Re: [ozmidwifery] level 2 midwives
no problem just think... this is the 'something new' you learnt today:) - Original Message - From: Mh [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 4:30 PM Subject: Re: [ozmidwifery] level 2 midwives Oh. (retires, blushing) - Original Message - From: Alese Koziol [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 2:58 PM Subject: Re: [ozmidwifery] level 2 midwives Monica, you are thinking of cytotec - Original Message - From: Mh [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 11:05 AM Subject: Re: [ozmidwifery] level 2 midwives Cervidil- is that the trade name for Misoprostol(sp)? If so, midwives use it where I work, both for immediate treatment of post partum haemorrhage and in IOL for intra uterine death. Monica - Original Message - From: Alese Koziol [EMAIL PROTECTED] To: ozmidwifery ozmidwifery@acegraphics.com.au Sent: Tuesday, November 01, 2005 11:50 PM Subject: [ozmidwifery] level 2 midwives Many thanks for the clarification. In VIC the Midwives whose roles you describe might be any year level after qualification and although would tend to be at least 2-3 years out, most would be a rating of Grade 3 or above and include the Clinical Nurse (midwife) specialist role which is a site specific role that recognises the expert clinicician. Grade 3 roles are usually second in charge to the unit manager. My next question for the list is to ask of any sites where Midwives are using cervidil. Cheers Alesa Alesa Koziol Clinical Midwifery Educator Melbourne -- 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] Re:cervidil
Thanks Lisa... do the midwives use it or is it inserted by MO?? And which state are you in? Cheers Alesa - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 4:58 PM Subject: Re: [ozmidwifery] Re:cervidil They use Cervidil at Ashford, It has quite an aggressive action provided it's inserted correctly. It's not easy to put in however being extremely awkward. It's almost impossible to place it in the posterior fornix. One Ob described it to a patient as a tampon. I found this very amusing as it's Barbie sized! Lisa - Original Message - From: Larissa Inns To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 3:58 PM Subject: [ozmidwifery] Re:cervidil I only know of a couple of private OB's who use it at one of our local private hospitals. Most choose not to use it because of the cost. Hugs,Larissa. My next question for the list is to ask of any sites where Midwives are using cervidil. Cheers Alesa
Re: [ozmidwifery] Re:cervidil
Which is interesting as compared with two dose of Prostin it is actually cheaper however as described in a different post it is a challenge to insert and we have an OB who is trying to use Midwives to induce labour using this method. We feel (particularly as 70% of our inductions are social) that this should be their (OB) role, thus the reason for my interest in common practice around the country. We (the Midwives) are currently conducting prostin IOL but want to draw the line in the sand somewhere.. Alesa - Original Message - From: Larissa Inns To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 4:28 PM Subject: [ozmidwifery] Re:cervidil I only know of a couple of private OB's who use it at one of our local private hospitals. Most choose not to use it because of the cost. Hugs,Larissa. My next question for the list is to ask of any sites where Midwives are using cervidil. Cheers Alesa
Re: [ozmidwifery] Re:cervidil
Cervidal is used where I work in W.A. Only for primips due to the cost factor. At this stage it is only inserted by the Drs. Naomi Which is interesting as compared with two dose of Prostin it is actually cheaper however as described in a different post it is a challenge to insert and we have an OB who is trying to use Midwives to induce labour using this method. We feel (particularly as 70% of our inductions are social) that this should be their (OB) role, thus the reason for my interest in common practice around the country. We (the Midwives) are currently conducting prostin IOL but want to draw the line in the sand somewhere.. Alesa - Original Message - From: Larissa Inns To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 4:28 PM Subject: [ozmidwifery] Re:cervidil I only know of a couple of private OB's who use it at one of our local private hospitals. Most choose not to use it because of the cost. Hugs,Larissa. My next question for the list is to ask of any sites where Midwives are using cervidil. Cheers Alesa
Re: [ozmidwifery] Re:cervidil
Naomi Wilkin wrote: Cervidal is used where I work in W.A. Only for primips due to the cost factor. At this stage it is only inserted by the Drs. Naomi Same here - a cost analysis was done and they found that multips usually only need on dose of prostin, whereas primips usually need 2. The cost of cervidil is somewhere between one and two prostin doses. Jo -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Re:cervidil
Midwives insert the cervidil there are no MO's. Ashford is the biggest private hospital in South Australia. Induction rate is also about 70% maybe more, for all the wrong reasons. What sort of results do you get with it? Lisa - Original Message - From: Alesa Koziol To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 6:47 PM Subject: Re: [ozmidwifery] Re:cervidil Thanks Lisa... do the midwives use it or is it inserted by MO?? And which state are you in? Cheers Alesa - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 4:58 PM Subject: Re: [ozmidwifery] Re:cervidil They use Cervidil at Ashford, It has quite an aggressive action provided it's inserted correctly. It's not easy to put in however being extremely awkward. It's almost impossible to place it in the posterior fornix. One Ob described it to a patient as a tampon. I found this very amusing as it's Barbie sized! Lisa - Original Message - From: Larissa Inns To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 3:58 PM Subject: [ozmidwifery] Re:cervidil I only know of a couple of private OB's who use it at one of our local private hospitals. Most choose not to use it because of the cost. Hugs,Larissa. My next question for the list is to ask of any sites where Midwives are using cervidil. Cheers Alesa
RE: [ozmidwifery] The Advertiser today...
