part of promotion for this program giving a local perspective on this particular segment (the first in a program about rites of passage) * phone your local ABC radiostation and offer to speak as a part of promotion for this program giving a local perspective on this particular segment (the first in a program about rites of passage) Here in Perth Lois Wattis the midwife involved will be on the morning show on Tuesday!!Denise, did you mean that Lois will be on the ABC radio morning show tomrrow morning? If so, do you know what time?Thanks,Jo
[ozmidwifery] Re: anit-D
Hi Kristin: I am presuming you mean the new brand of anti-D that has been re-introduced and can be given in prenancy and postpartum to Rh neg mothers (for prevention of haemolytic disease of the newborn HDN). This product has been for use in Australia for at least 36 months and is called Whin-Rho or Win Rho: this is just its brand name. I think anti-D prophylaxis in pregnancy was discontinued some years ago in Australia not because of safety (as was rummored) but because of supply. The Red Cross is currently building up their Australian supply and in the interim are using this product which is Canadian. I am not sure (as I was not in Australia at the time) but I think the former product in use here was Rhogam which is a US based company. As far as I was aware from the Merk (or Merck?) Index the only real difference in the products is the preservative used, Rhogam is one of those thimerosol preserved products while Win Rho is preserved with glycine. The other difference in use is that it takes longer for the free circulating anti-D (FCAD)to appear after the drug is administered postpartum. Anti-D in one form or another (one brand or another)has been around for prophylaxis in Rh neg mothers since the late 1960's and has been so successful in preventing sensitisation that Australia has a very small pool of sensitised donors which is what leads to the short supply of anti-D. All who are concerned are very astute to be cautious, because despite the good that has been done by this product it is a blood product and while its processing should theoretically preclude the passing on of viruses etc. as always there is much we still don't know. Do read Sara Wickham's articles as they are essential reading for truly informed consent. marilyn - Original Message - From: Kristin Beckedahl [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, October 25, 2004 1:52 AM Dear List, I have recently heard of the Anti-D that can be given during pregnancy (28weeks?) for the prevention of HDN... does anyone know how effective it is, and if it is safe...? Thanks, Kristin -- 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] BMid Info Session
Hi Abby: While on the one hand I agree with you that there ought to be at least an overview if not an introductuction to alternative/complementary therapies in a midwifery course I can also understand why this has been left out. I also agree with you with regard to the evidence based discussion. There are papers by Thompson and also Sara Wickham and others of course that discuss the hierarchy of evidence that can sabotage research at least in my opinion. If we limit ourselves to the randomised controlled trial as the only acceptable evidence to use or even the most acceptable, then we are surely hobbling ourselves; of course we don't do that but it seems at times that we dream of this limitation. Since my midwifery qualification was obtained at an alternative midwifery school (by Australian standards at least, mainstream now in the USA but with a pretty alternative origin) we did study alternative therapies from time to time as they applied to midwifery. However, many of us who had prior study in these areas from massage, acupressure, to herbs, homeopathy, naturopathy, and essential oils felt that the surface of these areas of study had barely been touched and what people who had no prior learning were left with was a cookbook approach: one size fits all if you will. This was, we felt of little benefit to the women we served beyond opening our minds to the possibility of alternative remedies. It was also possibly a disservice to these therapies. We were exposed to the works of leaders (and often the leaders too) in these fields (such as Susan Weed) and aware of further studies we could follow. I guess my point is, that even in a homebirth based alternative midwifery education there is insufficient time to give more than lipservice to alternative therapies. There are also limitations on how many alternative therapies can be used in a hospital situation and by whom. To become licensed we also had to be competent to use the medical pharmacopia of midwives, these medicines can do far more harm if used inapropiately and so detailed study must be done because they also save many lives and are an important part of a birth kit. There is quite simply only so much time and beyond this a student has to take it upon herself to study further. Since I haven't studied midwifery in Australia, I don't know how much time is spent on the history of the profession, or the history of medicine and alternative therapies in Australia. At Seattle Midwifery School we seemed (at the time) to spend an inordinate amount of time on the history, sociology, philosophy, and jurispudence of it all. If you go to the MANA website you can find out the limitations of midwifery practice state by