RE: [ozmidwifery] Sheila K @ HB conference
She has also visited Perth, I think with CAPERS for a seminar. She could have been here more often. She was a very entertaining and challenging speaker MM I think 1991 she was here for the International Homebirth Conference held in Sydney. She was also here a few years ago 2003?? 2004?? At the NACE conference in Sydney. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Genuine???
I received this today. Is it genuine?? MM Hello We have received a request to subscribe the following email address: [EMAIL PROTECTED] to the OzMidWifery mailing list. We need to make sure you want this subscription. If you do wish to subscribe, click the following link to confirm: http://cgi.mail-list.com/r?ln=ozmidwifery http://cgi.mail-list.com/r?ln=ozmidwiferyrn=s020705265021463 rn=s020705265021463 Or, if you prefer, Reply to this message and send it back to us without altering it. If this all a mistake or you no longer wish to subscribe, simply ignore this message. If you suspect someone may be abusing your email address, please contact us at [EMAIL PROTECTED] with complete details. Regards The OzMidWifery team.
RE: [ozmidwifery] newcastle conference Friday Feb9th Sat Feb 10th
Will not be able to travel from WA to attend, so can you give us feedback after the seminar Thanks, MM -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of catherine whelan Sent: Saturday, 3 February 2007 11:26 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] newcastle conference Friday Feb9th Sat Feb 10th Dear All, Places are filling fast for this innovative and informative gig. There are several international speakers of reknown... Do you know we have the worlds No 1 expert on CTG's here Prof. Sarbaratnam Arulkumaran, who is Prof of OG St Georges Hospital, London. Plus our own Prof, Maralyn Foureur, talking about the psycho-social effect of EFM. You will remember Maralyn ran the first RCT on one to one midwifery care as opposed to usual care, in Australia. Come be inspired, educated and challenged. Ring Dee on: (02) 49214727 see you there! Love catherine whelan _ Advertisement: Fresh jobs daily. Stop waiting for the newspaper. Search Now! www.seek.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t =757263760_r=Hotmail_EndText_Dec06_m=EXT -- 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] assistance required.
If someone can assist me to find the mail folder I created for Ozmidwifery emails, please mail me at [EMAIL PROTECTED] as I am not receiving any ozmid mail, even the ones I have sent. Thanks, MM
[ozmidwifery] assistance required.
My ozmid email folder seems to have disappeared. I don't know what key I accidently pressed to make this happen or how to retrieve or find the folder. Does anyone have any ideas? Thanks, MM
[ozmidwifery] FW: computer stuff
Thank you everyone for your suggestions. I have played around with it and Bingo! It re-appeared. As y0u can tell, I am of the age group where most computer stuff is a mystery, despite good tuition. Catching babies is much more fun! Thanks again, MM -Original Message- From: Jo Watson [mailto:[EMAIL PROTECTED] Sent: Friday, 2 February 2007 9:24 AM To: Mary Murphy Subject: computer stuff Hi Mary, I am pretty good with computers. Have you played around with your filters/message rules at all? What email program do you use? Have you checked your junk mail folder? Is it set to delete all junk each week? That's all I can think of for now. Hope you're well! x love Jo
RE: [ozmidwifery] Fund rebates
The voters can and the members of Health Funds can. We midwives cannot. We independent midwives have all been trying for years and years. Sometimes the ACMI has a go, but all to no avail so far. MM _ This is totally unacceptable and bloody outrageous - how can we change this???!! Kristin Medicare does not recognise Midwives as 'professionals' competent or capable of practicing without the supervision of a doctor in Australia. Therefore it will not recompense any services provided by them to pregnant women. HOWEVER: The exception is when working in a remote community : in which case you don't even have to be a midwife to provide pre-natal care, enrolled nurses aboriginal health workers with NO mid education are considered quite competent to provide maternity care which medicare will refund for as long as they are supervised (however loosely) by a doctor (who of course knows much more about normal pregnancy childbirth then any midwife) ! If Midwives were as qualified as a chiropractor, chiropodist, naturopath, herbalist etc then they would get recognition. It would appear that we just aren't up to scratch !!! Our skills whilst working within a hospital immediately disappear once we step off the premises apparently. Amazing stuff ! I rang medicare this this week to see on any level particually medicare 16400, if they would fund childbirth education classes. Unfortuantely they don't. They suggested ringing hte major health funds, I haven't gotten there yet, but wuold be interested to know too... Rachael Now all you work from home and have your own business midwives can you please tell me how I am able to offer health fund rebates IF I decided to fun my own business from home I have been thinking of it for a while - not homebirths as such cause I want insurance for that but other midwifery services that I can offer? -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
RE: [ozmidwifery] Mum Gives Birth In Toilet - Monash Medical Centre
I completely understand what Nikki is saying and agree with her abut the mothers expectations and lack of midwifery care. I also agree with the comment about the patronizing tone used to the mother..the midwives are upset. It reminds me of the Cheif medical officer of a tertiary hospital telling a woman who was holding her stillborn baby, that she had upset all my staff (drs m/ws) by refusing a caesarean early enough to save the baby. Callousness at its best. Amanda, I believe that a clean toilet is one of the cleanest places in the house, and maybe even the hospital. I agree with your view that birthing on the toilet or on the toilet floor isn't a negative thing but- Chosing to birth on the toilet is a bit different from being left alone and terrified. Lots of home birthing women choose the toilet as the most comfortable and efficient. MM
RE: [ozmidwifery] Midwives eat their young, don't they?
Midwives not only eat their young, they also eat their elders. MM Hi Honey and others, A more recent article on this issue can be found here: http://www.birthinternational.com/articles/hastie02.html and an earlier article on the same topic, also by Carolyn Hastie is here: http://www.birthinternational.com/articles/hastie01.html Both should be widely read and circulated. Cheers Andrea
RE: [ozmidwifery] For Sue
Amy, the Sue you are thinking of is also on this list. You will recognize her from her comments. You have spoken to her before. She may not want to be outed. Happy New Year MM Ahh...Ok. I must have, I got the two Sue's mixed up. You just never know in cyber world, you could be talking to your next door neighbor and never know! -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] waterbirth
Sue, what sort of bath is it? A proper one with good depth and width or a larger ordinary bath? MM _ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Susan Cudlipp Sent: Saturday, 23 December 2006 11:56 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] waterbirth Hi Amy Yes, that's the place. The policy is written, now apparently awaiting executive approval, then no doubt they'll find another reason to prevent us using the bath. Watch this space!! I'm tempted to wrap the door up in red tape as that is what seems to be happening. sigh Sue - Original Message - From: adamnamy mailto:[EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, December 21, 2006 9:06 PM Subject: RE: [ozmidwifery] waterbirth Sue, Can I ask, do you work at Swans? I saw in the local paper that they have upgraded the facilities and have installed and new bath. It would be a bit mean (not to mention misleading) to market it and then tell women they can't use it. Amy _ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Susan Cudlipp Sent: Thursday, 21 December 2006 9:55 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] waterbirth Mary, you may also be interested to know that our brand new bath (where I work) is yet to be used because we -apparently - have to have a policy in place before women are allowed to use it for labour! Even though no other hospital seems to have seen this as a necessary requirement. Births in this pristine piece of porcelain are verbotten, but we will utilise the KEMH policy for 'unplanned' waterbirths. However we are still wondering when the powers that be will actually risk letting our labouring women get into the bath. It's been sitting there unused for some months now!! Merry Christmas to you too, and to all on the list Sue - Original Message - From: Mary Murphy mailto:[EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, December 21, 2006 8:33 PM Subject: [ozmidwifery] waterbirth Thank you all for your swift replies. I am supporting midwife who, as a midwife in homebirth, did lots of water births and was recently present at a water birth in a hospital where SHE supported the midwife who supported a woman's wishes for a water birth. As we have only 'accidental' water birth policies in WA hospitals, these midwives are being 'hauled over the coals' for not making the woman get out of the water to birth. Lots of intimidation going on. This will all help. Thanks and Merry Christmas, Mary M _ Internal Virus Database is out-of-date. Checked by AVG Free Edition. Version: 7.5.432 / Virus Database: 268.15.15/581 - Release Date: 9/12/2006 3:41 PM _ Internal Virus Database is out-of-date. Checked by AVG Free Edition. Version: 7.5.432 / Virus Database: 268.15.15/581 - Release Date: 9/12/2006 3:41 PM
[ozmidwifery] waterbirth
Thank you all for your swift replies. I am supporting midwife who, as a midwife in homebirth, did lots of water births and was recently present at a water birth in a hospital where SHE supported the midwife who supported a woman's wishes for a water birth. As we have only 'accidental' water birth policies in WA hospitals, these midwives are being 'hauled over the coals' for not making the woman get out of the water to birth. Lots of intimidation going on. This will all help. Thanks and Merry Christmas, Mary M
[ozmidwifery] waterbirth
Hi everyone, I know this question has been asked before, but I can't remember the answer. Do we have any maternity units, birth centres etc who officially do waterbirth? I know homebirthers do, but I want to know about institutions. Thanks, MM
[ozmidwifery] midwife wanted
Are there any independent practicing midwives in the Sunshine Coast ..Noosa? MM
RE: [ozmidwifery] midwife wanted
Yes please Ramona. MM
[ozmidwifery] Quote of the week
This has my heartfelt endorsement. MM My involvement with midwifery has been the very best life I could have. I feel I have been living on sacred ground.- Jan Tritten
[ozmidwifery] testing
Haven't had an email for a while.. am I on? MM
[ozmidwifery] testing
Just testing. No mail for nearly a week. MM
RE: [ozmidwifery] Australian Birth Post-Natal Services Conference 2007
In which state and what date is this being held? MM
[ozmidwifery] homebirth costs.
