Re: [ozmidwifery] trials
Title: Message I worked with women as a mid student who were recruited into this trial - while oral seems more appealing than gels at first - I found waking up / disturbing women 2 hrly for the next oral dose was not conducive for the rest and relaxationrequired the night before birthing (and some of them were getting placebos anyway poor things). The skinny dividable hospital bed, no partner to snuggle up to, no foodetc etc.(common to all methods)...is not exactly the best way to prepare for a birth either. No wonder IOL have such a big failure rate. Although most failed IOL are recorded as FTP (blame the woman) or foetal distress so Enkin et al... says that IOL does not increase chance of c/s...When I queried the documentation of failed IOL -The CMC - with doctor concurring - said to me if she has 'some' contractions its not a failed IOL...hmmm. Suzi - Original Message - From: Dean Jo To: ozmidwifery@acegraphics.com.au Sent: Saturday, March 04, 2006 8:25 PM Subject: RE: [ozmidwifery] trials vaginal birth not achieved in 24 hours misoprostol 46.0% v dinoprostone 41.2% okay so if 46% did not birth vaginally and 22.7% had cs what happened to the other23.3% that didn't birth vaginally Also, are women going to be told that they havealmost a 50% chance of needing a cs with an induction?That inductions fail almost half the timegee I know, lets do what the prominent OB from Adelaide is suggesting and induce all women at 39 weeks andalmost double our cs rate! caesarean section 22.7% v 26.6% and we wonder why we have a national cs rate of over 25%!!! caesarean section for fetal distress 8.8% v 9.3% uterine hyper stimulation with changes in fetal heart rate 0.8% v 1.6% and yet the risk of rupture being an estimated 0.3% is too high to offer vbac as an optionlets give these women a drug that can hyper stimulate their uteri and increase the chance of serious morbidity or mortality and potentially leave them with a ruptured uterus despite not having a previous scar. *sigh* I seriously wonder sometimes how these academics get funded! Oh sorry, this was a drug company who will benefit from this study...not women. I have a suggestion: why doesn't someone get funding to do atrial into spontaneous non-interventative (minus the actual medical need)birthvs. active management and compare the outcomes? Lets actually see if natural noninvasive supported and educated birth is fraught with the dangers that we get thrown at us. grr grr grr Jo -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary MurphySent: Saturday, March 04, 2006 7:08 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] trials At least they asked the women’s preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial-BMJ,vol 332, no 7540, 4 March 2006, pp 509-511Dodd JM; Crowther CA; Robinson JS-(2006)OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral
[ozmidwifery] trials
At least they asked the womens preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial-BMJ,vol 332, no 7540, 4 March 2006, pp 509-511Dodd JM; Crowther CA; Robinson JS-(2006)OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author)
RE: [ozmidwifery] trials
Title: Message vaginal birth not achieved in 24 hours misoprostol 46.0% v dinoprostone 41.2% okay so if 46% did not birth vaginally and 22.7% had cs what happened to the other23.3% that didn't birth vaginally Also, are women going to be told that they havealmost a 50% chance of needing a cs with an induction?That inductions fail almost half the timegee I know, lets do what the prominent OB from Adelaide is suggesting and induce all women at 39 weeks andalmost double our cs rate! caesarean section 22.7% v 26.6% and we wonder why we have a national cs rate of over 25%!!! caesarean section for fetal distress 8.8% v 9.3% uterine hyper stimulation with changes in fetal heart rate 0.8% v 1.6% and yet the risk of rupture being an estimated 0.3% is too high to offer vbac as an optionlets give these women a drug that can hyper stimulate their uteri and increase the chance of serious morbidity or mortality and potentially leave them with a ruptured uterus despite not having a previous scar. *sigh* I seriously wonder sometimes how these academics get funded! Oh sorry, this was a drug company who will benefit from this study...not women. I have a suggestion: why doesn't someone get funding to do atrial into spontaneous non-interventative (minus the actual medical need)birthvs. active management and compare the outcomes? Lets actually see if natural noninvasive supported and educated birth is fraught with the dangers that we get thrown at us. grr grr grr Jo -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary MurphySent: Saturday, March 04, 2006 7:08 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] trials At least they asked the women’s preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial-BMJ,vol 332, no 7540, 4 March 2006, pp 509-511Dodd JM; Crowther CA; Robinson JS-(2006)OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author) --No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