I feel I need to reply to this mail, to say that in no way have I ever intended to aim criticism at midwives who choose to work in the 'system' which is where yes, I'm quite aware, that the vast majority of women birth. I have only the utmost respect for those who are able to provide a quality service, that is evidence based and woman centred, despite what I see as a system that predominantly doesn't support that. I could not do it, and I have several friends who can, and for that, on behalf of my women friends who birth in hospital I am thankful. I am also the first one to admit that I simply don't have the skills to work effectively in a high risk area, or any hospital unit, and that I would indeed need some further education or at least a refresher to attend women in this situation, and so I chose to work in the community instead. I have always afforded hospital based midwives the utmost respect, when circumstances have led me to require their assistance with a birthing woman. Unfortunately, I can't say the same has been returned. No tarring with a brush going on here, just a reality, that many of us out there putting our homes and families on the line every day, are unable to gain any form of respectful treatment from anyone, be they medical or midwifery staff, when we step foot in a hospital, even for the most appropriate reasons. I too wish for that unity you talk about, but I fear that until the woman, and her choices, no matter how safe or unsafe, well or ill advised, or absolutely for or against what we believe in, is the focus, we have a long way to go... With respect Tania -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of gch midwife Sent: Wednesday, 2 November 2005 6:25 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] The Advertiser today... I have been a keen reader of the ozmidwifery site for some time, and have always admired and respected the dedication, knowledge, and passion for achieving a normal birth, that is continually portrayed on the site by homebirth midwives. It was therefore, with great disappointment that I watched the criticism unfold recently regarding the skills/practice of hospital based midwives (or supposed lack there of!!). Comments like this appear arrogant and serve only to cause division within a profession striving to provide optimal outcomes regardless of where a woman chooses to birth. Time for a reality check. We are living in a 21st century society, not Utopia. There will always be women who are unable, for many reasons, to birth safely in the familiar environment of home, or supported in a birth centre model. For these women, thankfully, there are a dedicated group of midwives willing to care for them in a hospital environment. We do not need the care we provide undermined and devalued by midwives who consider themselves elitists in the area of childbirth. Instead, what is required is a unity within the profession and mutual respect for the work we each do. At what point in the evolution of midwifery practice was there a hierarchical system introduced which relegated hospital based midwives to the bottom of the pyramid, and elevated home birth midwives to the top of the pyramid I find comments such as deskilled and desensitised to the realities of birth and often lack confidence in their own midwifery skills extremely offensive and unprofessional. Criticism was also aimed at emphasis for hospital based midwives being on education in CTG interpretation, resuscitation and emergencies. As a hospital based midwife caring for high risk women with pregnancy complications (as well as uncomplicated pregnancy and childbirth), it would be grossly negligent of the midwife to not be competent in skills such as CTG interpretation, resuscitation and obstetric emergencies. If I was a woman birthing in a hospital environment, I would expect this level of education and expertise from my midwife. Regardless of your area of practice, be proud of where you work and the care you provide, but appreciate the unique skills and knowledge of other midwives who choose a different practice setting than your own. Hospital Based Midwife. From: Belinda [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] The Advertiser today... Date: Sun, 30 Oct 2005 18:00:33 -0800 not all midwives are oppressed or socialized unwillingly, they are often active participants in the way birth is medicalised and deemed as risk. they can be intelligent, educated women who believe in the way they manage birth. many only see it as work, something they do rather somethign that they are... to be proud of and cherished. unfortunately the lack of experience or knowledge about unmedicalsed ways of managing birth and the power of medicine and technology encourages and enforces their beliefs and practices. in saying this however once
RE: [ozmidwifery] The Advertiser today...
