Re: [ozmidwifery] ACTIVE Vs EXPECT MAGMT
Hi Judy, After reading your post it reminded me of what one of my friends said (she is a midwife and works for MSF). She was in western Africa and if a person had a Hb over 80 they would use them as a blood donar if they needed one!! Cheers MichelleMaternity Ward Mareeba Hospital [EMAIL PROTECTED] wrote: Just a comment on why so many PPH deaths in underdeveloped countries. At a symposium I went to in Saudi Arabia many years ago one of the speakers was an African Dr. His subject was anemia in the underprivelaged and he spoke of how severely anaemic many of the women are. As a result PPH is more quickly devastating than in a woman with a normal (or nearly normal) Hb level. Cheers Judy [EMAIL PROTECTED] 02/28/05 07:05am Hi everyone. Back on the list and great topics abound !!I wrote a critical analysis last yr on active vs expectant management formaglobal perspective. Interestingly the infamous Hinchinbrook trial didacknowledge the type of labours. However there were significantdiscrepancies in my observation of the methodology eg: the confidence ofmidwives to support expectant management and no record of home births.I have personally noted a large no of women having a pph following activemanagement (according to the 500 defn) but also following induction oflabour , particularly withg syntocinon. In some areas such as homebirththese drugs are never used for IOL, in addition to countries like Germanywhere I have heard of acupuncture now being offerred for IOL in the hospitalsetting.There are 2 main issues with PPH. The g! lobal maternal mortality rate isapprox 600, 000 women die a year (of reported deaths). Over 90% of thesedeaths are in developing countries and largely due to PPH. Drugs like syntoare viewed by some authors as problematic as many tropical areas cannotrefridgerate and therefore cannot use synto. There is move afoot to look atother methods that do not require refridgeration. One begs the question,why so many deaths ? Is it related to the various experiences of managmentby TBA's who attend to most of the births ? Is it related to the factthousands of women spend days in labour and on their own ? Is itdehydration ? Malnutrition ? The list goes on... It certainly isrelated to a poor level of care and pathetic govt priorities in my view, tonot ensure as many women as possible have pregnancy birth and postpartumcare.In my view this is where the true crisis of PPH lies.Having said that.! bsp; There is no global or even national standardisedmeasurement of loss (process), nor is there an agreed global standardiseddefinition of pph as many of you have so aptly pointed out.Certainly I think there is need for further research comparing the activeand expectant magmt techniques where there is no confidence bias, thatincorporates accurate defns of labour type also. Even a RCT looking at IOLwith synto vs No IOL of women 39-42 weeks and comparing their loss could besignificant.Thanks Sue for your insights on your practice and the wonderful knowledge ofJohn's wisdom. In my experience I always keep arnica and the australian bushflower essences on hand and discovered through my kinesiology practice aboutten yrs ago the need for a woman to have a homeopathic known as UstilagoMaidus twice antentally and three times in the immediate postpartum.I have then seen it used on three more occasions and would not hes! itate tohave it on hand, particularly for remote rural areas.On another note, I have also noted that pph is common for women who have aprecipitous labour. Often these women appear to be in shock after the highof a beautiful, sometimes intense or furious labour.On an emotional and spiritual reflection of practice, I have also noted itis not uncommon for women who have experienced abuse to have a very veryfast or very very long labour also. And a pph. It is afterall the essenceof the life/death paradigm and I try to remain aware of this particularly ifthe dissasociation and trauma of unrecognised abuse arises in labour. Ithink it is important when a pph is not obviously drug induced or activelyinduced, we are alert to what the 'triggers' of the emotion around a pphcould be.Again, another reason highlighting the importance of one-to-one midwiferycare.Also a comment re the G10 P9 woman - I would c! onsider assessing the wishesof the woman, the previous history, the current history and emotionalwellbeing as to whether the synto would be needed. I have also heard andwould be glad to follow up with the cnc who gave me this info that there iscurrent research concluding that the grand multi status is no longer afactor for routine synto.Kind Regards to you allSally-Anne Brown***This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is
Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Hello Marilyn I am surprised that litigation- mad America sanctioned midwives performing MROP. If the placenta is difficult to remove manual removal may result in death from shock as well as haemorrhage. Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 01, 2005 2:24 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Jenny: I know that what you say is Australian practice and if i were attending homebirths here I would always transfer rather than do a manual removal of either a partially detached placenta or retained products however it wasn't considered outside of a midwife's scope of practice in the USA where I practised (california and washington state), in fact it was required by state law that i be capable of carrying out this procedure. The exact procedure is detailed in Varney's Midwifery third edition, p. 843, Chap 68. Most certaily considered part of the midwife's scope of practice. I would suggest that any birth attendant practicing in an out of hospital setting should at least know what to do and have practiced the procedure just in case which is what Sue was saying is her situation. I have never actually done the procedure myself but was knowledgeable of it, tested on it with simulation (as it is NOT something you practice on someone) and aware when it is necessary. Definetely quite different than removing a placenta trapped in the vaginal vault, the os, or lower segment. marilyn - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, February 27, 2005 9:00 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Manual removal of a separated placenta is different to manual removal of a placenta still attached to the uterine wall. Removing a separated placenta from the os or lower segment is not difficult but it is uncomfortable for the woman. Manually detaching a placenta from the uterine wall is barbaric and traumatic and should not be carried out unless under adequate anaesthetic and fluid replacement. Granted a partially separated placenta is a high risk situation as bleeding will continue until separation. Although this is an emergency we would better to summon help and use bi-manual compression to slow/stop the bleeding until assistance arrives. If you are performing true manual removal of the placenta and membranes (ie partially separated placenta ) as a midwife you are practising outside your scope of practice. Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, February 28, 2005 7:31 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Hi Sue, I was taught that if doing a manual removal would effectively save the woman's life, then that was the best option. Obviously a risk vs benefit type of situation. The doctor I trained with did the occasional manual removal at home rather than the time challenging option of transferring, and always with the woman's cooperation. I work rurally, and sometimes the speed of the bleed and the distance from hospital would equal real damage to the woman. As I said in my posting, I have not had to perform a manual removal, but I can and would if it was a life saving procedure. I thought the hospital acted very dangerously by delaying many aspects of their management of the PPH I witnessed last year, and that all up, a manual removal there and then would have been the quickest and safest option. Instead the woman went on to lose much more blood over another 40 minutes or so until in theatre, and then faced the choice of transfusion. I found that management very scary. I have witnessed one manual removal in a hospital on the delivery bed after the cord tugging GP/Obs broke the cord whilst trying to extract the placenta (after a forceps delivery). He simply went straight in after the placenta and delivered it quite quickly. The woman was not too perturbed!! (and hadn't had any drugs either). So I guess it's a matter of training, attitude, access and appropriateness - all to be assessed in a very short time frame if a real bleed is occurring. Sue I am a bit confused here - can you please explain how you do manual removal in the home situation? Surely this is too dangerous a procedure to do at home? Thanks Sue - Original Message - *From:* Marilyn Kleidon mailto:[EMAIL PROTECTED] *To:* ozmidwifery@acegraphics.com.au mailto:ozmidwifery@acegraphics.com.au *Sent:* Monday, February 28, 2005 1:34 PM *Subject:* Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Totally agree Sue. I was taught manual removal too and exactly the same re when to apply gentle but firm CCT. However, for a manual
[ozmidwifery] Intrapartum Foetal Surveillance Education Program in Victoria
Can anyone tell me what the crux of this program is??? http://www.ranzcog.edu.au/ifse_program/index.shtml It seems to be about obstetricians educating midwives on CTG interpretation - I can envisage seeing a lot more caesars for "foetal distress" as a result, with babies apgars of 9 and 10 as the outcome.. Helen Cahill Feeling cynical
Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Needless to say the procedure is not done very often and always the preferred place would be a hospital and under analgesia if not anaesthetic. If it where done at home it would always be with the consultation of a backup obstetrician by telephone. However as I said it was a required skill at least in simulation for graduation. As in Sue's case many independent midwives there do work in rural and remote locations where despite all efforts actual transfer times can be greater than 1 hour usually due to weather. This expectation has been around since at least the 1970's and in some states such as Washington where midwifery never became illegal, since 1917. As always the procedure would only be done when the risks of not doing it outweigh the risks of doing it in that particular location. A friend of mine who has attended over 2,000 births in the Seattle area since 1981 has performed the procedure once in that time, successfully with the mother and baby being able to remain at home albeit with the midwife sleeping over. Obviously litigation risks have also changed in the last 30 years and also at least in Seattle so has the transfer transport facillitation. I have heard several descriptions from midwives in the Washington-Oregon corridor who have done