Re: [ozmidwifery] cord blood gases
Sorry Been to London to see Lion King with the kids! It was Fab! Perhaps we should all start to keep stats of babes in good condition with poor gases. I do not work in that environment any more, but it is the only way to prove what many of us are saying, Here are some refs. Some refs from hospital policies (advocating cord sampling) whichI have copies of are from 1984 interestingly! Apologies for the style of refs. Admin did them for me. Shelly Umbilical Cord Gases Umbilical Cord blood gas analysis Therp JA; rushing RS Obstet Gynecol Clin North AM. 1999 Dec; 26(4): 695-709 Medline 1998 Newborn acid base status umbilical cord morphology Atalla RK; Abrams K; Bell SC; Taylor DJ Obstet Gynecol. 1998 Nov; 92(5) : 865 8 Lipid peroxidation in cord blood at birth: the effect of labour. Rogers MS; Mongelli JM; Tsang KH; Wang CC; Law KP Br-J-Obstet Gynaecol. 1998 Jul; 105(7); 739-44 Umbilical cord blood gas analysis at delivery Hch-SF; Woodworth-A; Yeo GS Singapore Med J. 1998 Apr; 39(4) : 151-5 Umbilical cord blood acid base values in uncomplicated term vaginal breech deliveries Daniel Y; Fait G; Lessing JB etc. Acta Obstet- Gynecol Scand. 1998 Feb; 77 (2) : 182-5 MEDLINE 1997 Different types of acid-base changes at birth; fetal heart rate patterns, and infant outcome at 4 years of age. Hevbst A; Thorngren Jevneck K; WO-L; Ingemavsson 1 Acta Obstet Gynecol Scand 1997 Nov; 76 (10) :953-8 Lipid peroxidation in cord blood at birth a marker of fetal hypoxia during labour Rogers MS; Wang-W; Mongelli M; Pang CP etc. Gynecol Obstet Invest. 1997; 44 (4) : 229-33 Interpreting fetal heart rate tracings. Is there a difference between labour and delivery nurses and obstetricians? Beckmann CA; Van Mullem C; Beckmann-CR; Broekhiuzen FF J Reprod Med. 1997 Oct; 42(10) : 647-50 The Etiology of fetal acidosis as determined by umbilical cord acid base studies Johnson JW; Richards. DS Am J Obstet Gynecol. 1997 Aug; 177(2) : 274-80 discussn. 280 Umbilical cord blood sampling a tool for delivery quality control? Bulkmans N; Lyrenas-S; Hallberg G; Niklasson F Acta Obstet Gynecol Scand. 1997 May; 76 (5) : 419-22 Umbilical Cord Gas Analysis at Delivery; a time for quality data Westgate J, Garilbaldi JM ,Green KR British Journal of Obs and Gynae Dec 1994 Vol 101 pp 1054-1063 - Original Message - From: Shaughn Leach To: ozmidwifery@acegraphics.com.au Sent: Friday, October 20, 2006 9:52 AM Subject: RE: [ozmidwifery] cord blood gases Mary Here are some: Ross, M.G. Gala, R. 2002. Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. American Journal of Obstetrics and Gynecology 187:1: 1-9 Thorp, J.A., Dildy, G.A., Yeomans, E.R. et al. 1996 Umbilical cord blood gas analysis at delivery. American Journal of Obstetrics and Gynecology 175:3: 517-522 Harris, M., Beckley, S.L., Garibaldi, J.M. et al. 1996. Umbilical cord blood gas analysis at the time of delivery. Midwifery 12, 146-150 American College of Obstetricians and Gynecologists. 1991. Utlity of umbilical cord blood acid-base assessment. ACOG committee opinion No 138. In The ACOG 2002 Compendium of Selected Publications, Washington DC: ACOG Australian and New Zealand Perinatal Societies. 1995. The origins of cerebral palsy a consensus statement, MJA, 162: 85-90 Shaughn From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary MurphySent: Thursday, 19 October 2006 10:07 PMTo: ozmidwifery@acegraphics.com.auSubject: 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 Internal Virus Database is out-of-date.Checked by AVG Free Edition.Version: 7.1.394 / Virus Database: 268.13.4/476 - Release Date: 14/10/2006
RE: [ozmidwifery] cord blood gases
Mary Here are some: Ross, M.G. Gala, R. 2002. Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. American Journal of Obstetrics and Gynecology 187:1: 1-9 Thorp, J.A., Dildy, G.A., Yeomans, E.R. et al. 1996 Umbilical cord blood gas analysis at delivery. American Journal of Obstetrics and Gynecology 175:3: 517-522 Harris, M., Beckley, S.L., Garibaldi, J.M. et al. 1996. Umbilical cord blood gas analysis at the time of delivery. Midwifery 12, 146-150 American College of Obstetricians and Gynecologists. 1991. Utlity of umbilical cord blood acid-base assessment. ACOG committee opinion No 138. In The ACOG 2002 Compendium of Selected Publications, Washington DC: ACOG Australian and New Zealand Perinatal Societies. 1995. The origins of cerebral palsy a consensus statement, MJA, 162: 85-90 Shaughn From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy Sent: Thursday, 19 October 2006 10:07 PM To: ozmidwifery@acegraphics.com.au Subject: 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
