Re: [ozmidwifery] RE Twins
I have copied two articles which may be of some help to you. All the best, Leanne. Investigating the inter-twin interval Issue 11: 30 May 2005 Source: American Journal of Obstetrics and Gynecology 2005; 192: 1420-2 The length of time between the birth of the first and second twin has no significant effect on the immediate neonatal outcome of the younger twin, according to the results of a new study. Specialists in maternal-fetal medicine at the Saint Joseph Mercy Hospital in Ypsilanti, Michigan, USA, reviewed the hospitals medical records concerning the neonatal outcomes of all live-born viable vaginal twin deliveries over a 6-year period: a total of 144 sets of twins. They used statistical analyses to identify factors significantly associated with immediate neonatal outcomes of the second twin: the umbilical arterial pH, the umbilical venous pH, the 1-minute Apgar score and the 5-minute Apgar score. Overall, the inter-twin time interval for the twins studied ranged from a few minutes to an extreme of about 130 minutes. The 1- and 5-minute Apgar scores were significantly predicted only by gestational age and birth weight, while umbilical arterial and venous pH were significantly predicted only by the inter-twin interval. For every extra minute of the inter-twin interval, the arterial pH fell linearly by 0.00063 units, and the venous pH by 0.00081 units. Second twins born more than 45 minutes after the first twin typically had an arterial or venous pH that was 0.07 units lower than that of second twins born within 15 minutes of the first twin. Not clinically relevant? The researchers say their study confirms that a longer inter-twin interval is associated with a continuous slow decline in umbilical cord pH. But they add: However, although these pH differences may be of note from a physiologic standpoint, we do not believe that they are of a magnitude great enough to influence clinical management. They continue: We believe our data support the view that expectant management of the second twin birth is appropriate and do not support arbitrary intervention based solely on time. The second-twin delivery dilemma Issue 08: 22 Apr 2002 Source: European Journal of Obstetrics Gynecology and Reproductive Biology 2002; In press (lead author Pons J-C) The first twin has been delivered successfully, but what is the optimal method for delivering the second? The two main options are active and expectant management, a choice that has been the subject of debate among specialists for many years. That debate is now furthered by a new study comparing the two approaches. Specialists in Grenoble and Paris, France, carried out a retrospective study investigating twin births at two maternity units over a 2-3 year period: a total of 78 pairs of twins at the Port-Royal unit in Paris, and 113 pairs at the Antoine Beclere unit in Clamart. All the first twins had been delivered vaginally. The expectant approach At the Antoine Beclere, the obstetrics team generally applied the expectant approach to delivering the second twin. This is based on respect for the natural process of twin delivery: the delivery of the first twin (twin A), then an interval of 10-15 minutes marked by a halt to uterine contractions, then resumption of contractions and delivery of the second twin (twin B), followed by the afterbirth. As the researchers point out in their paper, the role of the medical team is to accompany this process, with watchful waiting, fetal heart rate monitoring, external version of the second twin in a transverse lie towards the longitudinal, and patience. An objective is to avoid maneuvers considered traumatizing (such as total breech extraction) or alternatives such as cesarean delivery of twin B. The average delay between the birth of two twins at this unit was 9 minutes. A total of 51 percent of deliveries were spontaneous, with intra-uterine manipulation applied to only 2 percent of the second twins. It was necessary to perform a cesarean to deliver the second twin in five of the 113 cases. The active approach In contrast, the team at the Port-Royal largely applied the active approach to delivering twin B, based on the view that time spent in utero after the birth of twin A is harmful. The difficulty of fetal monitoring and the risk of acute fetal distress and of retraction of the cervix may make the second twin's delivery very difficult, if not impossible, the researchers note. The active approach aims to limit the duration of the interval between the two births. After the birth of twin A, the artificial rupture of the membranes must be followed by twin B's birth, either spontaneously or assisted by obstetric maneuvers. At the Port-Royal, the average time between the two births was 5 minutes, and 43 percent of twin B births involved substantial intra-uterine manipulations to assist vaginal delivery. Only 27 percent of the deliveries were
RE: [ozmidwifery] RE Twins/placenta