I'm not questioning the value of midwifery care, more why Sydney midwifery care is so much more 'valuable' in the dollars and sense kind of way? Something that hasn't been mentioned is the lack of professional indemnity insurance for midwives. Midwives put their life and all their goods and chattels on the line every time they care for a woman. We are lucky in WA that the Gov. took heed of the continuous lobbying over about 10yrs and let us have a free homebirth program. We struggle to keep it. Midwives are indemnified by the Govt insurance, but at the cost of more bureaucracy and restricted options. I am not complaining, just pointing out some of the difficulties. MM
RE: [ozmidwifery] Cord clamping and waterbirth
Thank you Angela for your thorough reply. I always forget the very detailed anatomy of the circulatory changes and have to look it up and don't keep the right book at home. . I was thinking more of a convincing explanation as to why the blood doesn't run backwards from the baby towards the placenta, which is obviously still filled with blood. This appears to be the worry for the doctor. Doesn't she know the anatomy/physiology of the placenta, or is she just trying to bamboozle the woman? As an aside, I am of the impression that the cord vessels don't have any valves. Is that correct? MM From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Angela Rayner This is easier to follow when looking at a 'circulatory changes at birth' diagram, but I'll try to give a brief summary. Following birth the baby's circulatory system makes major adjustments in order to divert deoxygenated blood to the lungs for re-oxygenation. During fetal life approximately 10% of the cardiac output is circulated to the lungs through the pulmonary artery. With the expansion of the lungs and lowered pulmonary vascular resistance, virtually all of the cardiac output is sent to the lungs. Oxygenated blood returning to the heart from the lungs increases the pressure within the left atrium. At almost the same time, pressure in the right atrium is lowered because blood ceases to flow through the cord. As a result, a functional closure of the foramen ovale is achieved. During the first days of life this closure is reversible. Reopening may occur if pulmonary vascular resistance is high, for example when crying, resulting in transient cyanotic episodes in the baby. The septa completely fuses within the first year of life. The ductus arteriosus, which is nearly as wide as the aorta, provides a significant bypass of the lungs for the fetus. Contraction occurs almost immediately after birth. This is thought to be caused by sensitivity to increased oxygen tension and the reduction in circulating prostaglandin. As a result of altered pressure gradients between the aorta and pulmonary artery, a temporary reverse left to right shunt through the ductus may persist for a few hours although there is usually functional closure of the ductus within 8-10 hours of birth. _ The paediatrician who has never attended a waterbirth before is saying that she would have to clamp right away because if the woman is holding the baby on her chest, the blood can flow back through the cord to the placenta increasing her risk of PPH.
RE: [ozmidwifery] Cord clamping and waterbirth
Lieve writes: Yesterday I attended a waterbirth and the cord continued pulsing another 15 min after the birth of the placenta, 20 min after the birth of the baby. This can occur as a rebound pulse from the baby's heart beat. Obviously it can't be from a placenta pumping more blood to the baby, because there is no mechanism for this to happen. Am I right? MM
RE: [ozmidwifery] Misoprostol the Third stage of Labour
It always amazes me that these trials are on such a small number of women. While they are interesting, surely they are not able to be applied to the wider population of women? MM Results for the intravenous oxytocin (n = 311) and oral misoprostol (n = 311) groups are as follows -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: RE: [ozmidwifery] homebirth costs
How come there is such a big difference? I mean, that is a really BIG difference!! Midwives have always worked altruistically and undervalued their services. It takes an enormous emotional step for midwives to believe they are worth it. If midwives actually ask for this larger payment, would women still want to have their services? And then again midwives want women to be able to afford their services. Women now have an income from the Government that would pay for the midwife, but many parents see this as a payment to relieve the mortgage, clear debt or buy a big TV. It is more complex than just putting up the fees. MM Approx $2000-$2500 here in SA I think, from what I know anyway. Same in WA. MM
RE: [ozmidwifery] Alternative GBS
What about the risk of absorption of chlorhexidine? When the cream was used on newborn babies it was toxic. MM A Danish Obstetrician came to John Hunter Hospital (Newcastle NSW) and presented some time ago on the use of Chlorhexidine douche for women with GBS positive swabs. Very popular in Denmark apparently and is being heralded as the treatment for women in third world countries because it is cheap. The Cochrane review is equivocal in its endorsment, but the Danish Obs was very very convincing with her stats. When Belmont Birthing Service first opened, all the women with GBS positive swabs had to go to John Hunter to give birth because we were not credentialled to give IV antibiotics at Belmont. We are a stand alone midwifery service so do not have doctors onsite for assistance if someone had an anaphylaxis. Many of the women were very upset about not being able to have their babies at Belmont, whilst others were very unhappy about using antibiotics for all the good reasons already mentioned, so remembering the chlorhexidine douche presentation, we were able to provide that as an option for those women who were willing to use that as something that was not considered as effective as antibiotics. We have since done the nurse immunisers course and so are also able to give IV antibiotics at Belmont. Interestingly, most women still choose the douche. We can give the women the equipment to take home and they can douche themselves if they think they are going into labour, or if their membranes release. We give them two doses and they let us know what they are doing. The chlorhexidine is a lovely blue colour, so it is interesting to see women's vaginal discharge after the douche - looks different on the partograph :-) We have a GBS policy for us and an instruction sheet for the women. We also have an information sheet for women to read before they do the swab. If you would like a copy, please email me at work and I can send them to you. [EMAIL PROTECTED] warmly, Carolyn - Original Message - From: Melanie Sommeling [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 10:15 PM Subject: [ozmidwifery] Alternative GBS Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- 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] interesting studies
20061113-87# Acupuncture administered after spontaneous rupture of membranes
at term significantly reduces the length of birth and use of oxytocin. A
randomized controlled trial - Acta Obstetricia et Gynecologica Scandinavica
, vol 85, no 11, 2006, pp 1348-1353 Gaudernack LC; Forbord S; Hole E -
(2006)
Background. The objective was to investigate whether acupuncture could be a
reasonable option for augmentation in labor after spontaneous rupture of
membranes at term and to look for possible effects on the progress of labor.
Methods. In a randomized controlled trial 100 healthy parturients, with
spontaneous rupture of membranes at term, were assigned to receive either
acupuncture or no acupuncture. The main response variables were the duration
of active labor, the amount of oxytocin given, and number of inductions.
Results. Duration of labor was significantly reduced (mean difference 1.7 h,
p=0.03) and there was significant reduction in the need for oxytocin
infusion to augment labor in the study group compared to the control group
(odds ratio 2.0, p=0.018). We also discovered that the participants in the
acupuncture group who needed labor induction had a significantly shorter
duration of active phase than the ones induced in the control group (mean
difference 3.6 h, p=0.002). These findings remained significant also when
multiple regression was performed, controlling for potentially confounding
factors like parity, epidural analgesia, and birth weight. Conclusion.
Acupuncture may be a good alternative or complement to pharmacological
methods in the effort to facilitate birth and provide normal delivery for
women with prelabor rupture of membranes. (17 references) (Author)
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6.
20061116-67* Reducing Cesarean Delivery Rates: An Active Management Labor
Program in a Setting with Limited Resources - Journal of the Medical
Association of Thailand , Vol 88, no 1, January 2005, pp 20-25 Somprasit C;
Tanprasertkul C; Atiwut Kamudhamas - (2005)
Objective: To determine the effect of an active management of a labor
program on the rate of cesarean section and labor outcomes in low-risk
nulliparous pregnancies in a setting with limited resources. Material and
Method: Nine hundred and seventy-five low risk nulliparous pregnant women
were randomized to receive either active management of a labor program (n =
325) or conventional management (n = 650). The rate of cesarean section and
labor outcomes were compared between the two groups using Chi-square and
t-tests. Results: The subjects in the active management program had
significantly shortened first stage of labor and total duration of labor
compared with the conventional group (538.0 + 242.9 min vs 589.4 + 263.8
min, p 0.05, 539.3 + 261.4 min vs 610.3 + 264.4 min, p 0.001,
respectively). There was no statistical difference found in the rate of
cesarean section and other labor outcomes. Conclusion: The active management
program shortened the first stage and duration of labor in low-risk
nulliparous pregnant women. (The full text is available at:
http://www.medassocthai.org/journal/files/Vol88_No1_20.pdf) (22 references)
(Author)
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[ozmidwifery] PPH
20061113-80# Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergo metrine in the management of the thirs stage of labor - Acta Obstetricia et Gynecologica Scandinavica , vol 85, no 11, 2006, pp 1310-1314 Fujimoto M; Takeuchi K; Sugimoto M; et al - (2006) Objectives. To determine the efficacy of intravenous oxytocin administration compared with intravenous methylergometrine administration for the prevention of postpartum hemorrhage (PPH), and the significance of administration at the end of the second stage of labor compared with that after the third stage. Methods. A prospective study was undertaken: two major groups (oxytocin group and methylergometrine group) of 438 women with singleton pregnancy and vaginal delivery were studied during a 15-month period. These two groups were subdivided into three subgroups: 1. intravenous injection (two minutes) group immediately after the delivery of the fetal anterior shoulder, 2. intravenous injection (two minutes) group immediately after the delivery of the placenta, and 3. drip infusion (20 min) group immediately after the delivery of the fetal head. In each group, quantitative postpartum blood loss, frequencies of blood loss 500 ml, and need of additional uterotonic treatment were evaluated. Results. As compared with methylergometrine, oxytocin administration was associated with a significant reduction in postpartum blood loss and in frequency of blood loss 500 ml. The risk of PPH was significantly reduced with intravenous injection of oxytocin after delivery of the fetal anterior shoulder, compared with intravenous injection of oxytocin after expulsion of the placenta (OR 0.33, 95%CI 0.11-0.98) and intravenous injection of methylergometrine after delivery of the fetal anterior shoulder (OR 0.31, 95%CI 0.11-0.85). Conclusions. Intravenous injection of 5 IU oxytocin immediately after delivery of fetal anterior shoulder is the treatment of choice for prevention of PPH in patients with natural course of labor. (6 references) (Author)
[ozmidwifery] Blood gasses
20061113-79# The effects of time on pH and gas values in the blood contained in the umbilical cord - Acta Obstetricia et Gynecologica Scandinavica , vol 85, no 11, 2006, pp 1307-1309 Valenzuela P; Guijarro R - (2006) Background. The pH and gas analysis of umbilical cord blood is an accepted practice in most maternity hospitals. The data that is obtained after a latency period in processing the cord blood samples is evaluated to determine whether it is useful for the clinic. Methods. The umbilical cords from 50 term infants were clamped immediately after delivery. Samples of artery and vein blood were drawn 5, 60, and 120 min postpartum and pH, pO2, and pCO2 levels were measured. Results.No significant differences were found after 60 min in the average values for pH in the arterial and venous paired samples, though the arterial and venous pCO2 values declined significantly. The arterial pO2 values increased significantly. After 120 min, no significant differences in the average values for the venous pH and pO2 paired samples were found. The arterial pH values increased significantly, however, and the arterial and venous pCO2 values declined significantly. The arterial pO2 values increased significantly. Conclusions. Though statistically significant differences occurred over time, these changes were so modest clinically that the data could still be used even when an immediate analysis of the umbilical cord was not possible. (12 references) (Author)
[ozmidwifery] placental abruption
Guess who is on the browser? MM Prepregnancy risk factors for placental abruption Minna Tikkanen A1, Mika Nuutila A1, Vilho Hiilesmaa A1, Jorma Paavonen A1, Olavi Ylikorkala A1 A1 Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland Abstract: Background. To define the prepregnancy risk factors for placental abruption. Methods. One hundred and ninety-eight women with placental abruption and 396 control women without placental abruption were retrospectively identified among 46,742 women who delivered at a tertiary referral university hospital between 1997 and 2001. Relevant historical and clinical variables were compared between the groups. Multivariate logistic regression analysis was applied to identify independent risk factors. Results. The overall incidence of placental abruption was 0.42%. Placental abruption recurred in 8.8% of the cases. The independent risk factors were smoking (OR 1.7; 95% CI 1.1, 2.7), uterine malformation (OR 8.1; 1.7, 40), previous cesarean section (OR 1.7; 1.1, 2.8), and history of placental abruption (OR 4.5; 1.1, 18). Conclusions. Although univariate analysis identified many risk factors, only smoking, uterine malformation, previous cesarean section, and history of placental abruption remained significant after multivariate analysis, increasing the risk of placental abruption in subsequent pregnancy. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors. _ Keywords: Placental abruption, placenta, risk factors
[ozmidwifery] ask for 2nd opinion
Journal of Obstetrics Gynaecology Publisher: Taylor Francis Issue: Volume 25, Number 2 / February 2005 Pages: 115 - 116 URL: Linking http://journalsonline.tandf.co.uk/%28a0anjt55lj5eqq45gdgc4dfy%29/app/home/l inking.asp?referrer=linkingtarget=contributionid=K314384NL611LM79backto=c ontribution,1,1;issue,3,47;journal,15,75;linkingpublicationresults,1:100389, 1; Options DOI: 10.1080/01443610500040547 Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment KS Oláh Department of Obstetrics and Gynaecology, Warwick Hospital, Lakin Road, Warwick, CV34 6BW, UK Abstract: During a 5-year period there were 32 cases where the vaginal assessment performed by a specialist registrar in the second stage of labour was re-assessed within 15 minutes by a consultant obstetrician. The examination was prompted by a request for permission to perform a caesarean section in the second stage of labour. The results suggest a significant discrepancy between the consultants and the specialist registrar's findings, with 44% of the cases indicating a difference in the position of the head, and 81% a difference in the station of the head. No comment was made about caput or moulding in the majority of cases (94%). The study findings suggest that vaginal examination, like instrumental delivery, is a skill that is being eroded and will require formal instruction to address this problem.