None of these references are particularly up to date. How interesting. Lisa Barrett - Original Message - From: Shaughn Leach To: ozmidwifery@acegraphics.com.au Sent: Friday, October 20, 2006 6:22 PM Subject: RE: [ozmidwifery] cord blood gases Mary Here are some: Ross, M.G. Gala, R. 2002. Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. American Journal of Obstetrics and Gynecology 187:1: 1-9 Thorp, J.A., Dildy, G.A., Yeomans, E.R. et al. 1996 Umbilical cord blood gas analysis at delivery. American Journal of Obstetrics and Gynecology 175:3: 517-522 Harris, M., Beckley, S.L., Garibaldi, J.M. et al. 1996. Umbilical cord blood gas analysis at the time of delivery. Midwifery 12, 146-150 American College of Obstetricians and Gynecologists. 1991. Utlity of umbilical cord blood acid-base assessment. ACOG committee opinion No 138. In The ACOG 2002 Compendium of Selected Publications, Washington DC: ACOG Australian and New Zealand Perinatal Societies. 1995. The origins of cerebral palsy a consensus statement, MJA, 162: 85-90 Shaughn From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary MurphySent: Thursday, 19 October 2006 10:07 PMTo: ozmidwifery@acegraphics.com.auSubject: 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
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 -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 18 October 2006 22:31 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord 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. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
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? The facts on storage was from a 2001 article. What is the window of research time that carries sufficient power? I'm sure there will be something. I'm happy to look if you give me exactly what you want. Lisa Barrett - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, October 19, 2006 7:23 PM Subject: 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. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] cord blood gases
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. Lisa Barrett - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, October 19, 2006 7:23 PM Subject: 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. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Fw: [ozmidwifery] cord blood gases
Has something significant changed in the last 12 years then Mary? The facts on storage was from a 2001 article. What is the window of research time that carries sufficient power? I'm sure there will be something. I'm happy to look if you give me exactly what you want. 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
Hi Mary, I suppose you could be right about the technology.I am going to the WCH hospital today. I'll find out how old their machine is. I rang a hospital in Britian (I know it's not here but you have to workwith what you know sometimes) To find outwhen they replaced their machine. They have had the same on for 15 years, used differently over the years but not changed. IWould think you could successfully argue that the data is relevant if the technology is unchanged. -I had a quick scout around and couldn't find anything that interesting past the 2001 paper I already referenced. However it is all very boring to read through. It would be very interesting if someone out there at a hospital could find out how old the references for the protocols are. Do you mind me asking Mary, do you work in the government scheme in Perth or are you independent? Lisa Barrett
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
Re: [ozmidwifery] cord blood gases
I can have a look at work this afternoon if it's not too chaotic.See what I come up with.JoOn 19/10/2006, at 10:06 PM, Mary Murphy wrote:"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
Christine Sorry - I don't have research evidence to support my anecdotal observations. Interesting how anecdotal evidence/theoretical complications is enough to prevent hospitals providing waterbirth (and other woman-centred birth options) despite the research to back it up. We are in a system that choses what the agenda is - and it is not an agenda based around women's needs. Rachel ps. the dead baby with the good cord gases had a normal base excess (which I would expect) but also a normal ph which I thought was supposed to reflect an acute hypoxic episode - which this baby obviously had. From: Christine Holliday [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] cord blood gases Date: Wed, 18 Oct 2006 08:50:47 +0930 Do you have any figures for the well babies with abnormal cord gases as this evidence would not support routine cord gases on all babies but anecdotal evidence such as this won't provide us with any support particularly when it could be the machine or operators. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of michelle gascoigne Sent: 18 October 2006 05:45 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Melissa As reported by others already I have seen MANY babes born who were in good condition at birth with very poor gases. Do we tell parents that? I know your baby looks well but the blood gases that you 'consented?' to are suggesting otherwise. If the baby is in really poor condition can we console ourselves or the parents with the results of good cord blood gases? We recently had a big issue in this country where organs from babies and children who had sadly died were kept for medical research without consent. Many parents were outraged! I donot believe that you can take samples from a cord (any more than organs)and not get permission with your reasons for taking them, which