the procedure at least once and successfully. As with Sue many of these midwives were originally trained and educated by docs who were still attending homebirths through the 1970's, consequently they were taught many procedures that were not part of the hospital repertoire. Others have taken placements in developing countries (from Jamaica to the Phillipines) in charity hospitals where this (manual uterine exploration without anaesthetic) unfortunately is standard procedure even after the placenta has delivered, I am not sure but I actually think this was standard obstetric practice in the USA through the 1970's and maybe why it was also included as part of midwifery practice. Contrary to Australian perceptions of both nursing and midwifery in the USA and Canada, Nurses and Midwives there have provided basic care in many frontier outposts for a long time, it isn't all LA and NY though even there nurse practitioners and midwives practice. To be honest Australia seems much more litigation minded than the USA at least to me. Intervention is actually much more routine here and for public hospitals the c/s rate is almost 10% higher, I am comparing Washington, Oregon and California with Queensland. You also have to be aware that where midwives work in the USA whether it is in or out of hospital they do work with the authority of at least a nurse practitioner in Australia. An obstetric nurse would never do an MROP but neither would she catch a baby, a midwife would only do an MROP with consultation with an OB and would certainly step aside if one were available where she was attending a woman. Of course if a midwife performed the procedure inappropriately and especially if the mother was harmed she could expect to have her licence suspended if not revoked. Nurse Midwives in the USA can and do perform procedures and have prescription priveleges that are certainly part of the GP's scope of practice here. I am surprised at the number of retained placentas I have become aware of since working here and the associated extreme blood loss (approaching 2L), what was a truly rare occurrence for me is actually quite common in a hospital at least much more common that I expected. Since I didn't work in the hospital there except on occassions of transfer, I can't really compare the hospital systems, so their MROP rates in hospital may actually be similar. marilyn - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 01, 2005 4:59 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Hello Marilyn I am surprised that litigation- mad America sanctioned midwives performing MROP. If the placenta is difficult to remove manual removal may result in death from shock as well as haemorrhage. Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 01, 2005 2:24 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Jenny: I know that what you say is Australian practice and if i were attending homebirths here I would always transfer rather than do a manual removal of either a partially detached placenta or retained products however it wasn't considered outside of a midwife's scope of practice in the USA where I practised (california and washington state), in fact it was required by state law that i be capable of carrying out this procedure. The exact procedure is detailed in Varney's Midwifery third edition, p. 843, Chap 68. Most certaily considered part of the midwife's scope of practice. I would suggest that
RE: [ozmidwifery] breastmilk for preterm babies
Hi I work in NICU (in addition to being a student midwife). We encourage the mothers to begin expressing ASAP and we use al the milk and colostrum. We tend to begin enteral feeds quite quickly ie in the first 2-3 days at a very low rate... perhaps 1ml 12 hrly for littlies. We have a clear policy regarding storage of EBM. Can be in the fridge for up to 5 days. We freeze a lot of milk and it can be kept in the deep freeze for 6-12 months depending on the type of freezer. Once defrosted we use it within 24 hrs. All EBM is double checked before use. All calories are double checked. We don't get a lot of HIV mothers so I am unsure about our practice there, however we have had mothers with Hep B who have breastfed. Hope this answers the question Cheers Linz -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Denise Fisher Sent: Wednesday, March 02, 2005 9:08 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] breastmilk for preterm babies Hi all I've had an enquiry from a Lactation Consultant in France wanting to know about how we in Australia manage mother's milk for our preterm babies. Could you please share with me what your NICU and SCBU does? ie... is all colostrum and breastmilk automatically saved and given to the baby as soon as baby is tolerating enteral feeds? How is this milk stored? Does the mother have to be checked for HIV, Hep B, C, CMV, HTLV1, HTLV2? Is mothers own breastmilk treated in any way - ie must be frozen, must be pasteurised, etc. All I want is a general idea - you don't need to identify your units, unless of course you are particularly proud of your excellent breastfeeding-friendly practices :-) Thank you Denise *** Denise Fisher Health e-Learning http://www.health-e-learning.com [EMAIL PROTECTED] -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.300 / Virus Database: 266.5.7 - Release Date: 3/1/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.300 / Virus Database: 266.5.7 - Release Date: 3/1/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Looking for Jackie Kitschke.