[ozmidwifery] GBS
Journal of Obstetrics Gynaecology Publisher: Taylor Francis Issue: Volume 25, Number 5 / July 2005 Pages: 462 - 464 URL: Linking http://journalsonline.tandf.co.uk/%28a0anjt55lj5eqq45gdgc4dfy%29/app/home/linking.asp?referrer=linkingtarget=contributionid=M7633N7UV3130772backto=contribution,1,1;issue,11,42;journal,12,75;linkingpublicationresults,1:100389,1; Options DOI: 10.1080/01443610500160261 Group B streptococcus disease in neonates: To screen or not to screen? O. Subair A1, P. Wagner , F. Omojole , H. Morgan A Department of Obstetrics and Gynaecology, Whittington Hospital, London, UK Abstract: Summary An audit was undertaken of the prevention of early-onset Group B streptococcus (EOGBS) disease in neonates. The prevention strategy in use involved offering Intra-partum Antibiotic Prophylaxis (IAP) to mothers with identified risk factors, which include maternal fever in labour gt; 38°C, previous baby with GBS disease, prolonged rupture of membranes gt; 18 h, pre-term labour, GBS urinary tract infection and known GBS carriage. The most common risk factor identified was GBS carriage (41%) which was known ante-partum but logistical problems prevented these mothers from receiving adequate prophylaxis 4 h before delivery and so were classified as at risk of GBS disease. We found an incidence of GBS in our unit of 0.55 per 1,000 births over the study period. One neonate developed EOGBS disease and the mother had no identifiable risk factor ante-partum/intra-partum. Recent recommendations from the Royal College of Obstetricians and Gynaecologists (RCOG) could reduce the number of babies having sepsis screens performed as the time interval from beginning IAP to delivery has been shortened to 2 h and routine surface cultures or blood cultures are not recommended in well newborns. The evidence is lacking at this point to recommend universal screening for GBS in all pregnant women but patients are increasingly aware of this option and may request anogenital swabs to assess GBS carriage.
RE: [ozmidwifery] getting synto etc
Drs refuse to write the script on the excuse that they will not be there when it is given and they can't take responsibility for the use of the drug. I know this sounds like a stupid reason, but their insurer's say they cannot prescribe it if they are not procedural obstetric GPs. MM I would be concerned at the legality of them being able to refuse the request for the script. Homebirth isn't illegal but what if a woman did die at home because the doc refused the prescription? From: Mary Murphy mailto:[EMAIL PROTECTED] Andrea, it is my understanding that one still has to have a Dr's order (e.g. prescription) before a midwife can actually give the drug. Prior to the CMP being under the umbrella of the State Health Dept, WA metro midwives had to get the woman to get a script from their doctor for synto, Vit K and xylocine 1% for suturing. There are few doctors who will actually do this. Strange, they say you might bleed to death at home but won't give any help in preventing this scenario. Good luck, MM _
RE: [ozmidwifery] Cord clamping and waterbirth
I have never heard of this theory. What about all the babies who are born on the bed and the mother holds the baby on her chest before the cord is clamped. I think a lesson in anatomy and physiology is called for. Anyone out there who can explain it in detail? MM _ The paediatrician who has never attended a waterbirth before is saying that she would have to clamp right away because if the woman is holding the baby on her chest, the blood can flow back through the cord to the placenta increasing her risk of PPH.
RE: [ozmidwifery] getting synto etc
Lisa, Misoprostal for PPH is used on a regular basis at our tertiary hospital. I had a client who planned to go home 4hrs after the birth of twins and the staff gave her Miso about an hour after the birth..she was not hemorrhaging, it was given in case. It is also available to the CMP homebirth midwives if needed. It would only be used as an emergency drug during a transfer to hospital for a severe PPH. Not been needed so far thank goodness. It is used in hospitals much more extensively than one thinks. It is de-facto legal; frequent effective use in the same situation makes it so. Dont know what a court would make of it tho. MM misoprostal isn't licenced here is Australia. I wouldn't be prescribing it if I were a GP. When I was Working at a private Hospital the Obs kept it in their own possesion. It isn't licenced to be kept at the hospital as far as I know. The pharmacy at the hospital wouldn't touch it. It's not the sort of drug you should have at a homebirth anyway. Lisa Barrett
RE: [ozmidwifery] homebirth costs
Same in WA. MM Approx $2000-$2500 here in SA I think, from what I know anyway From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of diane Sent: Wednesday, 15 November 2006 4:51 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] homebirth costs Wow thats a significant difference between NSW and Vic, what about elsewhere?? Cheers, Di -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.5/534 - Release Date: 14/11/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.5/534 - Release Date: 14/11/2006
RE: [ozmidwifery] hanging baby scales
Sonja wroteI now have a beautiful digital set with a lovely purple sling to hang the babies in. Please tell us more. Like Where did you get them, how much do they cost, to what weight do they measure, what brand are they? Thanks, MM
RE: [ozmidwifery] getting synto etc
Andrea, it is my understanding that one still has to have a Drs order (e.g. prescription) before a midwife can actually give the drug. Prior to the CMP being under the umbrella of the State Health Dept, WA metro midwives had to get the woman to get a script from their doctor for synto, Vit K and xylocine 1% for suturing. There are few doctors who will actually do this. Strange, they say you might bleed to death at home but wont give any help in preventing this scenario. Good luck, MM From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Andrea Quanchi Sent: Wednesday, 15 November 2006 2:29 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc you can purchase syntocinon at www.livingstone.com.au Andrea Q On 14/11/2006, at 9:13 PM, cath nolan wrote: I have a few births at home coming up and was wondering about synto and other drugs in my kit. How do others purchase them? Do I have to have a script from a doctor? The other issue that I do find difficult is the issue of cost for homebirth.Others I have been involved in have been for friends and colleagues. Does anyone have a schedule of payment and cost that they use? I am meeting with a couple on Monday and would love to have a bit more idea. Any feedback will be greatly appreciated, Thanks Cath
[ozmidwifery] lotus placenta
Hello wise women, I need advice about a lotus birth, (not new to me) who is also Rh neg. I need to get enough blood for group and coombes. In your experience, is there sufficient blood in the placental vessels after a physiological 3rd stge ? What is the best way to hndle this? I have had lots of Lotus Placentae but not with RH neg. women. Thanks, MM
RE: [ozmidwifery] lotus placenta
Thanks everyone for your replies. I am now confident I can get the sample I need . MM Hi Mary, There is always plenty of blood in placental veins - even a fair while after the birth. I remember one time I was collecting blood for a homeopathic preparation and got to it about an hour after the birth - still easy to get the blood. Always makes me aware of blood exchanges occurring bt baby and delivered placentas whilst cord still intact. So I just wipe the cord over a good vein and insert needle - can take it from a few veins if necessary. Sometimes it leaks a bit from the vein afterwards - I don't jump in to it - probably 20 mins or so after placenta is delivered. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Call to action
Minister for Health Contact Us Home 8 November 2006 Input invited on the future direction of maternity care in WA The introduction of local midwifery practices and family birth centres are just two of the new ideas put forward in a discussion paper about the future of maternity care in Western Australia. Director General of Health Dr Neale Fong said these services would allow women to access a wider choice of options for safe maternity care and would build on the excellent services already available in this State. I encourage the community and health professionals to have their say on this discussion paper to ensure that people involved in receiving and delivering maternity care help set the direction, he said. The views collected from this phase of consultation, together with international and national best practice and evidence-based research, will form the basis of a new maternity care policy, which will be available for comment next year. Dr Fong said this multi-phased consultation approach had been adopted so that as many people as possible had the opportunity to be involved and give their views. Dr Fong said information was sought on the following questions: Do you think the proposed options will help women become more involved in their maternity care? Do you have any comments on how the future could look as described in the discussion paper? If the options suggested in the discussion paper were available, would you use them? What other maternity options should be offered? What other health reform strategies need to be integrated with maternity care when formulating state policy? What other issues would you like to raise in regard to providing public maternity care in WA? The public has until 31 December to comment on the discussion paper that was written in consultation with health professionals and the Health Consumers Council as part of the Future Direction in Maternity Care Consultation. Copies of the discussion paper can be obtained on the website http://www.clinicalnetworks.health.wa.gov.au. Responses should be sent to: Future Directions of Maternity Care Consultation Department of Health Clinical Network Support Unit Reply Paid 80686, Locked Bag 59 Perth BC WA 6849 Or Email: healthpolicy@health.wa.gov.au Actually the web address is http://www.clinicalnetworks.health.wa.gov.au/maternitycare/index.cfm
[ozmidwifery] testing
No mail for days. Is it just quiet? MM
RE: [ozmidwifery] Fully dilated no urge to push
Did the woman have an epidural in? MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Philippa Scott Sent: Thursday, 2 November 2006 9:03 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Fully dilated no urge to push Hi Wise Midwives and others, I have a question. I attended a birth on Monday of a primip who was fully dilated after 10 hours of mostly 4/10 contractions. Waters broke 15 minutes after VE and then she continued with 4/10. This kept up for about 3.5hrs before Dr felt she should start pushing anyway as she was now experiencing prolonged 2nd stage. (Dr words) The Mum had had hip problems during pg and OP baby but at fully baby was LOA but ascinclitic (SP?) and slightly deflexed) We tried numerous things in those couple of hours to help baby straighten up but did not happen. She pushed then with no urge in a supported kneel for about 1.5 hours and could get head to on view but not around the bend. Dr VEd again said baby has not moved at all, but said there appeared to be sufficient space etc and accepted MW was seeing head with each push. A vacuum was used to straighten baby and then Mum virtually did the work. As it happens after baby was born it was discovered in theatre that she had Placenta accrete but that is another story. So my question is if fully and no urge why does uterus continue to contract? And does any of this really make sense? Thank you all, Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville
[ozmidwifery] quote
Our midwifery is often closely wrapped up in our identities partly because we are called to the path that requires all of the love we have to give, then a little more. Jan Tritten, Mother of Midwifery Today .