state in the USA. Because of these limitations many midwives have honed their practice of these ancient arts if you will, not because they were superior to modern medicines but quite simply because 1. they worked at least to some degree and 2. they (the midwives) could not be arrested (for practising medicine without a license) for carrying them. MANA is establishing a data base and hopefully will collect data on the use of alternative therapies. marilyn - Original Message - From: Abby and Toby [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Saturday, October 23, 2004 6:51 AM Subject: [ozmidwifery] BMid Info Session Hi, Today I attended the information session for the direct entry BMid at UTS. Sounded interesting, lots of people there, but I must admit I was disappointed to learn the NO alternative therapies will be taught. No herbs or anything. I find it so hard to accept that, in a course teaching about natural birth, alternative things can't be taught because they are apparently not evidence based but all medical interventions will be taught?? Sorry to rehash this subject I really don't want to get in another arguement about it. I went with a positive outlook and came away very disappointed. I find it hard to understand how learning to facilitate natural birth would include all medical interventions, but not all the natural tools we can use. How can student midwives learn to really be with woman if they are not given a chance to learn all the skills involved? To me it does still seem so medical. I really believe that the proof is there with alternative therapies, maybe just not the type of evidence that the medical professionals will accept. I really am feeling so disappointed as I was excited to go and see what was happening and maybe even get a little more tempted to study midwifery here, but now I just feel disillusioned. Love Abby -- 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] AMA and midwifery-led care
Try this MJA article at: http://www.mja.com.au/public/issues/181_08_181004/dec10468_fm.html There was an article by the authors / AMA press release in Monday's Courier Mail (18/10/04) marilyn - Original Message - From: Kirsten Wohlt [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, October 18, 2004 3:39 AM Subject: [ozmidwifery] AMA and midwifery-led care Would I be right in assuming the AMA is not in favour of the suggested government initiative to promote midwifery-led hospital care for low risk pregnancy? I have an assignment due, and need a reference! I've been 'googling' for ages and can't find anything in black and white. Any help out there? Many thanks, Kirsten -- 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] FFP
I am not attempting to endorse or support any party. Simply inform them and lobby them. If I were endorsing a party, I would agree with you, however I am simply seeking to find out if FFP has a position on maternity care and if not maybe create or instigate a discussion about maternity care within the party. We all wrote letters to all the main party candidates, at least I did: from John Howard to Len Harris (who is One Nation and gave one of the better responses and may have lost his senate seat), Bob Katter (who is my local member though I didn't vote for him), Bob Brown, Kerry Nettle, Andrew Bartlett, and Mark and Julia and others. The discussion may be mute since maybe FFP wont have a senator after all and so may not hold the balance of power . The election is over and now is the time to see what those who have been elected actually have to offer. And call them to task if they are way off base. For the next 3 years they should be courting us. Anyway, that's what I think. I also think it would be great if we could create an environment where all the politicians supported NMAP and affordable sustainable safe maternity care regardless of their other policies. Dream on I know ... well I am a dreamer... take good care marilyn - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, October 12, 2004 7:17 PM Subject: Re: [ozmidwifery] FFP I believe all midwives and midwifery students should first ask themselves whether or not they want support from and association with any party that endorses a candidate who claims on national radio/print media/TV that all lesbians are witches and should be burnt at the stake. Maybe time to tread lightly, miriam Marilyn Kleidon [EMAIL PROTECTED] wrote: Hi Abby and Philippa and all: I looked at the FFP website this morning and actually sent off an email via their contact button. I kind of melded a few of the letters that we were sending to the politicians prior to the election. I will paste it below. I don't have the credentials to write a religious letter so it has no such content, purely secular. All the best. Dear Andrea: Since your party may now hold the balance of power in the Australian Senate I am writing to you to bring to your attention the issue of Safe, Sustainable Maternity Care and the National Maternity Action Plan (NMAP). Re: Safe, Sustainable Maternity Care and the National Maternity Action Plan (NMAP). I write to you as a concerned mother, midwife, and member of the Maternity Coalition. I support the campaign for choice and evidence based practice in maternity care for all Australian women. Safe, affordable maternity care is of major importance. Childbirth is the single most important reason for hospitalization in Australia. Australian maternity