Hi Jackie, I do not know whether you still remember me. I am originally from Belgium and as a part of my midwifery education, I did a placement at the women's children's hospital. I have very fond memories of my time in the birthing centre. It took me ages and ages to get my registration sorted over here, but I can expect it any day now. I am currently applying for several jobs since I haven't had all that much experience over here, it is hard to provide them with some referees. Would you mind being one of my referees? What are you doing at the moment? I have noticed that the birthing centre is no longer there. Hope you are well that you'll get this message in the very near future. Greetings love, Sara De Houwer. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Intrapartum Foetal Surveillance Education Program inVictoria
Dean Jo wrote: A unit in the UK reduced their cs rate astronomically by implementing some strategies: one being continuous up skilling of CTG readout interpretations. Perhaps the increase in cs is related to misinterpretations and this might help perhaps??? Jo The way we are trying to reduce our foetal distress c/s rate with good apgars is to educate the new doctors better on doing foetal scalp sampling to determine actual oxygenation of the baby, rather than just going by the CTG. It has resulted in more FBS's (obviously) but those whose traces look sinister are not just being whipped off to theatre without first identifying a real need to do so. In an audit we did, there were a few c/s done with the woman at 7cm dilated, for foetal distress, good apgars, good cord pH's and NO foetal blood sampling done. That's what we are trying to change. Jo (RM)
[ozmidwifery] Human Milk Bank
This info is cut and pasted from Jen Semple's email to the MC Midwives list in August 2004: FYI.. Apologies for the cross-post...http://www.theage.com.au/articles/2004/08/12/1092102573402.htmlAustralia's first milk bankAugust 12, 2004 - 1:06PMAustralia's first milk bank is to start offering breast milk to newmothers in Victoria from the beginning of next year.Melbourne-based lactation consultant Margaret Callaghan plans to openthe private service which will pasteurise milk donations and offer themto mothers who cannot produce enough for their own babies.The proposal has raised questions about how the new service would beregulated.Ms Callaghan said the private company setting up the Victorian milk bankplanned to set up in NSW next and then to establish clinics nationwide.She said new mothers who wanted to donate would be screened for diseaseand would then express the milk at home."It wouldn't be like a cow shed," she said.The milk would be pasteurised and given to premature babies whosemothers for some reason could not provide enough milk.Premature babies would be targeted initially as they were the mostlikely to suffer necrotising enterocolitis (NEC), or bowel blockages,after being fed formula, she said.Mothers milk also aided neurological development and reduced the risksof infections, Ms Callaghan said.Hospitals used to provide excess milk from new mothers to babies whoneeded it until the rise of the spectre of AIDS in the 80s.Ms Callaghan said that as the average age of mothers increased, so hadthe demand for breast milk."I have people ringing me saying 'Where can I get some human milkfrom'," she said.The president of paediatrics and child health of the Royal AustralasianCollege of Physicians, Professor Don Roberton today said any move tomake breast milk more available was positive as long as the milk wasproperly screened for disease.Professor Roberton said human milk had advantages over formula,especially for premature babies."But we also have to be very aware of any potential risks that mightoccur with human milk," he said.Breast milk would need to be carefully screened in the same way donatedblood was, he said.Breast milk banks operate in the UK, the USA and parts of Europe but theprospect of them opening in Australia has raised the question of who isresponsible for their regulation.A Therapeutic Goods Administration spokesman said a breast milk bankwould be a state rather than a federal responsibility.A spokesman for the Victorian Department of Human Services said a breastmilk bank would come under the State food act.The operators would have to show their product was "free of infectionand fit for human consumption" and convince the government that they hadstrict screening processes in place, he said.- AAP No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.300 / Virus Database: 266.5.2 - Release Date: 28/02/2005
Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Thanks for the detailed insight Marilyn. My view is probably clouded by the stark memory I have of a GP performing a MROP on an unanaesthetised or analgesed woman when I was a student. I can still see the look of pain and terror on her face as she headed for the overbed light. I accept we can do these procedures as long as we are accredited. Cheers Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, March 03, 2005 12:35 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Needless to say the procedure is not done very often and always the preferred place would be a hospital and under analgesia if not anaesthetic. If it where done at home it would always be with the consultation of a backup obstetrician by telephone. However as I said it was a required skill at least in simulation for graduation. As in Sue's case many independent midwives there do work in rural and remote locations where despite all efforts actual transfer times can be greater than 1 hour usually due to weather. This expectation has been around since at least the 1970's and in some states such as Washington where midwifery never became illegal, since 1917. As always the procedure would only be