[ozmidwifery] Blood gasses( Long)
This Technical report covers fetal monitoring in a really comprehensive way. www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.700 Re blood gases, I promise not to bother you again, but still having difficulties finding recent studies. This first one appears to explain the process and meanings better than any other I have read. I excerpted some interesting points from the articles I read. MM 1. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 101:1054-1063, 1994 Umbilical Cord Blood Gas Analysis at Delivery: A Time for Quality Data. Jennifer A. Westgate, Jonathan M. Garibaldi, Keith R. Greene 2, Postpartum Determination of Umbilical Artery Blood Gases: Effect of Time and Temperature Moshe Manor, Isaac Blicksteina, Ynon Hazan, Orna Flidel-Rimon1, and Zion J. Hagay 1 Depts. of Obstet. and Gynecol. and Neonatol., Kaplan Hosp., 76100 Rehovot, Israel (affiliated with Hadassah-Hebrew Univ. School of Med., Jerusalem); a author for correspondence: fax 972-8-9411944, e-mail [EMAIL PROTECTED] Determination of cord blood gases and pH is recommended in all neonates with low Apgar scores to distinguish metabolic acidosis from hypoxemia or from other causes that might result in low Apgar scores (1). Although the metabolic acidosis found in cord blood is a poor predictor of long-term neurological injury (2), assessment of umbilical cord blood gas is helpful to exclude intrapartum or birth events that cause acidosis and serves as legal evidence against any alleged association with poor outcome (3). 3. Obstet Gynecol Clin North Am. 1999 Dec;26(4):695-709. Related Articles, Links Umbilical cord blood gas analysis. Thorp JA, Rushing RS. St. Luke's Hospital of Kansas City, Missouri, USA. Umbilical cord blood gas and pH values should always be obtained in the high-risk delivery and whenever newborn depression occurs. This practice is important because umbilical cord blood gas analysis may assist with clinical management and excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. The most useful umbilical cord blood parameter is arterial pH. Sampling umbilical venous blood alone is not recommended because arterial blood is more representative of the fetal metabolic condition and because arterial acidemia may occur with a normal venous pH. A complete blood gas analysis may provide important information regarding the type and cause of acidemia and sampling the artery and vein may provide a more clear assessment. The sampling technique is simple and easily mastered by any treatment person in the delivery room. Preheparinized syringes ensure a consistent dose and amount of heparin. Depending on how normality is defined and on the population studied, normal ranges for umbilical cord blood gas values vary (see Table 1). In general, the lower range for normal arterial pH extends to at least 7.10 and that for venous pH to at least 7.20. Many different factors during pregnancy, labor, and delivery can affect cord blood gases. Umbilical blood sampling for acid-base status at all deliveries cannot be universally recommended because many facilities do not have the capabilities to support such a practice and in doing so may impose an excessive financial burden. Considering the costs, the accumulated published data, and the nonspecificity of electronic fetal monitoring in the evaluation of fetal oxygenation, it may be more rational to implement universal cord blood gas analysis. Care providers and institutions with the logistical capabilities in place should consider the cost efficacy of routine cord blood gas analysis because it is the gold standard assessment of uteroplacental function and fetal oxygenation/acid-base status at birth. 4. Umbilical Cord Blood Gas Analysis at Delivery S F Loh, A Woodworth, G S H Yeo (research carried out in 1994. MM) Umbilical cord blood gas values reflect the last moment of fetal oxygenation and acid base balance prior to delivery. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological develop In acute hypoxic insult of short duration, fetal and placental blood may not have sufficient time to equilibrate and this may be reflected in a large arterial-venous difference in BDecf. However, in long-standing hypoxic insult, lactic acid produced by the baby was given time to be removed across the placenta to saturate the placental extracellular fluid compartment. In conclusion, we are sure that umbilical cord blood gas analysis is useful to ascertain whether a particular case of fetal compromise is due to perinatal asphyxia. Selectively paired umbilical cord blood gas analysis, when properly done and correctly interpreted offers insight into metabolic events occurring in the perinatal period and enables the obstetricians to learn from individual patient. It also provides the neonatologists with a baseline of the neonates metabolic condition. A
RE: [ozmidwifery] Rest phase before 2nd stage
I think this was a recent discussion? I have seen if often enough to recognize it as a normal part of labour. some women need 10 mins, some 2 hrs and even longer. It is all about being aware and alert to the woman and babys condition. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Kristin Beckedahl Sent: Sunday, 22 October 2006 9:51 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Rest phase before 2nd stage I know this was recently discussed on the list - but I was wondering how long you lovely midwives haveseen this occur for within a natural labour? I remembermine lasting about 10mins (enough time to get out of the car - nota great place to do transition! - and into BC) What is considered too long? 2 hours? What are the 'typical time limits' - when would risk factors be considered? Thanks, Kristin Research and compare new cars side by side at carpoint.com.au -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
RE: [ozmidwifery] Breastfeeding Calendar
Isnt junes baby just the most perfect attachment? Good for showing women what they are aiming for. MM The Australian Breastfeeding Association's 2007 Calendar is now available. May I go so far as to say it's the best EVER! Gorgeous photos. Perfect for promoting breastfeeding on any hospital wall. Perfect for your own home. Perfect for Christmas. Only $15 plus postage. Purchase from http://www.mothersdirect.com.au/ Regards, Barb Glare Mum of Zac, 12, Daniel, 10, Cassie 7 Guan 3 Counsellor, Warrnambool Vic [EMAIL PROTECTED] ** Ph (03) 5565 8602 Director, Australian Breastfeeding Association Mothers Direct www.mothersdirect.com.au
[ozmidwifery] CTG
This is the most recent review of the value of CTG. It is convincing and has the power of numbers, but no one take any notice of it. MM Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Alfirevic Z, Devane D, Gyte GML This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X). The Cochrane Database of Systematic Reviews 2006 Issue 3 Copyright 2006 The Cochrane Collaboration. Published by John Wiley Sons, Ltd. Plain language summary: Authors' conclusions Continuous cardiotocography during labour is associated with a reduction in neonatal seizures, but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography was associated with an increase in caesarean sections and instrumental vaginal births. The real challenge is how best to convey this uncertainty to women to enable them to make an informed choice without compromising the normality of labour.
RE: [ozmidwifery] cord blood gases
One problem with this research is the date. 1994. I am sure that it would not be viewed as valid for the battle we have with those in favour. Has anyone got anything really recent with sufficient power to be convincing? MM Thanks Lisa will start wading in the next few days. All these comments on the cord gases show we have a lot of knowledge, ideas and principles but we need to get organized and work together to implement sensible ideas practices and not all work on our own and not achieving anything. Christine blood gases Chritine, I think you'll find if you read the piece on the taking of gases has all the information in it. Including the fact that they think a larger study should be done as aciodois of 7.05 has no long term effects. It is worth wading through the whole thing. http://www.cs.nott.ac.uk/~jmg/papers/brjog-94.pdf Lisa Barrett . -- -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] cord blood gases
Has something significant changed in the last 12 years then Mary? Lisa, the usual window, especially when technology and machines is concerned is 5 yrs. Sometimes older research is used when there are multiple research papers over a long period of time, like in newborn jaundice. What you could do Mary is ask them what research they are using to back up the use of cord gases and see how long ago that was produced. I have never collected a cord sample for gasses as I only practice in homebirth. I guess we could look up the protocols for taking the cord blood and see what the references. Could someone who works in a hospital do that for us please? MM
RE: [ozmidwifery] cord blood gases
I work with the community Midwifery Program in Perth. Up until feb this year I also took private clients. MM Do you mind me asking Mary, do you work in the government scheme in Perth or are you independent? Lisa Barrett
[ozmidwifery] risk
A difficult subject with thousands of references. No wonder we are all confused. The reference below is interesting. MM The cardinal rule of risk communication is the same as that for emergency medicine: first do no harm. BMJ2003;327:725-728(27September), doi:10.1136/bmj.327.7417.725 Education and debate Communication and miscommunication of risk: understanding UK parents' attitudes to combined MMR vaccination Paul Bellaby, director1
RE: [ozmidwifery] risk
Off the top of my head and without philosophical musings, I read thousands of words in dozens of references (just try googling health risk management) and this was the only thing I saw about doing no harm to the patient. Most of it was all about being blamed for harm that might be done and how to minimize being taken to the cleaners. It was not contained in the body of the quoted article by paul bellarmy whose article is interesting. I forget which one it was in, but could probably find it again if needed. Thanks for the compliment. MM What strikes you as particularly interesting about that Mary? I'm very interested in your perspective as you are one of the wisest women I know. warmly, Carolyn
RE: [ozmidwifery] risk
Visit BMJ2003;327:745-748(27September), doi:10.1136/bmj.327.7417.745 Strategies to help patients understand risks. J Paling. I have found his Palings Perspective Scale and P P Palette very useful in explaining the degree of risk to women re screening tests and possible outcomes of various actions. MM Off the top of my head and without philosophical musings, I read thousands of words in dozens of references (just try googling health risk management) and this was the only thing I saw about doing no harm to the patient. Most of it was all about being blamed for harm that might be done and how to minimize being taken to the cleaners. It was not contained in the body of the quoted article by paul bellarmy whose article is interesting. I forget which one it was in, but could probably find it again if needed. Thanks for the compliment. MM What strikes you as particularly interesting about that Mary? I'm very interested in your perspective as you are one of the wisest women I know. warmly, Carolyn
[ozmidwifery] doubles
I am receiving 2 of everyones emails. Is this happening to others or just me? MM
RE: [ozmidwifery] doubles
Oh oh, it doesnt sound good. It is up to 5 now. Ill have to get it checked. Thanks, MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Jo Watson Sent: Saturday, 14 October 2006 4:40 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] doubles Just singles here, Mary. Hope you're well :) xx Jo On 14/10/2006, at 4:16 PM, Mary Murphy wrote: I am receiving 2 of everyones emails. Is this happening to others or just me? MM
RE: [ozmidwifery] cord blood gases
It is a CYA measure. Not evidence based care for the benefit of babies or mothers. MM -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Sadie Sent: Friday, 13 October 2006 4:25 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Cord blood gases are routine for every birth at KEMH, Perth :( Sadie - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 4:07 PM Subject: [ozmidwifery] cord blood gases Hi all, Just wondering how common it is for cord blood gases to be done in maternity units. I work in a small metro. hospital with a very busy maternity unit and our medical 'powers that be' are pushing for them to be done at every birth. Something we, the midwives, are very, very reluctant to do. I was also wondering if anyone knows of any research that may help us to prevent this from becoming a routine thing. Thanks Naomi. -- 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] cord blood gases