in the end is purely to protect against litigation. My experience of inaccuracies would certainly not help me to feel protected by the results of any blood gases. Some of the reasons that I speculate for inaccuracies are in collection methods speed of analysis accuracy of the machine (we had one in theatre and one in labour ward and would get diffferent results on same blood from each machine.) Then goodness only knows what effect clinical practices in labour have on the results. Simply in practice I saw nothing that gave me faith in them as a useful tool and I am unable to sell them to parents when we are collecting evidence to protect us from future litigation. I am keeping out of the way of football so going off on one now! If we care for women to the very best of our ability, if we build a relationship with them and the trust and respect us they are much less likely to sue. Our efforts would be better placed here I think! Ultimately a no fault compensation scheme for parents of children with pregnancy/birth injuries would get away form us spending so much energy defending ourselves. I will post the references but have to type them up. Shelly - Original Message - From: Melissa Singer [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, October 16, 2006 4:24 AM Subject: Re: [ozmidwifery] cord blood gases Hi Shelley, I recently attended a advanced fetal assessment course at our tertiary hospital and all the pros for cord blood gases were presented. CTG's were discussed with pros and cons such as 80% show some abnormality but 80% of babies are not sick or acidotic. It was presented as one of certain diagnostic tools for fetal acidosis and therefore useful for litigation. You mentioned the results are inaccurate. I'd be very interested in hearing why they are inaccurate. We don't do them and I don't agree with routinely doing them so any more information would be helpful. Thanks Melissa - Original Message - From: michelle gascoigne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 14, 2006 10:39 PM Subject: Re: [ozmidwifery] cord blood gases Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect
Re: [ozmidwifery] cord 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
Melissa As reported by others already I have seen MANY babes born who were in good condition at birth with very poor gases. Do we tell parents that? I know your baby looks well but the blood gases that you 'consented?' to are suggesting otherwise. If the baby is in really poor condition can we console ourselves or the parents with the results of good cord blood gases? We recently had a big issue in this country where organs from babies and children who had sadly died were kept for medical research without consent. Many parents were outraged! I donot believe that you can take samples from a cord (any more than organs)and not get permission with your reasons for taking them, which in the end is purely to protect against litigation. My experience of inaccuracies would certainly not help me to feel protected by the results of any blood gases. Some of the reasons that I speculate for inaccuracies are in collection methods speed of analysis accuracy of the machine (we had one in theatre and one in labour ward and would get diffferent results on same blood from each machine.) Then goodness only knows what effect clinical practices in labour have on the results. Simply in practice I saw nothing that gave me faith in them as a useful tool and I am unable to sell them to parents when we are collecting evidence to protect us from future litigation. I am keeping out of the way of football so going off on one now! If we care for women to the very best of our ability, if we build a relationship with them and the trust and respect us they are much less likely to sue. Our efforts would be better placed here I think! Ultimately a no fault compensation scheme for parents of children with pregnancy/birth injuries would get away form us spending so much energy defending ourselves. I will post the references but have to type them up. Shelly - Original Message - From: Melissa Singer [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, October 16, 2006 4:24 AM Subject: Re: [ozmidwifery] cord blood gases Hi Shelley, I recently attended a advanced fetal assessment course at our tertiary hospital and all the pros for cord blood gases were presented. CTG's were discussed with pros and cons such as 80% show some abnormality but 80% of babies are not sick or acidotic. It was presented as one of certain diagnostic tools for fetal acidosis and therefore useful for litigation. You mentioned the results are inaccurate. I'd be very interested in hearing why they are inaccurate. We don't do them and I don't agree with routinely doing them so any more information would be helpful. Thanks Melissa - Original Message - From: michelle gascoigne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 14, 2006 10:39 PM Subject: Re: [ozmidwifery] cord blood gases Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it done. I will search out my references and post them seperately. Our debate was published in a midwifery mag here! Shelly Midwife - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 9:07 AM 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