care is out of step with available evidence and the needs of women. In New Zealand, Canada, some states of the USA, and the United Kingdom, women are able to choose the care of a midwife throughout their pregnancy and birth. In the 10 years since New Zealand women were able to choose, midwifery care increased from 14% to over 70%. The relationship that is formed when midwives care for women is well documented. The World Health Organisation recognizes the midwife as the most 'appropriate' and 'cost effective' carer for healthy women. I am aware that 80-85% of Australian women are healthy and are best cared for by midwives, however, less than 1% of women can access continuous midwifery care throughout their pregnancy. Midwifery care has the potential to: ü Re-open many maternity services that have closed in recent years ü Provide much needed support to GP's and specialist Obstetricians and enable them to provide services to those with medical conditions, rather than healthy women ü Reduce Australia's over medicalisation of childbirth (particularly the unacceptable caesarean section rate of around 30%) and in the process save money. ü Help address post-natal depression that has been linked to surgical birth ü Through greater participation in healthcare and a focus on wellness promote self responsibility and address consumer litigation issues I ask you to acknowledge the wealth of evidence that proves the care of a known midwife as the most appropriate and cost effective maternity care for the majority of women. I also ask that you pursue this as an important issue and support the establishment of commonwealth funding for on-going community midwifery programs in metropolitan, regional and rural Australia to enhance current maternity care and provide a sustainable maternity services framework. Maternity Care: Choice and Equity for Australian Women I write to support Maternity Coalition's campaign seeking urgent assistance for independently practicing midwives in obtaining professional indemnity (PI
Re: [ozmidwifery] Post rupture discussion
Hi Jo: I think this comment was mine: I did read the comment about the complacency of VBAC that had occurred during the last few years with interestI could see how that could be viewed. BUT could it be the ever creeping obstetric interventions imposed upon VBACS that led to the increased rupture outcomes? Do you know what I mean? That is exactly what I meant: because the natural birth outcomes were so good, interventions such as augmentation of labour and all the induction regimens were deemed suitable for vbac also where as previously they (the interventions)had been either unavailable or implementated with considerable caution. There were 4 women with catastrophic uterine ruptures in the Seattle area from 1998 to 2001 that I know of, all had either been induced (2 with cytotec)or augmented, however what this led to (in combination with that vbac study) was that only hospitals with 24hr c/s surgery availability (called a doc in the box) where accepting women for vbac's. Forget birth centres at that time and homebirth midwives who were accepting vbac women were frowned upon. marilyn - Original Message - From: Dean Jo To: [EMAIL PROTECTED] Sent: Wednesday, October 13, 2004 4:13 AM Subject: [ozmidwifery] Post rupture discussion Hi everyone, I was offline kind of when the uterine rupture thing was discussed. So sorry this is a tad old! Lol As the co-ordinator of CARES here in SA you can imagine how familiar I am with this case and the repercussions of it. VBAC was allowed in the birth centre at Flinders Medical Centre until July/August of 2001. The refusal came just 5 weeks after I had my vbac in the BC at Flinders which was an amazing near water birth. I cried for days after hearing it. We now no longer recommend FMC for VBAC. (Sorry FMC midwives on this list, but we cant and wont whilst WCH will accept them with OB approval which they have done and when TQEH was accepting VBACs even after 2cs before their unit closed.) The arguments for removing the right to birth in the BC after cs given to me by the head of OB during correspondence included the outcomes of the case in question. He probably wished he hadnt brought it up as I made it clear to him that if the woman in question was in the BC then she would not have endured what she did. He then fell back on the need for continuous monitoring reason for barring birth centre VBAC.dont they LOVE that one!! The reality of the new policy was that the vbac pendulum was given a right royal shove back into the negative with the release of the findings regarding this case. I did read the comment about the complacency of VBAC that had occurred during the last few years with interestI could see how that could be viewed. BUT could it be the ever creeping obstetric interventions imposed upon VBACS that led to the increased rupture outcomes? Do you know what I mean? It concerns me greatly when outcomes from the management (or mismanagement) of vbac in the labour ward setting, (i.e. the medical model of vbac care), are used to negate the options of birth centre care of vbacs. Has anyone actually studied the outcomes of VBAC in BC and compared outcomes with the medical model? Not to my knowledge here in Aust. There is only one study that was a US study in 1997 and the VBAC rate was 98%. Lynne Staff has a brilliant VBAC outcomes in her unit also but do these ever get acknowledged when looking at safe vbac management? Anyway, theres my 2 cents worth ~ there were a few people wondering why I hadnt made any comments to date. Lol! Seriously though, it is a very interesting topic and one in which I relish being apart of! Cheers Jo ---Outgoing mail is certified Virus Free.Checked by AVG anti-virus system (http://www.grisoft.com).Version: 6.0.775 / Virus Database: 522 - Release Date: 10/8/2004