The problem with all of this is that the low apgars and low cord blood gasses dont really help much. There are babies that have terrible results and grow up fine and babies whos results are only slightly low who have developmental problems. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Briege Lagan Sent: Friday, 13 October 2006 5:12 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Naomi In units where I work within Northern Ireland,cordblood gases are only done if Emergency caesarean section is performed Instrumental vaginal delivery is performed A fetal blood sample has been performed in labour Birth, if the babys condition at birth is poor These are the recommendations from The Use of Electronic Fetal Monitoring. National Institute for Clinical Excellence. May 2001 http://www.nice.org.uk/page.aspx?o=guidelineC Other articles which may be of interest to you are: The merit of routine cord blood pH measurement at birth http://www.atypon-link.com/WDG/doi/pdf/10.1515/JPM.1999.021 Umbilical cord pH and risk factors for acidaemia in neonates in Kerman http://www.emro.who.int/Publications/Emhj/1101_2/PDF/13%20Umbilical%20cord%20blood.pdf Umbilical cord blood sampling and expert data care http://www.k2ms.com/support/Documents/K2EDCPD.pdf Hope this helps Briege Briege Lagan PhD Student/Clinical Midwife Specialist University of Ulster Northern Ireland Naomi Wilkin [EMAIL PROTECTED] wrote: Hi all, Just wondering how common it is for cord blood gases to be done in maternity units. I work in a small metro. hospital with a very busy maternity unit and our medical 'powers that be' are pushing for them to be done at every birth. Something we, the midwives, are very, very reluctant to do. I was also wondering if anyone knows of any research that may help us to prevent this from becoming a routine thing. Thanks Naomi. -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe. Send instant messages to your online friends http://uk.messenger.yahoo.com
[ozmidwifery] Interesting article
British Journal oi Obstetrics and Gynaecology April 1993, Vol. 100, pp. 303-306 COMMENTARIES In Australia, approximately 50% of women carry some form of private health insurance for childbirth, with some variation between States. This gives them access to an obstetrician of their choice and to either private hospital accommodation or to a private bed in a public hospital as an intermediate patient. The obstetrician (or in a rural setting, a general practitioner/obstetrician) is remunerated on a fee-for-service basis by the Federal Government, receiving a global schedule fee for obstetric care regardless of complications of pregnancy or the type of delivery. The obstetric specialists fee currently amounts to $AU600. The patient is responsible for meeting any difference between the private obstetricians fee and the schedule fee. This extra fee varies between obstetricians and may be as high as an extra $AU600 but on average is an extra $AU110 (Deeble 1991). The average fee-forservice payment to private obstetricians and gynaecologists in Australia in 1991 was $AU291 600 which does not include income from extra billing (OReilly 1992). The other 50% of Australian women who do not carry private health insurance have their medical and hospital charges covered by a compulsory levy applied to all income earning Australians (1.25% of gross salary); there are no direct charges for public health services. This gives obstetric patients access to a public hospital where care is provided by salaried doctors and midwives. Almost no private obstetric hospitals in Australia produce annual clinical reports and most mixed hospitals produce information in which public and private data are combined. However, in those hospitals from which data are available an approximate doubling of caesarean section and instrumental delivery rates is seen for private births compared to public births with caesarean section rates for private patients often in the range of 30 to 35%. A similar doubling of intervention rates for private patients has been observed in the United Kingdom with 10.4% caesarean section rates for NHS patients compared to 22.5% for patients in pay beds (Macfarlane 1988). It is probable that these higher intervention rates are not due to the biological or medical differences between private and public obstetric patients. If anything, private patients are, in general, better nourished, better educated and better prepared for birth; they might be expected to require (and wish for) less intervention in childbirth. Not surprisingly, there is no evidence to show that these higher intervention rates confer any improvement in outcome for the mother or her baby (Cary 1990). When testing the strength of an association between two variables, a doselresponse relationship increases the likelihood of a causal effect. The data from Australia and the USA indicate such a dose/response relationship in the association of private insurance and high intervention Obstetric intervention and the economic imperative
[ozmidwifery] interesting article 2
CLINICAL OPINION American Journal of Obstetrics and Gynecology (2006) 194, 9326 Myth of the ideal cesarean section rate: Commentary and historic perspective Ronald M. Cyr, MD* Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI Received for publication July 10, 2005; revised September 12, 2005; accepted October 8, 2005 KEY WORDS Cesarean section rate Myth History of cesarean section John Whitridge Williams Evidence-based medicine Attempts to define, or enforce, an ideal cesarean section rate are futile, and should be abandoned. The cesarean rate is a consequence of individual value-laden clinical decisions, and is not amenable to the methods of evidence-based medicine. The influence of academic authority figures on the cesarean rate in the US is placed in historic context. Like other population health indices, the cesarean section rate is an indirect result of American public policy during the last century. Without major changes in the way health and maternity care are delivered in the US, the rate will continue to increase without improving population outcomes. _ 2006 Mosby, Inc. All rights reserved. Since the earliest days of the modern cesarean sectiondthe 1880sdthere has raged within the profession a debate about the appropriate indications for this operation.1,2 For several decades after the availability of antibiotics and blood banking, the cesarean section rate in the US remained in the 4% to 6% range. Between 1968 and 1978, the rate tripled to 15.2%, and discussion of cesarean section moved permanently into the public domain. A 1981 report commissioned by the National Institutes of Health (NIH) expressed concern about the rising rate, and its recommendations for reducing cesareans included qualified support for VBAC.3 By the 1990s, individual hospital cesarean section and VBAC rates were being published, and interpreted by consumer groups as indicators of obstetric care quality. In 1991, the Healthy People 2000 initiative advocated a 15% cesarean rate as a US health promotion objective by the year 2000.4 Despite expert and lay opinion that many cesareans are unnecessary, the rate continues to increase in the USdexceeding 27% in 2004dand shows no sign of abating.5,6 Indeed, there is growing discussion and acceptance of patient-choice cesarean section as a legitimate birth option.7,8 A recent editorial opined that Its time to target a new cesarean delivery rate.9 It is the premise of this essay that attempts to define, or enforce, an ideal cesarean section rate are futile, and should be abandoned. It will be argued that the cesarean rate is a consequence of individual value-laden clinical decisions, and that it is not amenable to the methods of evidence-based medicine. The influence of academic authority figures on the cesarean rate in the US will be placed in historic context. Like other population health indices, the cesarean section rate is an indirect result of American public policy during the last century. Without Dr Cyr is the 2003 ACOG/ORTHO-McNEIL Fellow in the History of American Obstetrics and Gynecology. * Reprint requests: Ronald M. Cyr, MD, Department of Obstetrics and Gynecology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0276. E-mail: [EMAIL PROTECTED] 0002-9378/$ - see front matter _ 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2005.10.199
[ozmidwifery] WV Based med rejected
This is part of the text of the last article. Isnt it amazing that individualization is O.K for obstetricians, but not for women wanting normal births? MM The recent emphasis on evidence-based medicine has tended to overshadow the need for individualization in obstetrics. RCTs provide information about populations, but cannot replace clinical judgment. Even if it is true, for example, that cesarean section is generally safer for babies in breech presentation, neither mother nor child would be well served by emergency surgery performed when the breech is on the perineum. Although RCTs provide the highest level of evidence, their external validity is often limited by small sample size and the recruitment biases inherent to the research process. Furthermore, investigators are not a random sample of providers. In the statistical spirit of our time, it is probably fair to say that clinical judgment and technical ability are normally distributed within the profession. These attributes are not often equally developed in the same individual, nor is there any evidence that academic achievement correlates positively with clinical excellence. In light of such confounding factors, it is prudent to maintain a degree of skepticism about the conclusions of any study. The future of cesarean section .we have all regretted that we have not done a cesarean in certain cases, but I have yet to regret one that I have done.23 Few obstetricians would disagree with this sentiment, expressed by a prominent New York obstetrician in 1920. Given this attitude, is there an upper limit to the cesarean rate? As the obstetric population becomes older, heavier, and increasingly primiparous, the cesarean rate in the US will continue to rise. This trend will be accentuated by the reluctance, or inability, of obstetricians to perform 934 Cyr
RE: [ozmidwifery] asthma in labour
Yes, it has been used in a different delivery method, but definitely has been and probably still is, for calming contractions. I am sure some one who is familiar with it will reply. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Janet Fraser Sent: Thursday, 12 October 2006 6:29 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] asthma in labour Hi all, can bronchodilators, particularly ventolin, for severe asthmacause labour to slow or stall? Would it's action of relaxing smooth muscle have this effect on the uterus or is an inhaled drug (even in strong doses) too little entering the bloodstream for an effect? TIA. J For home birth information go to: Joyous Birth Australian home birth network and forums. http://www.joyousbirth.info/ Or email: [EMAIL PROTECTED]
RE: [ozmidwifery] Fwd: term breech trial
Title: Re: [ozmidwifery] Fwd: term breech trial When else would we allow a supposedly expert practitioner to say we dont have the skillsand we are unwilling to develop them so that women can feel confident in our care.? How about a midwife who says, Oh no, I dont have the necessary midwifery skills to look after you in a holistic way, and Im not interested in learning either. It is outrageous!!. MM Also the Ob's when questioned have been using that as the excuse-lack of skill- for not supportive vaginal breech when asked about it by the women.
[ozmidwifery] quote
Quote of the Week: One of the most natural remedies I know of is grown and cultivated in the human spirit. It is the healing art of listening. Alison Parra Bastien
RE: [ozmidwifery] term breech trial - ECV option
Title: Re: [ozmidwifery] Fwd: term breech trial Lisa, could you describe this for us? MM She had a breech birth in the water. As far as I'm concerned it is a normal vaginal birth and although it was a compound presentation it was very straight forward indeed.