Re: [ozmidwifery] cord blood gases
Naomi That was one of the big issues for us too! Hence the debate. Women are supposed to be informed antenatally. I know that they are being taken but women are seldom asked and seldom know. How dreadful! Shelly - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, October 16, 2006 8:57 AM Subject: Re: [ozmidwifery] cord blood gases Thanks everyone for your responses so far re cord blood gases. It will all be so helpful when we 'go into battle'. Shelly, you commented about letting the parents make the decision. This is one of our biggest areas of concern, as the medicos have made no mention of how informed consent will be obtained, and 'asking at the time', which was one response to this, is so very inappropriate. I truly despair at the interpretation of 'informed consent' that I regularly see at my place of work. Your references on this will be so useful. Naomi Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it done. I will search out my references and post them seperately. Our debate was published in a midwifery mag here! Shelly Midwife - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 9:07 AM 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. -- Internal Virus Database is out-of-date. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.12.12/461 - Release Date: 02/10/2006 -- 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. -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.13.4/476 - Release Date: 14/10/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] cord blood gases
Do you have any figures for the well babies with abnormal cord gases as this evidence would not support routine cord gases on all babies but anecdotal evidence such as this won't provide us with any support particularly when it could be the machine or operators. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of michelle gascoigne Sent: 18 October 2006 05:45 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Melissa As reported by others already I have seen MANY babes born who were in good condition at birth with very poor gases. Do we tell parents that? I know your baby looks well but the blood gases that you 'consented?' to are suggesting otherwise. If the baby is in really poor condition can we console ourselves or the parents with the results of good cord blood gases? We recently had a big issue in this country where organs from babies and children who had sadly died were kept for medical research without consent. Many parents were outraged! I donot believe that you can take samples from a cord (any more than organs)and not get permission with your reasons for taking them, which in the end is purely to protect against litigation. My experience of inaccuracies would certainly not help me to feel protected by the results of any blood gases. Some of the reasons that I speculate for inaccuracies are in collection methods speed of analysis accuracy of the machine (we had one in theatre and one in labour ward and would get diffferent results on same blood from each machine.) Then goodness only knows what effect clinical practices in labour have on the results. Simply in practice I saw nothing that gave me faith in them as a useful tool and I am unable to sell them to parents when we are collecting evidence to protect us from future litigation. I am keeping out of the way of football so going off on one now! If we care for women to the very best of our ability, if we build a relationship with them and the trust and respect us they are much less likely to sue. Our efforts would be better placed here I think! Ultimately a no fault compensation scheme for parents of children with pregnancy/birth injuries would get away form us spending so much energy defending ourselves. I will post the references but have to type them up. Shelly - Original Message - From: Melissa Singer [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, October 16, 2006 4:24 AM Subject: Re: [ozmidwifery] cord blood gases Hi Shelley, I recently attended a advanced fetal assessment course at our tertiary hospital and all the pros for cord blood gases were presented. CTG's were discussed with pros and cons such as 80% show some abnormality but 80% of babies are not sick or acidotic. It was presented as one of certain diagnostic tools for fetal acidosis and therefore useful for litigation. You mentioned the results are inaccurate. I'd be very interested in hearing why they are inaccurate. We don't do them and I don't agree with routinely doing them so any more information would be helpful. Thanks Melissa - Original Message - From: michelle gascoigne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 14, 2006 10:39 PM Subject: Re: [ozmidwifery] cord blood gases Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it done
RE: [ozmidwifery] cord blood gases