Surely the condition of the placenta can be monitored by fetal movements and growth. An unhealthy placenta is going to affect the baby quickly. Placentas do deteriorate towards the end of pregnancy, that's one reason they don't like babies to go too far past term. But then there are ways to assess fetal wellbeing that has to also reveal the placentas condition. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of jesse/jayne Sent: Thursday, 2 June 2005 12:11 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] RE Twins/placenta And, can the condition of twins placenta/s be expected to deteriorate earlier than a singleton's?? Jayne - Original Message - From: Justine Caines [EMAIL PROTECTED] To: OzMid List ozmidwifery@acegraphics.com.au Sent: Thursday, June 02, 2005 11:28 AM Subject: Re: [ozmidwifery] RE Twins They say there is no way of telling the condition of the placenta, Hello Midwives out there Is the above true?? Is it specific to twins? I thought an ultrasound could certainly show the condition of the placenta JC -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] RE Twins
Having read both the articles supplied, comment on the second one. I know the OB people have to gain skills for emergencies but it is pretty pathetic to subject mothers and babies to the trauma and anxiety of these obstetric interventions just for practice. Another example of women and babies not being respected by the medical establishment in that hospital. Cheers Judy --- leanne wynne [EMAIL PROTECTED] wrote: I have copied two articles which may be of some help to you. All the best, Leanne. Investigating the inter-twin interval Issue 11: 30 May 2005 Source: American Journal of Obstetrics and Gynecology 2005; 192: 1420-2 The length of time between the birth of the first and second twin has no significant effect on the immediate neonatal outcome of the younger twin, according to the results of a new study. Specialists in maternal-fetal medicine at the Saint Joseph Mercy Hospital in Ypsilanti, Michigan, USA, reviewed the hospitals medical records concerning the neonatal outcomes of all live-born viable vaginal twin deliveries over a 6-year period: a total of 144 sets of twins. They used statistical analyses to identify factors significantly associated with immediate neonatal outcomes of the second twin: the umbilical arterial pH, the umbilical venous pH, the 1-minute Apgar score and the 5-minute Apgar score. Overall, the inter-twin time interval for the twins studied ranged from a few minutes to an extreme of about 130 minutes. The 1- and 5-minute Apgar scores were significantly predicted only by gestational age and birth weight, while umbilical arterial and venous pH were significantly predicted only by the inter-twin interval. For every extra minute of the inter-twin interval, the arterial pH fell linearly by 0.00063 units, and the venous pH by 0.00081 units. Second twins born more than 45 minutes after the first twin typically had an arterial or venous pH that was 0.07 units lower than that of second twins born within 15 minutes of the first twin. Not clinically relevant? The researchers say their study confirms that a longer inter-twin interval is associated with a continuous slow decline in umbilical cord pH. But they add: However, although these pH differences may be of note from a physiologic standpoint, we do not believe that they are of a magnitude great enough to influence clinical management. They continue: We believe our data support the view that expectant management of the second twin birth is appropriate and do not support arbitrary intervention based solely on time. The second-twin delivery dilemma Issue 08: 22 Apr 2002 Source: European Journal of Obstetrics Gynecology and Reproductive Biology 2002; In press (lead author Pons J-C) The first twin has been delivered successfully, but what is the optimal method for delivering the second? The two main options are active and expectant management, a choice that has been the subject of debate among specialists for many years. That debate is now furthered by a new study comparing the two approaches. Specialists in Grenoble and Paris, France, carried out a retrospective study investigating twin births at two maternity units over a 2-3 year period: a total of 78 pairs of twins at the Port-Royal unit in Paris, and 113 pairs at the Antoine Beclere unit in Clamart. All the first twins had been delivered vaginally. The expectant approach At the Antoine Beclere, the obstetrics team generally applied the expectant approach to delivering the second twin. This is based on respect for the natural process of twin delivery: the delivery of the first twin (twin A), then an interval of 10-15 minutes marked by a halt to uterine contractions, then resumption of contractions and delivery of the second twin (twin B), followed by the afterbirth. As the researchers point out in their paper, the role of the medical team is to accompany this process, with watchful waiting, fetal heart rate monitoring, external version of the second twin in a transverse lie towards the longitudinal, and patience. An objective is to avoid maneuvers considered traumatizing (such as total breech extraction) or alternatives such as cesarean delivery of twin B. The average delay between the birth of two twins at this unit was 9 minutes. A total of 51 percent of deliveries were spontaneous, with intra-uterine manipulation applied to only 2 percent of the second twins. It was necessary to perform a cesarean to deliver the second twin in five of the 113 cases. The active approach In contrast, the team at the Port-Royal largely applied the active approach to delivering twin B, based on the view that time spent in utero after the birth of twin A is harmful. The difficulty of fetal monitoring and the risk of acute fetal distress and of retraction of the cervix may make the second