RE: [ozmidwifery] Breastfeeding
I agree with Janet re the basis of this fear. I have seen it in extended family and she was helped by complimentary therapy. Also she was able to B/F for 18mths on a shield. The woman could see any number of therapists, e.g. homeopath, Flower remedies, kinesiology, etc. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Andrea Bilcliff Sent: Thursday, 12 October 2006 9:06 AM To: Ozmidwifery Subject: [ozmidwifery] Breastfeeding I'm posting this on behalf of a birth attendant who has contacted me. She will be supporting a womansoon who has for want of a better term, 'breast issues'. The woman really wants to breastfeed but thethought of itmakes her feel ill. She hates it when her partner touches her breasts. The birth attendant is not sure whether this is related toprevious sexual abuse or not. I've never come across this situation before and wondered if others had experience of this and what helped the women? Thanks, Andrea Bilcliff
RE: [ozmidwifery] RE: Risk
Title: Re: [ozmidwifery] RE: Risk Any chance of something more specific Justine? I cant seem to find him. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Justine Caines Sent: Wednesday, 11 October 2006 9:23 PM To: OzMid List Subject: Re: [ozmidwifery] RE: Risk Hi Vedrana and All I think you are referring to the work of Jeff Richardson from Monash University in Melbourne. Yes it is very good stuff. Interestingly I spoke to him (some time ago) and one of his colleagues from the Health research unit at Monash. He understood my links between his work and obstetrics and yet would not do anything, fearful of maintaining his funding (I despair!!). I then spoke to a female colleague at his suggestion and she attacked me for saying childbirth was essentially safe (!!!) And then all but cried about her experience (!!). This is what we come up against when lobbying politicians and decision makers. You should find Jeffs work at www.monash.edu.au and then search for him Kind regards Justine
RE: [ozmidwifery] Fluids in labour
Re the woman I cared for who fitted because of hyponatraemia. I wondered whether she was already low in sodium because she only ever drank reverse osmosis filtered water and never added salt to food. She was on a very restricted macrobiotic diet, but not so well balanced. Mm I think we need to keep in mind what athletes would be drinking to replace fluids during a 24 hour period, and remember that while women are labouring and also resting, they are sometimes sweating and labouring in water, and so we should surely be encouraging them to drink to quell their thirst. Surely we shouldn't be trying to limit the amount women drink, given that most women find it hard to tolerate anything much in established labour...I don't recall this woman drinking to excess, and I've certainly been at much longer labours where a flat baby hasn't been the outcome. Tania x -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.407 / Virus Database: 268.13.1/469 - Release Date: 9/10/2006 -- 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] IUGR
The important measurement here is the abdominal circumference. 4 weeks below gest age indicates IUGR. The next important measurement is U/S Doppler flow. This, + Amniotic fluid levels are the most reliable indication of babys health. Reverse Doppler flow the most ominous. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Christine Holliday Sent: Tuesday, 10 October 2006 6:14 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] IUGR The BPD is Bi-Parietal Diameter and is the width of her babys head. She should really ask her midwife what this means as I believe this would indicate IUGR and that close observation is wise including a follow up USS in a few weeks to monitor growth as this may have slowed. On the bright side the baby may have been breathing in when they measured it which gives a false reading, I presume thought that they watched for a while before taking the measurement to try and ensure this was not the case. It is difficult to give advice with just a snapshot of a womans pregnancy and I may have a different opinion if I knew the woman and her whole history. Hope this helps. Christine -Original Message- From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au]On Behalf Of Kelly @ BellyBelly Sent: 10 October 2006 18:34 To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] IUGR A mum and dear friend I am supporting is due on November 9th and has had two previous IOL for IUGR. At her scan today, she said: Head Circ around 31cm just a couple of days off Gestational Age... aka perfect Leg bone length - Perfect about 4 days off Gest Age BPD (not sure what that is) - Approx a week under Gest Age Amnio Levels - Perfect Blood flow through cord - Perfect AC (stomach circ) - 4 weeks below gestational age - she checked it 3 times. So they graphed it and the computer automatically plotted it and gave a weight reading. 4lb 11oz the computer was saying give or take 13% on each side of that. So looks like another tiny baby on my hands. Now we have to sit and wait what they say at my next antenatal appointment, at my last she said if there is an issue she may call me in early. They checked this scan against Kameron and Lachlans too at the same gest age and Ashton is not far off what they were predicted for both the boys. Lachlan at 35wks 1 day they predicted 4lb 9oz. I am 35wks 5 days today. So pretty much the same, so I am expecting a 6lb something to be born. Can anyone offer and insight into this is it an indicator that IUGR may be diagnosed again? Best Regards, Kelly Zantey
RE: [ozmidwifery] missing mail
Yes and for others as well. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of cath nolan Sent: Tuesday, 10 October 2006 7:56 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] missing mail I am getting Susan Cudlipp's test message coming in my email inbox, not to the diverted ozmid list. Is this happening to anyone else?, Cath.
RE: [ozmidwifery] GBS and Staph
The routine dose in our tertiary hospital is Benzyl penicillin 1.2g stat then 600mg 4 hrly. In active labour. No wonder the bugs get confused. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Katy O'Neill Sent: Saturday, 7 October 2006 1:43 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] GBS and Staph Interesting, our regime is different Amoxil IV 1gm 6th hourly. Katy. - Original Message - From: sharon To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 8:35 PM Subject: RE: [ozmidwifery] GBS and Staph Thats right gbs is group b streph which is found on vaginal swab at 36 weeks treated with benzpennicillin during labour every 4 hours commencing with a loading dose of 3 gms then 1.2 gm every four hours while in active labour. Regards sharon
[ozmidwifery] Keytones-confusing
In summary, the literature suggests that mild to moderate ketosis is a normal consequence of labour although the association between high ketonuria and the progress of labour is inconclusive. There is also no evidence to inform the debate about the beneficial or detrimental effect of ketone bodies to the mother or fetus. It appears that ketosis only becomes a problem when it exceeds, what is assumed to be, normal levels. Normal ketone levels tend to be exceeded when labour becomes prolonged. There is no conclusive evidence demonstrating that prolonged labour causes an over-production of ketone bodies or an over-production of ketone bodies causes prolonged labour. This is part of chapter 3 of a textbook whose name I couldnt find in the reference on google. However, it was just one of many to debate the normality or not of keytonuria. Most come down on the side of Keytonuria does not translate to serum ketones without the presence of other symptoms. And Keytonuria does not necessarily mean keytoacidosis.
RE: [ozmidwifery] Sports drinks
I think that there is no doubt about the fact that extra fluids reduces ketonuria, the debate is : Is ketonuria harmful or beneficial or just neutral? It may be that what is pathological in illness may be a product of normal metabolism in labour. From what I have read, Ketoacidosis is the harmful state, not ketonuria and ketonuria is not necessarily a symptom of ketoacisosis. More confused? MM
[ozmidwifery] Inexperiened?
First time mother - the inexperienced uterus and vagina may cause a difficult or prolonged delivery. This is one of the causes listed for Congenital Hip dysplasia on the Victoria better health site. MM
RE: [ozmidwifery] Fluids in labour
About 10 yrs ago I had a client who had a fit after the birth from hyponatremia. She had a mouthful of water with every contraction over a 12 hr labour. She drank reverse osmosis filtered water. The baby was fine, although this was one of the rare times I cut an episiotomy to get the baby out quickly. A case of low sodium through hyper-hydration. It was very worrying. MM Subject: RE: [ozmidwifery] Fluids in labour Just to add confusion about this issue, I remember a woman in labour who had a long labour and drank a large amount of fluid and the baby had hyponatraemia (I think it was low in something) and when we checked the mother she too was very dilute in many of her essential elements. She recovered without incidence but the baby was unwell until we administered replacements to bring levels back to normal. Sorry it is a vague story but it is another thing to think of when being over enthusiastic in encouraging fluids, although this is much rarer than the dehydrated woman who needs hydrated to recommence contractions. Christine -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] No Contractions
Di, It sounds as tho you managed a difficult situation in the best way you knew, and that is all one can do. You are now seeking to learn from it and we will obviously give you tips based on our experiences. Dont feel that you should have etc. Many midwifery authors in all kinds of natural birthing magazines like Midwifery Today etc, have spoken about the rest and recovery stage where the body needs to gather its strength for the final stage. It usually happens at the end of a demanding first stage and the woman showing signs of tiredness. I am old enough to remember doctors saying turn her on her side and give her a rest, Sis, in a time when IV fluids, synto drip and epidurals were available but not used so aggressively. At the transition between the first and second stage in a primip, the urge to push with each contraction needs to be resisted for a little while and breathed through, so that there is no pushing on a cervix that is not completely out of the way. We often cant reach that little bit at the back, but it is still there. We talk of an anterior lip, but there can be a posterior one too. The urge to push is triggered by the baby putting pressure on the nerves, even tho there is still a lip etc. Pushing without contractions is not usually the most productive thing, but as I said, you handled it the best way you knew how.remeber the discussion onundirected pushing? I am sure you will get lots of tips which will help us all in our practice no matter where we are. Cheers, MM
RE: [ozmidwifery] No Contractions
Hi Lisa, there was definitely no intent of implied criticism when I said no should haves. Just a reminder that we beat up on ourselves all the time . OH maybe I should have, shouldnt have. etc. We each have to respond to the best of our clinical judgment, in the way we see it, at the time. It is hard to say I would do this when because there is no hard and fast rule, just that rush of adrenalin and a sense of alarm that makes us act. Sorry I cant elaborate further. I agree about the fluids. In fact quite a while ago I read some articles about the presence of keytones being normal in labour. sorry cant remember where. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Lisa Barrett Sent: Friday, 6 October 2006 1:19 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] No Contractions Sorry Mary If my language inferred should have but when would you get a woman to push without a contraction?. Exception maybe breech out to nape of neck with worries about the baby's condition. IV fluids doesn't constitute any part of normal physiological labour unless I've missed something vital. When asked for opinion in future I will refrain from giving any unless my language is less confrontational. Lisa Barrett - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 8:17 AM Subject: RE: [ozmidwifery] No Contractions Di, It sounds as tho you managed a difficult situation in the best way you knew, and that is all one can do. You are now seeking to learn from it and we will obviously give you tips based on our experiences. Dont feel that you should have etc. Many midwifery authors in all kinds of natural birthing magazines like Midwifery Today etc, have spoken about the rest and recovery stage where the body needs to gather its strength for the final stage. It usually happens at the end of a demanding first stage and the woman showing signs of tiredness. I am old enough to remember doctors saying turn her on her side and give her a rest, Sis, in a time when IV fluids, synto drip and epidurals were available but not used so aggressively. At the transition between the first and second stage in a primip, the urge to push with each contraction needs to be resisted for a little while and breathed through, so that there is no pushing on a cervix that is not completely out of the way. We often cant reach that little bit at the back, but it is still there. We talk of an anterior lip, but there can be a posterior one too. The urge to push is triggered by the baby putting pressure on the nerves, even tho there is still a lip etc. Pushing without contractions is not usually the most productive thing, but as I said, you handled it the best way you knew how.remeber the discussion onundirected pushing? I am sure you will get lots of tips which will help us all in our practice no matter where we are. Cheers, MM
RE: [ozmidwifery] intact peri
Not so clear cut. On the whole it means not directed, as many of the women I care for are on their knees in a water tub and I cant see their perineum. I talk about this during their pregnancy and try to remind them to go gently. I find that women who are free to move their body as they choose (water is great for this) are able to be in touch with what they need to do. Does this mean hundreds of intact perineums? No. It means that sometimes there is a tear and sometimes not. A hard question to get the right answer. MM A little off-topic when you dont do directed pushing you do not tell a woman when to push, but do you tell her when not to push? Or another way to put it does directed pushing only include telling a woman when to push, or telling her when not to push as well? Vedrana From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy Sent: Monday, October 02, 2006 4:59 AM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] intact peri Hi Paivi, I cannot give you statistics of homebirth as I do not have immediate access to them. I will see if we have any stats on our service that I can access. Just in general, the main way to protect the perineum is not to tell the woman to push, but to allow her to use her natural open glottis pushing, an keep hands off. At home we do not do directed pushing. I cannot speak for birth centres, but their philosophy is much the same. Each midwife does different things, but it is not usual to use compresses or perineal massage during birth. Is that what you have found Jan? I wouldnt put too much weight on the Bastian research as not all of us completed her surveys. I personally have done 3 episiotomies in 24 yrs, but would do one if I thought necessary. Hospital midwives will have to answer the one about epidurals. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Päivi Sent: Monday, 2 October 2006 4:54 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] intact peri Hi all, I am writing an article on episiotomy. I need to know what is the % of intact perineum among homemidwifes or birth centres? This is when the mother is having a natural birth. Does this change if the mother has an epidural and is having the baby in a hospital? What I mean is that how much can the hospital midwife do to save the perineum if the mother has opted for epidural? Is it still mainly to do with the skills of the midwife? Or is it a harder job with a medicated mom? Do you all practise hot compresses, perineal massage with oil (during birth) / perineal support? What is the % of intact peri in a waterbirth? Many questions... Thank you for any ideas or comments. Päivi
RE: [ozmidwifery] Speaking of steps backwards...