Lisa, I am hoping you are still reading this list and can send me the references regarding the length of time before the results for cord gases deteriorate and not needing to put them on ice as I asked earlier. If you wish to email them to me off line that is OK and I will forward them to group. Thanks Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 13 October 2006 21:08 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] cord blood gases
Still here Christine, holding my tongue very well :-) working on the undesirable thing. http://www.cs.nott.ac.uk/~jmg/papers/brjog-94.pdf This is very interesting as it analysed how gases were taken. http://www.clinchem.org/cgi/content/full/44/3/681 This is the extract from this study that showed no difference between room temp:- The first null hypothesis was that there was a difference between the two samples of each group, caused by the methodology of blood sampling and analysis. The data shown in Table 1 , however, indicate no significant differences between the two samples; therefore, the rejection of the null hypothesis implies high reproducibility of the method. The second null hypothesis suggested a difference between samples tested immediately and those tested after storage for 1 h in the refrigerator, caused by the effect of time and temperature. The data shown in Table 1 indicate no significant difference between the mean values of all analytes tested in both groups. The third null hypothesis suggested a difference between samples examined immediately and after storage of 1 h at room temperature, caused by the effect of time. However, the data shown reject this hypothesis and suggest that a period of 1 h has no effect on the analytes tested. The fourth null hypothesis was that temperature had an effect on the test results. The data shown in Table 1 also reject this hypothesis and suggest that temperature alone does not affect the tested variables. Thanks Lisa Barrett - Original Message - From: Christine Holliday [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 18, 2006 8:54 AM Subject: RE: [ozmidwifery] cord blood gases Lisa, I am hoping you are still reading this list and can send me the references regarding the length of time before the results for cord gases deteriorate and not needing to put them on ice as I asked earlier. If you wish to email them to me off line that is OK and I will forward them to group. Thanks Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 13 October 2006 21:08 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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
RE: [ozmidwifery] cord blood gases
Thanks for sending these, don't hold your tongue for too long. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 18 October 2006 09:42 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Still here Christine, holding my tongue very well :-) working on the undesirable thing. http://www.cs.nott.ac.uk/~jmg/papers/brjog-94.pdf This is very interesting as it analysed how gases were taken. http://www.clinchem.org/cgi/content/full/44/3/681 This is the extract from this study that showed no difference between room temp:- The first null hypothesis was that there was a difference between the two samples of each group, caused by the methodology of blood sampling and analysis. The data shown in Table 1 , however, indicate no significant differences between the two samples; therefore, the rejection of the null hypothesis implies high reproducibility of the method. The second null hypothesis suggested a difference between samples tested immediately and those tested after storage for 1 h in the refrigerator, caused by the effect of time and temperature. The data shown in Table 1 indicate no significant difference between the mean values of all analytes tested in both groups. The third null hypothesis suggested a difference between samples examined immediately and after storage of 1 h at room temperature, caused by the effect of time. However, the data shown reject this hypothesis and suggest that a period of 1 h has no effect on the analytes tested. The fourth null hypothesis was that temperature had an effect on the test results. The data shown in Table 1 also reject this hypothesis and suggest that temperature alone does not affect the tested variables. Thanks Lisa Barrett - Original Message - From: Christine Holliday [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 18, 2006 8:54 AM Subject: RE: [ozmidwifery] cord blood gases Lisa, I am hoping you are still reading this list and can send me the references regarding the length of time before the results for cord gases deteriorate and not needing to put them on ice as I asked earlier. If you wish to email them to me off line that is OK and I will forward them to group. Thanks Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 13 October 2006 21:08 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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
Re: [ozmidwifery] cord blood gases