RE: [ozmidwifery] RE Twins/placenta
There is research that says placentas go on making new cells, even at the 'end' of the gestation period. (no I don't have the reference, just something I skimmed over one time)Also,some placentas can malfunction even at 28 weeks and others don't at 42 + weeks, so it is not necessarily a time thing . MM growth. An unhealthy placenta is going to affect the baby quickly. Placentas do deteriorate towards the end of pregnancy, that's one reason they don't like babies to go too far past term. But then there are ways to assess fetal wellbeing that has to also reveal the placentas condition. And, can the condition of twins placenta/s be expected to deteriorate earlier than a singleton's?? Jayne Subject: Re: [ozmidwifery] RE Twins They say there is no way of telling the condition of the placenta, Hello Midwives out there Is the above true?? Is it specific to twins? I thought an ultrasound could certainly show the condition of the placenta JC -- 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] MidResearch
I'm keen to see anything on this too. I did a search on it a few weeks ago, and discovered that in all people, the dominant arm tends to have a higher BP. So I guess you take it on the right arm because most women are right handed and you want the higher BP from a PE perspective? Also, sitting/supine affects BP. I did find these: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrievedb=PubMedlist_uids=9219119dopt=Abstract http://www.greenjournal.org/cgi/content/abstract/55/3/285 which might help. Please let me know if you find anything else. Kate - Original Message - From: Ceri Katrina [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, June 01, 2005 9:18 PM Subject: Re: [ozmidwifery] MidResearch On the topic of research, does anyone have any evidence on why we take BP on the right arm antenatally?? And any other guidelines or evidence on 'how' to take the BP??? thanks Katrina -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Mid positions available in Warragul, Vic.
There are 2 positions going at our wonderful work place: Midwife in Charge Team Midwife Anyone out there who may be interested (we have the best VBAC rate in the State...possibly the country?) please take a look at our website apply. We need more like-minded midwives to join us!! http://www.wghg.com.au/jobads.htm Cheers Carol -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
[ozmidwifery] quote
Thought for the Day: Optimists convert stumbling blocks to stepping stones. W. Howard Wight, Jr.
Re: [ozmidwifery] MidResearch
Hi Kate I think the right arm is used exclusively so that we all collect blood pressure data from pregnant women in the same way. The woman's BP recordings can then be scientifically compared with BP data collected from other pregnant women. The initiative of gathering comparative data globally came from an international group of researchers looking at hypertension in pregnancy (all hypertension specialists) many years ago. I can't remember the name of the group - perhaps someone else on this list knows it? The group recommended that professionals involved in maternity care should use the same assessment techniques globally to assist collection of reliable research data. Australian midwives can be assured that if they record a pregnant woman's BP using the appropriate cuff applied to the right arm, with the woman sitting and feet supported, that the data they collect can be safely compared with that collected from an pregnant Inuit woman living in Alaska. That's my understanding Cheers Jan Jan Robinson Independent Midwife Practitioner National Coordinator Australian Society of Independent Midwives 8 Robin Crescent South Hurstville NSW 2221 Phone/Fax: 02 9546 4350 e-mail address: [EMAIL PROTECTED]> website: www.midwiferyeducation.com.au On 2 Jun, 2005, at 19:15, Kate /or Nick wrote: I'm keen to see anything on this too. I did a search on it a few weeks ago, and discovered that in all people, the dominant arm tends to have a higher BP. So I guess you take it on the right arm because most women are right handed and you want the higher BP from a PE perspective? Also, sitting/supine affects BP. I did find these: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrievedb=PubMedlist_uids=9219119dopt=Abstract http://www.greenjournal.org/cgi/content/abstract/55/3/285 which might help. Please let me know if you find anything else. Kate - Original Message - From: Ceri Katrina [EMAIL PROTECTED]> To: ozmidwifery@acegraphics.com.au> Sent: Wednesday, June 01, 2005 9:18 PM Subject: Re: [ozmidwifery] MidResearch On the topic of research, does anyone have any evidence on why we take BP on the right arm antenatally?? And any other guidelines or evidence on 'how' to take the BP??? thanks Katrina -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au> to subscribe or unsubscribe.