[ozmidwifery] FFP
Hi Abby and others: I am wondering if you or anyone else know Family First's position on homebirth and PI insurance for midwives? I am only wondering because of your biblical familiarity and so may be off base entirely. In the USA at least, conservative christians, especially pentecostals and/or evangelical christians were the backbone of the homebirth movement and I am wondering if this is so with the FFP and if they would support midwives and PI insurance, NMAP etc. pondering marilyn -- 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] FFP
Great, Abby. It may well be a difficult discussion for some of us, however they could also be a powerful alliance for midwives and childbearing women. As you may be aware conservative christians come in many types of clothing and hairstyles etc., in the USA difficult to tell apart superficially from our more alternative clients at times or dotcomers at other times if you know what I mean. In any case the FFP may be a source of support for midwives as yet untouched. marilyn - Original Message - From: Abby and Toby [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, October 12, 2004 2:57 AM Subject: Re: [ozmidwifery] FFP christians were the backbone of the homebirth movement and I am wondering if this is so with the FFP and if they would support midwives and PI insurance, NMAP etc.pondering marilyn Hi Marilyn, I have been thinking about that all day. To be honest, I don't know where they stand, but I think them more than any other party, could be easily convinced of the necessity of midwives, continuity of care, NMAP and PI. It is so strange how in america, as you say, the christians were the backbone of the homebirth movement, but here I have met hardly any christian women that trust in the design of their birthing bodies..maybe that will soon change. I am working on getting together a letter to send to Family First. I know there are some wonderful scriptures that support natural birth, midwifery and breastfeeding so I am on a mission so to speak!lol! I think, if approached from the right angle, honestly and biblically, that they would see the reality and the need. I noticed on their website that they are interested in mental health issues and I really want to work with that. We all know what a difference it would make to mums and their children, then society, if birth was bought back to its natural elements and if mothers had the care and support that they deserve. Just like that saying, gentle birth for a peaceful earth Could go on and on.I didn't know how I felt about them at first, still don't really, but what I do know is that I can speak their language more so than any other party, if that makes sense. They look pretty conservative thoughdon't know how they'd react to a dreadlocked, pierced, birth activist! We'll seelots of young christians are breaking out of the stereotypes and AOG churches usually have thriving youth groups. A woman on another list, (Janet are you on here?) has written to them to ask where they stand with midwifery so I'll let you know their response. wrote to another list earlier that good or bad, for midwifery and birth, I think it could be quite positive. Love Abby -- 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] Induction by Rupture of Membranes
Abby: If the doc was able to do a stretch and sweep then he was able to reach her cervix, and some dilation had occurred as he was able to put his finger inside the cervical os and then sweep between the cervix and membranes probably doing some cervical stretching as well. Theoretically supposed to stimulate natural prostaglandin production and maybe get labour started without ARM. Ditto to all Leanne said re ARM. The most natural methods of labour stimulation are orgasmic sex followed closely by significant nipple stimulation: semen will provide the prostaglandins and oxytocin surges the natural stim to at least prime the uterus for labour. Failing both of these lots of loving touch ( oxytocin is the love hormone). From there you can go to acupressure points and acupuncture.Then herbs and lastly castor oil. You can find recipes for these on various web sites. marilyn - Original Message - From: leanne wynne [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, October 06, 2004 8:22 PM Subject: RE: [ozmidwifery] Induction by Rupture of Membranes Hi Abby, If your client wants a normal birth she should avoid an induction unless it is medically indicated, not just because she is a couple of days past her due date. The theory behind an artificial rupture of membranes is that once the forewaters are gone, which had been cushioning the baby's head from coming down firmly on the cervix, the pressure from the foetal head can stimulate contractions. Of course, once the membranes are ruptured the doctors will put a time limit on how long they will wait before starting a syntocinon infusion to also start contractions. Prostaglandin tends to be used if the cervix is very unfavourable for