done when the risks of not doing it outweigh the risks of doing it in that particular location. A friend of mine who has attended over 2,000 births in the Seattle area since 1981 has performed the procedure once in that time, successfully with the mother and baby being able to remain at home albeit with the midwife sleeping over. Obviously litigation risks have also changed in the last 30 years and also at least in Seattle so has the transfer transport facillitation. I have heard several descriptions from midwives in the Washington-Oregon corridor who have done the procedure at least once and successfully. As with Sue many of these midwives were originally trained and educated by docs who were still attending homebirths through the 1970's, consequently they were taught many procedures that were not part of the hospital repertoire. Others have taken placements in developing countries (from Jamaica to the Phillipines) in charity hospitals where this (manual uterine exploration without anaesthetic) unfortunately is standard procedure even after the placenta has delivered, I am not sure but I actually think this was standard obstetric practice in the USA through the 1970's and maybe why it was also included as part of midwifery practice. Contrary to Australian perceptions of both nursing and midwifery in the USA and Canada, Nurses and Midwives there have provided basic care in many frontier outposts for a long time, it isn't all LA and NY though even there nurse practitioners and midwives practice. To be honest Australia seems much more litigation minded than the USA at least to me. Intervention is actually much more routine here and for public hospitals the c/s rate is almost 10% higher, I am comparing Washington, Oregon and California with Queensland. You also have to be aware that where midwives work in the USA whether it is in or out of hospital they do work with the authority of at least a nurse practitioner in Australia. An obstetric nurse would never do an MROP but neither would she catch a baby, a midwife would only do an MROP with consultation with an OB and would certainly step aside if one were available where she was attending a woman. Of course if a midwife performed the procedure inappropriately and especially if the mother was harmed she could expect to have her licence suspended if not revoked. Nurse Midwives in the USA can and do perform procedures and have prescription priveleges that are certainly part of the GP's scope of practice here. I am surprised at the number of retained placentas I have become aware of since working here and the associated extreme blood loss (approaching 2L), what was a truly rare occurrence for me is actually quite common in a hospital at least much more common that I expected. Since I didn't work in the hospital there except on occassions of transfer, I can't really compare the hospital systems, so their MROP rates in hospital may actually be similar. marilyn - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 01, 2005 4:59 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Hello Marilyn I am surprised that litigation- mad America sanctioned midwives performing MROP. If the placenta is difficult to remove manual removal may result in death from shock as well as haemorrhage. Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 01, 2005 2:24 PM Subject: Re: [ozmidwifery] MORE ACTIVE
Re: [ozmidwifery] Analgesia post LUSCS
Where I work (large teaching hospital, dedicated 24hr Pain Management Team, painrelief protocols codified by anaesthetic dept and adhered to by all from VMO down,) if LSCS was performed under epidural the women frequently have a bolus of Morphine down the EDB catheter prior to it being removed at the end of surgery. They are then managed with excellent pain relief with panadol and anti- inflammatories. There is a general ban on narcotics for 24 hrs but if necessary more analgesia would be arranged by the on site anaesthetic registrar after examination. Others who had a GA (and maybe a spinal) have a IV PCA using either Morphine or Fentanyl with the dosage and lockout time set by the anaesthetist at time of op but altered by on call anaesthetist if necessary (rare). This stays for maybe 2 days. They also have regular panadol and usually Voltaren. All, unless asthmatic etc, have PR Voltaren before leaving the op theatre. Some also have reguar Endone but I can't remember which circumstances- I'm usually in Delivery. The level of pain control seems fantastic, especially when contrasted with the 3/24 Pethidine I was given after an emergency LSCS 15 years ago. Then, I could barely move and it was only by grim determination that I was able to look after my daughter. (and bloodymindedness- no one else was having my baby!) Now they are up and around, moving slowly but quite easily and able to get in and out of bed with none of the agony I recall. Hope that helps, Monica - Original Message - From: Cheryl LHK [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, March 02, 2005 9:23 AM Subject: [ozmidwifery] Analgesia post LUSCS Not exactly natural birth I know, but can you give me some ideas of what your doctors/obst's order for analgesia days1-2 post LUSCS? Small hospital, and each doctor tends to have his own ideas, and sometimes we end up with all kinds of concoctions!! It doesn't make me very happy when I come onto night-duty, find women teary, in pain with nothing more than Panadol some days! But I'm the first to admit that since I haven't a a LUSCS (three NVB's) I tend to keep up the pain relief because I think it must be very, VERY painful having major abdo surgery then up and learning about a baby as well. Is the LUSCS recovery period any more or less painful than other abdo surgery? Thanks in advance. Cheryl -- 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.