RE: [ozmidwifery] trials
Title: Message I attended a birth at home early this morning as 2nd midwife. Primip, vaginal water birth, non -directed second stage, physiologic 3rd stage. Small 2nd deg. Tear, sutured by midwife. A beautiful birth of a.3.7kg baby. I was speaking to a midwife who works in the birth suite of our large teaching hospital where about 5,000 women give birth. Some high risk but most potentially normal birth. She was thrilled to hear about the birth. She said she never sees anything like it where she works. How sad,. MM Subject: RE: [ozmidwifery] trials vaginal birth not achieved in 24 hours misoprostol 46.0% v dinoprostone 41.2% okay so if 46% did not birth vaginally and 22.7% had cs what happened to the other23.3% that didn't birth vaginally Also, are women going to be told that they havealmost a 50% chance of needing a cs with an induction?That inductions fail almost half the timegee I know, lets do what the prominent OB from Adelaide is suggesting and induce all women at 39 weeks andalmost double our cs rate! caesarean section 22.7% v 26.6% and we wonder why we have a national cs rate of over 25%!!! caesarean section for fetal distress 8.8% v 9.3% uterine hyper stimulation with changes in fetal heart rate 0.8% v 1.6% and yet the risk of rupture being an estimated 0.3% is too high to offer vbac as an optionlets give these women a drug that can hyper stimulate their uteri and increase the chance of serious morbidity or mortality and potentially leave them with a ruptured uterus despite not having a previous scar. *sigh* I seriously wonder sometimes how these academics get funded! Oh sorry, this was a drug company who will benefit from this study...not women. I have a suggestion: why doesn't someone get funding to do atrial into spontaneous non-interventative (minus the actual medical need)birthvs. active management and compare the outcomes? Lets actually see if natural noninvasive supported and educated birth is fraught with the dangers that we get thrown at us. grr grr grr Jo -Original Message- From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy Sent: Saturday, March 04, 2006 7:08 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] trials At least they asked the womens preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial-BMJ,vol 332, no 7540, 4 March 2006, pp 509-511Dodd JM; Crowther CA; Robinson JS-(2006)OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author) -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2
RE: [ozmidwifery] trials
Title: Message the sad thing is that she works at a teaching hospital where they have only one thing they are familiar with -managed birth...so they are perpetuating the status quo. it is sad Mary. -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
Re: [ozmidwifery] trials
On 3/4/06, Dean Jo [EMAIL PROTECTED] wrote: cs what happened to the other 23.3% that didn't birth vaginally What the research said was that 23.3% did not deliver within 24hours. So they either failed to be inducded at all or took longer than 24hours to birth their babies. Also, are women going to be told that they have almost a 50% chance of needing a cs with an induction? Obviously only 22.5% actually required a CS (Yes too high still acording to WHO guidlines) but where did you get 50% risk from? That inductions fail almost half the time Once again where does this percentage come from. You raise really valid issues but this trial seemed to me to be offering birthing women a better option for induction than the very invasive Vaginal option. Yes we do too many IOL'S and way too many C/S's. But many women don't know, don't care or don't have any choice and this particular peice of research might just give them one more option that is less invasive. As for the VBAC situation - women can choose a vbac, many choose elective C/S too. At least they asked the women's preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial - BMJ , vol 332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther CA; Robinson JS - (2006) OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author) -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- My photos online @ http://community.webshots.com/user/mike1962nz My Group online @ http://groups.yahoo.com/group/PSP_for_Photographers New Photo site@ Mike - http://mikelinz.dotphoto.com Lindsay - Http://likeminz.dotphoto.com Life is a sexually transmitted condition with 100% mortality and birth is as safe as it gets. Unknown -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