induction ie too closed or posteriior to perform an ARM. Hope this clarifies things somewhat for you. Leanne. From: Abby and Toby [EMAIL PROTECTED] Reply-To: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Subject: [ozmidwifery] Induction by Rupture of Membranes Date: Thu, 7 Oct 2004 13:02:53 +1000 Hi, I've got a question about hospitals inducing etc. I have a client going to St George public and her EDD was the 5th, mum and bubs are doing wonderfully, heads 3/5 engaged, heart rate fine etc. Went to see doc today who swept and stretched, clients words, that was OMG that was painful, male doc. She's booked in for AROM on the 18th. After recent discussions about AROM, I am just wondering why anyone would suggest this? I thought first course of hospital action was prostagladin? What is the thinking behind trying to get labour started with AROM? From what I understand, a lot of you believe it is sometimes beneficial in second stage, so why would anyone think it was good for getting things started? Of course you all know how I feel about any of that, lol! But my job is to be there and support my client in whatever she chooses so, I've got a few ideas of natural induction techniques does anyone else want to share some too? My client is really keen for a natural birth with minimal interventions, she had a very traumatic experience last time (her words). She has read some great books and I am not really sure why she is just going along with what is happening but I want to give her some good natural options. Thanks Love Abby -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ SEEK: Now with over 50,000 dream jobs! Click here: http://ninemsn.seek.com.au?hotmail -- 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] Mackay Birth Centre student placements
Maybe you could offer grad midwife positions so that they are on the payroll and hence covered by insurance. What a shame. marilyn - Original Message - From: Birth Centre-MBH To: [EMAIL PROTECTED] Sent: Wednesday, October 06, 2004 8:42 PM Subject: [ozmidwifery] Mackay Birth Centre student placements Thanks to those who reponded. We have since discovered the reason no students are getting through to us is that our health service is worried about insurance and wont have suppernumery students. We are extremely disappointed with this decision. We are a group of midwives wanting to share our experience and keen for student midwives to experience a midwifery model. With a shortage of midwives one would think the health services would be keen to have help educate students!!! Those still interested let us know and we'll contact you if the situation changes. Sue and Marion ***This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.Any unauthorised use, alteration, disclosure, distribution or review of this email is prohibited. It may be subject to a statutory duty of confidentiality if it relates to health service matters.If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone or by return email. You should also delete this email and destroy any hard copies produced.***
Re: [ozmidwifery] Students, training and other things was Re: uterine rupture 1998
You have both said it all very well i think. marilyn - Original Message - From: Jen Semple To: [EMAIL PROTECTED] Sent: Monday, October 04, 2004 6:33 PM Subject: Re: [ozmidwifery] Students, training and other things was Re: uterine rupture 1998 Yes, Kirsten. Well said. I was wondering how longit would take a student to write! :o) JenCallum Kirsten [EMAIL PROTECTED] wrote: Dear Abby, I couldn't close my mouth anymore, sorry! You give a poor impression of midwifery training in Australia. Coming from NZ, it's true its not the absolute greatest, BUT i can say that the universities here DO NOT teach a medicalised model of care. I am quite happy with my university and so far ALL my clinical experience has been with woman having homebirths and homebirth midwives, although in saying that, there are some wonderful midwives who i admire who also work in the public system! As for the debate on VE's etc, just because we learn something does not mean we will all go out and perform them every 5 minutes! There are many skills taught to us that could be seen as unnecessary interventions, why as Andrea Robertson in the Midwife Companion ( love this book!) says, talking unnecessarily to a woman in labour and distracting her can slow things down! Personally i would rather be confident and competent in these skills so if i have to do them i am gentle and cause as less harm and discomfort as i can to the woman. I would hate to be ignoarant and say " i don't need these interventionalist skills" and then have to perform a VE and not be able to do it carefully and gently. There are still many woman out there who request them, even if you don't think so. Again, my philosophies on birth will not change just because i have certain skills in my knowledge base, they don't change who i am or what kind of (student) midwife i am, or how i see things. Many of the skills we learn don't come from the uni itself, it's when we are on clinical placements and with our follow thru woman that we learn the most. I am forever indebited to the woman who have allowed me to be with them and to the amazing midwives who offer their advice and support. It is them all who i learn the most off, not textbooks, not the uni. Cheers, Kirsten Darwin. Find local movie times and trailers on Yahoo! Movies.