I think the answer is a clear NO. The research still does not support continuous monitoring. Even in VBACs the monitor does NOT warn of impending rupture. It tells one when the baby is in the abdomen. Other subtle clues are more important warning than the monitor. Nancy Reagan had it right. just say NO. MM ...this is Redlands Public, but apparently its gone through all of QLD Health public systems that higher risk pregnancy's need constant monitoring during labour. I told the midwife today that under no circumstances would I agree to constant monitoring. I asked her what they could do about it she said nothing really...
RE: [ozmidwifery] DO SOMETHING!
Kelly says I am not saying we need to be outrageous sales people - Why not? Isnt it interesting that we will allow others to sell their routine C/S, inductions and interference in normal birth, but we feel embarrassed to be outspoken in case we offend others. MM
RE: [ozmidwifery] intact peri
Hi Paivi, I cannot give you statistics of homebirth as I do not have immediate access to them. I will see if we have any stats on our service that I can access. Just in general, the main way to protect the perineum is not to tell the woman to push, but to allow her to use her natural open glottis pushing, an keep hands off. At home we do not do directed pushing. I cannot speak for birth centres, but their philosophy is much the same. Each midwife does different things, but it is not usual to use compresses or perineal massage during birth. Is that what you have found Jan? I wouldnt put too much weight on the Bastian research as not all of us completed her surveys. I personally have done 3 episiotomies in 24 yrs, but would do one if I thought necessary. Hospital midwives will have to answer the one about epidurals. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Päivi Sent: Monday, 2 October 2006 4:54 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] intact peri Hi all, I am writing an article on episiotomy. I need to know what is the % of intact perineum among homemidwifes or birth centres? This is when the mother is having a natural birth. Does this change if the mother has an epidural and is having the baby in a hospital? What I mean is that how much can the hospital midwife do to save the perineum if the mother has opted for epidural? Is it still mainly to do with the skills of the midwife? Or is it a harder job with a medicated mom? Do you all practise hot compresses, perineal massage with oil (during birth) / perineal support? What is the % of intact peri in a waterbirth? Many questions... Thank you for any ideas or comments. Päivi
[ozmidwifery] DO SOMETHING!
Many of us seem to think that it is a retrograde step, but telling each other stories will not change things. What can we do to put forward our views to the government? I guess we could rely on someone else to do something but WE really need to write to our Federal Health Minister, our local fed Politician, go and see them, etc. If everyone on this list wrote to Minister Tony Abbott, he would have to be a little bit impressed and may actually get more info before continuing on his rigid way. LETS DO IT. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of brendamanning Sent: Monday, 2 October 2006 8:13 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Backward step Going back to the maternity nurse or Gen/ Obstetric nurse workingin Midwifery ishow NZ worked in the 70's 80's. It was unsatisfactory then would be the same now, despite the fact the we did 6 months obsin our general training we weren't midwives it showed. I worked in mid whilst attending homebirths, worked in birth suite, postnatal, taught pre-natal classesspent 3 yearsin charge of SCN as a RGON in the early 80's when I went to train as a midwife justlike Di MI too found it a revelation. It's a retrograde step undermines all the recognition of your specialised professionyou Australian midwives have fought so hard for. It's just another path on: follow the American leader. With kind regards Brenda Manning www.themidwife.com.au - Original Message - From: D. Morgan To: ozmidwifery@acegraphics.com.au Sent: Monday, October 02, 2006 9:54 AM Subject: Re: [ozmidwifery] RE: I agree Michelle, I too worked in a rural area prior to completing my Mid many years ago and can still remember the revelations I felt while learning Midwifery.As anRN non Midwife, I was quite ignorant of what a true Midwife's role involved. It was scarey stuff. Cheers Di M
RE: [ozmidwifery] Any ideas??
I have cared for a number of overseas visitors who have come to Perth to have their baby at home in the water. As she will have to pay for all her hospital care, she would have to also foot the bill for the hospital service. We do not have any hospitals that offer waterbirth. If it is possible, a hospital that offers waterbirth would cut out the double payment she would have to make if she needs transfer for additional obstetric care. If she is married to a Malaysian man, this is less likely than if married to a Caucasian. Cheers, M From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of lisa chalmers Sent: Sunday, 1 October 2006 9:02 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Any ideas?? Hello to all , I received this email this morning and have no idea if what this woman wants is at all possible?? Has anyone got any experience of anything similar. i thinkits grest that she is actively persuing a birth experience that she wants and would love to give her some info. Many Thanks Lisa xxx Hello there. I would like to find out,is there such waterbirth laws in New Zealand also or only in SA? Is there any midwives services in New Zealand also? I'm actually a Malaysian,but i really want to have my child in Australia or New Zealand and not in Malaysia because my husband and i are very interested and really want to have an aqua baby due to all the benefits that waterbirth has and this service is not available here in Malaysia. I would really like to know how can i deliver our baby over there and how is the government's policy to go there and have a baby? Is it possible because we really want a waterbirth. Please do reply soon. Thank you very much for your cooperation. Regards, Jashpreet Kaur
RE: [ozmidwifery] Midwifery Today Conference in Germany
Title: Re: [ozmidwifery] Midwifery Today Conference in Germany I attended a MT conference in Eugene Oregon USA. It was varied, catering to different skill levels and very, very interesting. The Art of midwifery was blended with how to handle PPHs Sh. Dystocia etc etc. I met some wonderful midwives. Worthwhile attending. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of renee Sent: Thursday, 28 September 2006 9:13 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Midwifery Today Conference in Germany Hi Paivi I havent been before but am going along with another fellow student from my course. We are madly attempting to get all our assignments finished early before we go. So if you decide to go, say hi to us. On 27/9/06 11:21 PM, Päivi Laukkanen [EMAIL PROTECTED] wrote: Hi, Has anyone been to Midwifery Today Conferences? There is one in Germany next month, which sounds fantastic and I was thinking about going. Just thought if any of you have participated in the past? Päivi Childbirth Educator Finland
[ozmidwifery] QUOTE OF THE WEEK
We need to find a way between the rock of medical model standard of care and the hard place of women's insistence on pain-free, rapid childbearing to meet the needs of both mother and baby. Sharon Glass Jonquil
[ozmidwifery] Book
Does anyone have this book. I would like to either borrow or buy it ASAP. Thanks, MM Trying Again : A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss (Paperback) by Ann Douglas 2000.
RE: [ozmidwifery] FYI news article
The woman who best markets midwifery is Caroline Flint in the UK. We should copy her marketing strategies. MM Kelly says..If we want women to accept and value the midwife then it needs to be marketed better, it needs to be trendy and jazzed up! Not just a choice being two sides of the fence with opposing views as it is now. And they want to know what it will do for THEM and what THEY will get out of it. At the moment there are very many women who do not see birth as something that needs to be in the home or is safe in home thats just a fact which we have to work on.
RE: [ozmidwifery] FYI news article
Maybe contact Caroline herself through that site? Good luck. She is a very generous person. MM From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Vedrana Valcic Sent: Wednesday, 20 September 2006 6:11 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] FYI news article Where can I find out more about her marketing strategies? Midwives in Croatia would certainly appreciate info about effective marketing strategies. I found this site: http://www.carolineflint.co.uk/news/news.htm, but I dont know if there is something more detailed. Vedrana From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy Sent: Wednesday, September 20, 2006 11:11 AM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] FYI news article The woman who best markets midwifery is Caroline Flint in the UK. We should copy her marketing strategies. MM Kelly says..If we want women to accept and value the midwife then it needs to be marketed better, it needs to be trendy and jazzed up! Not just a choice being two sides of the fence with opposing views as it is now. And they want to know what it will do for THEM and what THEY will get out of it. At the moment there are very many women who do not see birth as something that needs to be in the home or is safe in home thats just a fact which we have to work on.
[ozmidwifery] Caroline flint.
http://www.birthcentre.com/index.html
RE: [ozmidwifery] FYI news article
The Caroline flint you have contacted is a politician, not the midwife. Try putting midwife in front of the google search. It is confusing to have two high profile people with the same name. MM From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Vedrana Valcic Sent: Wednesday, 20 September 2006 6:11 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] FYI news article Where can I find out more about her marketing strategies? Midwives in Croatia would certainly appreciate info about effective marketing strategies. I found this site: http://www.carolineflint.co.uk/news/news.htm, but I dont know if there is something more detailed. Vedrana From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy Sent: Wednesday, September 20, 2006 11:11 AM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] FYI news article The woman who best markets midwifery is Caroline Flint in the UK. We should copy her marketing strategies. MM Kelly says..If we want women to accept and value the midwife then it needs to be marketed better, it needs to be trendy and jazzed up! Not just a choice being two sides of the fence with opposing views as it is now. And they want to know what it will do for THEM and what THEY will get out of it. At the moment there are very many women who do not see birth as something that needs to be in the home or is safe in home thats just a fact which we have to work on.