Thanks everyone for your responses so far re cord blood gases. It will all be so helpful when we 'go into battle'. Shelly, you commented about letting the parents make the decision. This is one of our biggest areas of concern, as the medicos have made no mention of how informed consent will be obtained, and 'asking at the time', which was one response to this, is so very inappropriate. I truly despair at the interpretation of 'informed consent' that I regularly see at my place of work. Your references on this will be so useful. Naomi Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it done. I will search out my references and post them seperately. Our debate was published in a midwifery mag here! Shelly Midwife - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 9:07 AM 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. -- Internal Virus Database is out-of-date. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.12.12/461 - Release Date: 02/10/2006 -- 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] cord blood gases
Cord gases will be normal if it is an acute recent event, they are abnormal if it has been a chronic ongoing event this is why they are useful in litigation cases where the woman/child family are claiming negligence during labour, the usual being there were signs of fetal distress and a LSCS should have been done earlier, cord gases that are normal prove this was not the case. Just to play devils advocate I can understand how people feel the need to defend themselves against being sued when so often there is no proof that they did anything wrong at the time (benefit of hindsight being a wonderful thing of course). It is better to be doing cord blood gases to protect against litigation than even more LSCSs. I know it is only a few people that sue unnecessarily but as usual the few spoil it for the many. I would be interested to know what the rate of abnormal cord gases with a vigorous well baby were as sharing these stats are what will help decide sensible practices, we have to work towards being part of these decisions by using evidence and not just trying to go it on our own. Where I work the practice is to do cord gases at the births when a baby requires resus or there has been some problem in labour and any I have been involved in have been supportive of the care in labour. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of wump fish Sent: 16 October 2006 20:34 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Hi Melissa I realise that from a 'scientific' perspective cord gases represent an accurate way of assessing fetal distress. But, I was on duty when a baby died due to shoulder dystocia - it's cord gases were normal. Kind of knocked my already weak faith in the technology. It was also policy in that hospital to do routine cord gases. Midwives would sometimes get poor cord gases with a vigorous baby??? I found that I was 'unable to obtain' cord gases unless there was an indication and/or the parents had consented (how can anyone prove otherwise?). I was concerned that if a baby came out healthy and I got documented 'proof' of compromise I was setting myself up for problems. Also, what do you tell the parents? You baby seems ok, but it's cord gases indicate otherwise? Kind of risk assessment in reverse. Quite interesting that cord gas analysis became routine overnight but waterbirth took years of battling to get up and running. I think cord gas analysis is an issue that needs debating - especially in relation to allocation of resources. Rachel From: Melissa Singer [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Date: Mon, 16 Oct 2006 11:24:56 +0800 Hi Shelley, I recently attended a advanced fetal assessment course at our tertiary hospital and all the pros for cord blood gases were presented. CTG's were discussed with pros and cons such as 80% show some abnormality but 80% of babies are not sick or acidotic. It was presented as one of certain diagnostic tools for fetal acidosis and therefore useful for litigation. You mentioned the results are inaccurate. I'd be very interested in hearing why they are inaccurate. We don't do them and I don't agree with routinely doing them so any more information would be helpful. Thanks Melissa - Original Message - From: michelle gascoigne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 14, 2006 10:39 PM Subject: Re: [ozmidwifery] cord blood gases Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation
Re: [ozmidwifery] cord blood gases
Hi Shelley, I recently attended a advanced fetal assessment course at our tertiary hospital and all the pros for cord blood gases were presented. CTG's were discussed with pros and cons such as 80% show some abnormality but 80% of babies are not sick or acidotic. It was presented as one of certain diagnostic tools for fetal acidosis and therefore useful for litigation. You mentioned the results are inaccurate. I'd be very interested in hearing why they are inaccurate. We don't do them and I don't agree with routinely doing them so any more information would be helpful. Thanks Melissa - Original Message - From: michelle gascoigne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 14, 2006 10:39 PM Subject: Re: [ozmidwifery] cord blood gases Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it done. I will search out my references and post them seperately. Our debate was published in a midwifery mag here! Shelly Midwife - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 9:07 AM 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. -- Internal Virus Database is out-of-date. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.12.12/461 - Release Date: 02/10/2006 -- 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] cord blood gases
Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it done. I will search out my references and post them seperately. Our debate was published in a midwifery mag here! Shelly Midwife - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 9:07 AM 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. -- Internal Virus Database is out-of-date. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.12.12/461 - Release Date: 02/10/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[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.
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.
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 fromThe Use of Electronic Fetal Monitoring. National Institute for Clinical Excellence. May 2001http://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.1999.021Umbilical 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.pdfUmbilical cord blood sampling and expert data care http://www.k2ms.com/support/Documents/K2EDCPD.pdfHope this helps Briege Briege Lagan PhD Student/Clinical Midwife SpecialistUniversity 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.ThanksNaomi.--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
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
RE: [ozmidwifery] cord blood gases
We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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.
Re: [ozmidwifery] cord blood gases
- Original Message - From: Christine Holliday [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 7:23 PM Subject: RE: [ozmidwifery] cord blood gases We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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
We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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
Unfortunately Lisa, it is our hospital policy. Believe me, it is a pretty serious issue for any midwife that does not obtain cord gases. - Original Message - From: Lisa Barrett [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 7:38 PM Subject: Re: [ozmidwifery] cord blood gases We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] cord blood gases
Unfortunately Lisa, it is our hospital policy. Believe me, it is a pretty serious issue for any midwife that does not obtain cord gases. I'm sure that makes it ok then Sadie. Hospital policies are of course the ultmate deterant against making people think for themselves. Quite honestly if you don't do it and can back up why there is nothing to be afraid of. You can't be struck off for good practice. On the point of putting it in ice. Just to make sure I wasn't talking through my arse I have spent the evening reading up on blood gases. They do not change significantly within the first hour and the reading is still accurate at room temperature. Lisa Barrett . is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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. -- 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
On the point of putting it in ice. Just to make sure I wasn't talking through my arse I have spent the evening reading up on blood gases. They do not change significantly within the first hour and the reading is still accurate at room temperature. oh and accurate I don't know is the right word if you read the research into the way it's done etcetc. I should have read that before I posted. What I meant is that the blood doesn't deteriorate over the 1st hour at room temp. 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
Just wondering where you work Lisa? You sound incredibly sarcastic and dismissive of what is a working fact for me. Sadie - Original Message - From: Lisa Barrett [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 8:41 PM Subject: Re: [ozmidwifery] cord blood gases Unfortunately Lisa, it is our hospital policy. Believe me, it is a pretty serious issue for any midwife that does not obtain cord gases. I'm sure that makes it ok then Sadie. Hospital policies are of course the ultmate deterant against making people think for themselves. Quite honestly if you don't do it and can back up why there is nothing to be afraid of. You can't be struck off for good practice. On the point of putting it in ice. Just to make sure I wasn't talking through my arse I have spent the evening reading up on blood gases. They do not change significantly within the first hour and the reading is still accurate at room temperature. Lisa Barrett . is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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. -- 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