[ozmidwifery] NYTimes.com: Home Delivery Is Available
Title: E-Mail This This page was sent to you by: [EMAIL PROTECTED] Message from sender: Homebirth in New York State. Thought everyone might be interested. Take care Alphia NEW YORK REGION | June 2, 2005 Home Delivery Is Available By ANEMONA HARTOCOLLIS Midwifes keep busy despite a decline in births outside of hospitals. 1. Op-Ed Columnist: Truth and Deceit 2. Op-Ed Columnist: Fear and Rejection 3. Class Matters: The Five-Bedroom, Six-Figure Rootless Life 4. Watching New Love as It Sears the Brain 5. How Personal Is Too Personal for a Star Like Tom Cruise? Go to Complete List Advertisement /- E-mail Sponsored by Fox Searchlight Pictures \ Watch the teaser trailer now for ROLL BOUNCE - in theaters September 23 In the late 70s when roller skating was a way of life, X (Bow Wow) and his pals ruled supreme. But when the doors of their local skating rink close, it marks the end of an era and the beginning of another that sees the boys venture into foreign territory - uptowns Sweetwater Roller Rink, complete with its over-the-top skaters and beautiful girls. http://www.foxsearchlight.com/rollbounce/index_nyt.html Do you love NY? Get the insiders guide to where to stay, what to do and where to eat. Go to www.nytimes.com/travel for your NYC Guide now. Click here. Copyright 2005 The New York Times Company | Privacy Policy
[ozmidwifery] Fw: Friends of the Birth Centre Brisbane 10th Birthday Festival
THE BIRTH CENTRE BRISBANE10TH BIRTHDAY FESTIVAL YOU ARE INVITED! You may be aware the Birth Centre at Royal Women's Hospital Brisbane is approaching a 10 year milestone in June 2005. Friends of The Birth Centre Association do not want to let this achievement pass unrecognised. They are planning to hold a large family orientated festival on the Celebration Lawn at Roma Street Parklands on Saturday, 18th June 2005. They aim to generate public media interest with live entertainment, food, kids activities, interactive demonstrations and stalls to create a festival atmosphere. Please come one and all to offer your support particularly in the light of what has happened recently. Bring your family, friends and significant others to a day of fun and celebration. Hope to see you there, Anne Clarke Midwife Birth Centre -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[no subject]
Hi, I am forwarding this info for anyone who might like to do some casual work at Cohuna Hospital (on the Murray River in Victoria). They are experiencing some difficulties covering all of their shifts. Nicole Carver Hi Nicole, Sue from On Times Nurses has asked me to send you the following re the Midwife position at Cohuna Hospital Dates 6th June - 31st July. Pay - Cohuna Hospital will pay G2 Yr 9 rates, up to G5 when in charge. On Time will pay a 'top up' on an hourly rate, which is not taxable. Travelling is tax deductible, a log book is required for this. Kerang hospital has 2 weekend shifts available during the period, these weekends could be picked up as well. Please contact Sue Bourchier at On Time Nurses 1300 730 562 for further information Cheers David -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] MidResearch
The following link has relevant info. Instruction on how to take BP in preg. This is the consensus statement for Australia http://www.racp.edu.au/asshp/news.htm Jenny - Original Message - From: Ceri Katrina [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, June 01, 2005 9:18 PM Subject: Re: [ozmidwifery] MidResearch On the topic of research, does anyone have any evidence on why we take BP on the right arm antenatally?? And any other guidelines or evidence on 'how' to take the BP??? thanks Katrina -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.3.3 - Release Date: 31/05/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] 'Stateline' being aired @ 7.30pm Fri 3rd June, a must see
Hi Ozmidders (esp. QLDer's),In the ABC promo last night for 'Stateline' being aired@ 7.30pm tonight (Fri 3rd June)it showed snippets of Cherrell Hurst being interviewed, should be be VERY interesting viewing tonight. She was the Reviewer of the recent Report on QLD's Birthing Services entitled"Re-Birthing". Cheers.Jo