[ozmidwifery] routine VE's
Recently there was a question about the evidence for routine VEs in labour. I thought Id contribute this: Forms of care unlikely to be beneficial Frequent scheduled vaginal examinations in labor 31 Thought Id put this in as well. MM Routine directed pushing during the second stage of labor 32 Pushing by sustained bearing down during the second stage of labor 32 Breath holding during the second stage of labor 32 Early bearing down during the second stage of labor 32 Arbitrary limitation of the duration of the second stage of labor 32 'Ironing out' or massaging the perineum during the second stage of labor 32 www.birthpsychology.com/messages/cervical/cervical.html BMJ 1995;311:469 (19August) (exerpts) Study criticises protocols for labour A high proportion of the protocols provided by hospitals for women in normal labour are unsatisfactory, according to a new report from the Clinical Standards Advisory Group. The report cites regular vaginal examination during labour as an example of a routine procedure performed without providing evidence of benefit. All the protocols emphasised that labour should be managed with care and respect for the woman's wishes. But the report says: Some procedures are apparently recommended almost routinely. The assumption that they are necessary, in the interests of the child and woman, may be questioned. For example regular vaginal examinations (at least every 2 or 4 hours), rupture of the membranes at a cervical dilatation of 3-4 cm and the management of the second stage of labour. Comparison of the expected number of vaginal examinations indicated by the protocols with the number actually performed during labour showed that 71% of women had more vaginal examinations than expected. The Benefits of Using Water for Labour and Birth Extract from Water Birth by Janet Balaskas. Midwives who attend water births often have to develop different ways of assessing progress in labour. Instead of routine vaginal examinations to check dilation, the midwife relies on more subtle indicators, such as the womans breathing, vocalisations and movements. In fact, many midwives feel that attending labours and births in water has added an extra dimension to their midwifery skills, including an extra sensitivity to changes in the mother without the need for manual confirmation.
[ozmidwifery] routine vag exams
I did google this and cut and paste a heap of quotes. Then I lost it!. You could google it yourself and see what comes up. You could also follow up on Mary Stewarts research. MM hsc.uwe.ac.uk/net/research/Default.aspx?pageindex=7pageid=259 Vaginal examination in labour: power, control and decision making Funding body: Faculty of Health Social Care Contact: Mary Stewart [EMAIL PROTECTED] Vaginal examination is a common procedure, undertaken by midwives and obstetricians in order to assess progress in labour. Despite its routine nature, little attention has been paid to the experiences of those undergoing or performing the vaginal examination. In particular, no research has been carried out to explore who has power and control over decision-making about the procedure. There are three research questions that will be addressed. These are: 1. Who has power and control over decision-making about vaginal examination in labour? 2. In what ways does current practice reflect issues of power, control and decision-making? 3. What influences midwives and obstetricians decision-making regarding vaginal examination An ethnographic approach is being used, integrating narrative enquiry. The research design will be underpinned by feminist principles in that the research attempts to map and explore womens experiences and address issues of power, autonomy and control. Data are being collected through the use of observation in the field, and interviews with midwives, obstetricians and women whose labours have been observed. In addition, field diary and reflexive diaries are being used. Analysis of data will include thematic content, analytical memos and the use of computer software. A narrative approach is being used for data analysis, identifying narrative sequences within the text and using the method of analysis put forward by Catherine Riessman. Data collection began in June 2003 and will continue for several more months. However, several themes are already emerging. One of these involves the decisions midwives make about whether a vaginal examination will be overt, in which case it is documented in the clinical records, or whether it is hidden and never formally acknowledged. Further themes are being developed using concept of mapping and this will continue throughout the research process.
[ozmidwifery] Mec Stained Liquor
From National Womens Hospital NZ. www.adhb.govt.nz/newborn/Guidelines/Admission/MeconiumStainedLiquorAndMAS.htm - Delivery Room Management The Paediatric Resident (SHO, Registrar, or NS-ANP) should be called if there is thick meconium staining or light meconium plus fetal distress. There is no advantage in oral and pharyngeal suction as the head delivers and this is no longer indicated. 1 Suctioning does not alter the chance of developing respiratory distress or symptomatic meconium aspiration syndrome, even in sub-groups with thick meconium, fetal distress or delivered by Caesarean section. If the baby is apparently vigorous at birth (heart rate 100, spontaneous respiration, reasonable tone), intubation and tracheal suction is not indicated, unless the baby subsequently has poor respiratory effort or early respiratory distress. 2 Intubation of vigorous babies does not improve respiratory outcomes and can result in trauma to the infant. Intubation and tracheal suction should be performed if the baby has moderate or thick meconium and depression at birth. Meconium stained amniotic fluid (MSAF) occurs in about 12% of deliveries. Meconium aspiration is defined by meconium aspirated from below the vocal cords. However, Meconium Aspiration Syndrome (MAS) defines a wide array of respiratory symptoms associated with MSAF. MAS usually presents as respiratory distress and cyanosis. Pulmonary hypertension is common. www.cs.nsw.gov.au/rpa/neonatal/html/newprot/Meconium.htm - Royal Prince Alfred Hospital: Meconium staining of the amniotic fluid (MSAF) is found in approximately 15% of pregnancies. MSAF rarely occurs before 38 weeks' gestation. The incidence of this condition increases with longer gestations and approximately 30% of newborns have MSAF at 42 weeks.2 Several lines of evidence challenge the concept that aspiration of meconium is responsible for severe MAS and suggest that other events cause the syndrome, with meconium in the lungs as an co- incidental finding.3, 4 The passage of meconium in utero may be a response to stresses such as chronic hypoxia, acidaemia or infection, processes that may interfere with clearing of meconium.1 Post delivery prevention of MAS used to be focussed on adequate suctioning. It was believed that diligent suctioning of the fetal oropharynx and trachea at delivery could decrease the rate of MAS. However, recent randomized studies showed no reduction of severe MAS with early oropharyngeal suctioning and/or endotracheal suctioning of the trachea.7, 8, 9 Paediatric staff should be present at deliveries where there is thick meconium staining of the liquour or where there is evidence of fetal distress. A multicentre randomised controlled trial found there was no advantage in oral and pharyngeal suction as the head delivers. 8 Yet, the Royal Womens says:www.rwh.org.au/nets/handbook/index.cfm?doc_id=459 At both vaginal and operative deliveries perform thorough suctioning of the mouth and pharynx after delivery of the head and before delivery of the shoulders. Guide the catheter into the posterior pharynx via a finger inserted into the infants mouth. Use a size 12Fr catheter set at 100mmHg. Repeat the procedure until no further meconium is obtained.
[ozmidwifery] caesareans
Preventing first time mothers having an induction for non or dubious medical reasons would go a long way to preventing complicated labours and C/S for lack of progress and/or fetal distress. There seems to be an epidemic of inductions, as tho this is the best way for women to go in to labour. Much more controlled. It is just that artificial control that causes the problems. Like opening an egg with a hammer instead of letting the chicken hatch. MM AS 1 OB colleague states: if we could just prevent the first CS happeningshe wouldn't be faced with this awful dilemma now ie to VBAC or not.
[ozmidwifery] routine VE
Did this make it to the List?: Hi Sarah, it's a good question. If I were her, I'd be looking for evidence that VEs can increase GBS infections, e coli infections, etc. There must be data somewhere about the less VEs the better for women with PROM, maybe that could be used. I always like to turn it around and say Could the people who want to do VEs q 2 hrs please prove that that has a health benefit! Why should we have to prove that keeping fingers out of vaginas is the safer thing? Those are my thoughts, Gloria Lemay in Vancouver, BC http://www.glorialemay.com
RE: [ozmidwifery] VBAC after more than one c-sec in the perinatal data?
Same as the WA form. Contact the state Health statistics dept. they have all the data. MM From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of brendamanning Sent: Saturday, 16 September 2006 1:12 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] VBAC after more than one c-sec in the perinatal data? Hi Janet, On the Victorian perinatal data collection unitform whichshould befilled out returned by all midwives tothe above unitfor every birth (home or otherwise) there is a section which asks: No41:was the last birth a CS ? No 42: Total no of previous CS? Is this what you mean ? I have recently been midwife at VBAC after 3CS and a VBAC following 2 CS. So they are happening. Just need more of them. AS 1 OB colleague states: if we could just prevent the first CS happeningshe wouldn't be faced with this awful dilemma now ie to VBAC or not. With kind regards Brenda Manning www.themidwife.com.au - Original Message - From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Saturday, September 16, 2006 1:30 PM Subject: [ozmidwifery] VBAC after more than one c-sec in the perinatal data? Hi all, is there some way in which the perinatal data for each state records vb after multiple c-secs in the hospy system? I wonder if it's too statistically insignificant or is there a part of the data I haven't noticed. I know they're different in each state as well. How about hospy's own data? Are people recording how many c-secs women have before a vb? We really need MIPPs to be recording HBACs so we can contrast that with the truly appalling national average. I've only seen blanketVBAC figures, not how many surgeries prior. Anyone know? J For home birth information go to: Joyous Birth Australian home birth network and forums. http://www.joyousbirth.info/ Or email: [EMAIL PROTECTED]
[ozmidwifery] Quote of the week
The flowering of midwifery education is in the opening, the grace, the surrender, the beauty and the union with what is great and good, and the strength that comes with this. From Midwifery Today.
[ozmidwifery] Post term induction
http://www.lamaze.org/institute/flawed/postterm1.asp follow this link for a very interesting summary of the evidence. MM
[ozmidwifery] C/S again
Low-risk cesareans carry increased neonatal mortality risk Source:Birth 2006; Not yet available online Examining infant and neonatal mortality among women with no indication of medical risks or complications who undergo a primary cesarean delivery. Low-risk mothers who opt for a cesarean face a higher risk of infant and neonatal mortality than those who deliver vaginally, researchers report. These findings should be of concern for clinicians and policy makers who are observing the rapid growth in the number of primary cesareans to mothers without a medical indication, said Marian McDorman, who led the study. The team, from the Centers for Disease Control and Prevention in Atlanta, Georgia, analyzed data on more than 5.7 million live births and 12,000 infant deaths over a 4-year period. The researchers focused on women with a singleton full-term gestation and no indicated medical risks or complications. They found that, overall, infants born to these low-risk women had a low incidence of neonatal death, at about one in 1000 live births. However, further analysis showed that those delivered by cesarean section had twice the risk of death as those delivered vaginally. This is worrying because the overall rate of cesarean delivery rose by 41 percent between 1996 and 2004 in the USA, while the incidence in women with no indication for cesarean almost doubled. Posted: 31 August 2006 Current Medicine Group 2006
RE: [ozmidwifery] Synto question
According to the box, Syntocinon and syntometrine should be stored at between 2-8 degrees C. Leaving it out of the fridge in room temperature for short periods of time should not affect it, but the best people to ask are the distributors, Look on the box for details. MM Just a quick question does anyone know how long Syntocinon can be out of refrigeration before it starts loosing its effectiveness? Where I am working at the moment there are an amazing number of PPH's, and also the common practice of drawing up the synto and having it ready often hours before the birth. Aside from all the other medical intervention which would contribute to PPH, if controlled cord traction is started after a dose of ineffective synto,it's probably contributing to the PPH's. Cheers Michelle On Yahoo!7 Photos: Unlimited free storage keep all your photos in one place!
RE: [ozmidwifery] The Purple Line
Tania, could I please have a few more details? E.g. author and complete title of article? I am also puzzled by the (8681). I cant seem to access it with the details you provided. Thanks, MM Tania wrote: For anyone who's interested, the original piece of research was pubished in the Lancet 1997, 335(8681): 122 entitled Clinical Method for Evaluat