Dear Sadie, I am incredibly dismissive of policy and procedure that is not backed up with evidence based practice. I felt I was no more sarcastic than you were in your reply. I am an independent midwife in South Australia, I have been a midwife since 1988 I worked in Britain both as midwife in charge of labour ward and homebirthing. As part of my visa requirements when I came to Australia I had to work in the system. I was midwife in charge of the unit overnight at Ashford Hospital. As soon as I met my requirements ( 2 whole years) I started to homebirth again. I have extensive experience of working with the system, and in Australia it is crap. If people don't start to question and stand up and be counted then we are going to get nowhere. You can't just use working in the system as an excuse for practice that isn't based in research and evidence. When I was in charge at Ashford, I realise I created lots of difficult situations (it's a private hospital) but I couldn't not question argue,advocate for women's birth rights and fall into line just because that's what is expected. I know how hard it is to work inside the system and I'm sorry that you are confronted by hearing that something's that you do are less than optimal. I made my choices by being independent. Everytime I go near a hospital I have to justify myself, answer questions be judged by their standards (which are pretty awful). I am willing to stand up and be counted for my beliefs which are by the way evidence based well researched and very women centred. If that offends you I apologise. What do you do Sadie? 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
Absolutely routine in private births where I work, but getting there with the public ones, too, sadly. Jo On 13/10/2006, at 4:07 PM, Naomi Wilkin 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 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
We dont have a machine in our unit. I think we may have one somewhere in the hospital, but thankfully no one is pushing for us to get one. Why would they want to do gasses on a babe with good `apgars? The NICE guidelines sound reasonable. Di - Original Message - From: Briege Lagan To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 7:12 PM 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 SpecialistUniversity 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.ThanksNaomi.--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
RE: [ozmidwifery] cord blood gases
If only all the women, their families and the children born were of the same mind then we wouldn't have to consider any defensive practice, unfortunately this is not the case and I do not see anything wrong with midwives looking after them selves providing they are not causing problems to mother and baby. It is not just that you can't get struck off for bad practice it is the stress and despair as you spend the time (and money) defending yourself. I am well aware about the information that says not to cut a cord on a compromised baby but it many situations it can be impossible to do this depending on the whereabouts of the woman and baby and the resus needed e.g. intubation. Could you please send the references about not needing to put blood for cord gases on ice and the length of time before cord gas results deteriorate as I must admit I have not looked at this myself but merely followed our labs advice. Sadie, it has become hospital policy then your choice is to continue to do this or change the policy, ignoring the policy will only make your life too stressful to practice at your best, I do sympathise with your predicament just gather all the information and keep plugging away. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Sadie Sent: 13 October 2006 22:27 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Just wondering where you work Lisa? You sound incredibly sarcastic and dismissive of what is a working fact for me. Sadie - Original Message - From: Lisa Barrett [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 8:41 PM Subject: Re: [ozmidwifery] cord blood gases Unfortunately Lisa, it is our hospital policy. Believe me, it is a pretty serious issue for any midwife that does not obtain cord gases. I'm sure that makes it ok then Sadie. Hospital policies are of course the ultmate deterant against making people think for themselves. Quite honestly if you don't do it and can back up why there is nothing to be afraid of. You can't be struck off for good practice. On the point of putting it in ice. Just to make sure I wasn't talking through my arse I have spent the evening reading up on blood gases. They do not change significantly within the first hour and the reading is still accurate at room temperature. Lisa Barrett . is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au 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
Re: [ozmidwifery] cord blood gases
We do not do routine gases but have just begun having to keep a length of clamped cord to do gases on in retrospect if a baby is unexpectedly flat at or soon after birth. katy. - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 6:07 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. __ NOD32 1.1798 (20061011) Information __ This message was checked by NOD32 antivirus system. http://www.eset.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