As a doula, I have noticed a huge difference in some hospital based midwives -the emphasis is on the word some in that sentence. I have witnessed women being manipulated by midwives because the midwife was unable to accept the woman did not wish to adhere to the unit policies...especially vbac related policies, or simply because I am an invited member of the birth team! Language and insinuation have been used to coerce, threaten and scare women into compliance. That is something that I have found to be the most upsetting quality...when the focus is on what suits the unit not the woman...be it the pressure of the unit or the fear of retribution upon a midwife that stands up for the rights of the woman, it reinforces the problems with the system. -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.361 / Virus Database: 267.12.6/151 - Release Date: 10/28/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] The Advertiser today...
I too wish for that unity you talk about, but I fear that until the woman, and her choices, no matter how safe or unsafe, well or ill advised, or absolutely for or against what we believe in, is the focus, we have a long way to go... Hear, hear, Tania. J -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] hospital based midwife
I really want to add my 2 cents in and respond. I have worked in hospitals and also at home and also have had my own children born in hospitals and at home. My working life has been predominately in hospitals. Whilst I have worked with beautiful midwives in the hospital setting, I have also worked with women with whom I felt ashamed to be in the same ward, hospital and profession. I have also met homebirth midwives who behaved poorly, were rude, and not honourable in their relationships with their clients and other midwives. My experiences in hospitals have been frequently disappointing - but its my fellow midwives I have been most disappointed with, there are so many discourtesies that occur. The sanctity of the birth room is very rarely guarded by midwives. Thepassive aggressive behaviour is entrenched. Maybe I have been working in thewrong places (I am sure of it) but the day that I can walk into a hospital and not cringe at the behaviour that is the cultural normwill be the happiest day of my life. I am speaking from my heart andcalling as I see it. If you are fortunate enough to be working in a perfect system with honourable women then my humblest apologies.I believe there is something very wrong with the system and if we can't name it then it we can't even begin to look at it. I am not blaming hospital midwives either - they are doing what they have been trained to do (therein lies much of the problem). I don't believe any of the posts have been intended as a personal attack on hospital midwives but instead a discussion on the problems withinthe maternity services in Australia (which of course is hospital based). Maxine Wilson
Re: [ozmidwifery] hospital based midwife
Maxine and Jo, I completely agree. I hear birth stories all the time which reflect what you're describing (my own included)and until women and evidence come first in our system, none of this can change. J
Re: [ozmidwifery] risk management
Dear Rachel Again I have experience this also working in a midwifery led setting Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. - Linda Hes - Original Message - From: wump fish [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, November 01, 2005 11:34 AM Subject: Re: [ozmidwifery] risk management Denise I agree that adverse events analysis can be a very positive and useful way to learn and improve practice. But, I think we should also analyse those events that go well and learn and improve from them. Rachel From: Denise Hynd [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] risk management Date: Mon, 31 Oct 2005 16:03:36 +0800 Dear Rachel I suspect your experience is a reflection of the personalities and their power structure rather than adverse events analysis I only have a midwifery based experience of adverse events analysis and I felt it was an intersting structure which gave form and direction and which I feel we used as it was intended to address what can be done better to lessen the risk of a recurrence. Nothing is perfect when people are involved this is another way of looking at a situation which can as you have experienced can be abused!! Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. - Linda Hes - Original Message - From: wump fish [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, October 30, 2005 11:45 AM Subject: RE: [ozmidwifery] risk management I just think that the there are a number of problems generated by applying the current risk management strategies in health care to midwifery care. The strategies centred around adverse events analysis claim to be focussed on systems and not individuals. However, this is often not how they are perceived by those involved in the events. In the UK we had 'risk management meetings' every morning to discuss the events in the last 24hrs. Everyone was invited, but of course most midwives were busy caring for women and couldn't get to them. Instead management and the drs sat around and used the notes to discuss care (no names but everyone knew who was involved), the risk of litigation and improvements etc. This was very intimidating for the midwives and was referred to as 'the lynch mob' or the 'witch hunt'. These meetings often totally missed the point because they were focussed on what the participants thought was important - not the women. For example, one of the women I cared for postnatally had had an emergency c-section for fetal distress. The baby ended up with a cut on his face and the meeting discussed the cut. The mother did not give a stuff about the cut on her baby's face, but I spent many hours at her house due to the psychological effects of her experience during an unneccesary fetal blood sampling (flash backs, nightmares, anxiety attacks etc). They would analyse and discuss a poor forceps birth and how to improve the technique - but would not discuss and analyse how this OP baby could have been encouraged to rotate during labour so that the forceps did not need to be used in the first place. I became quite famous at these meeting for my opinionated and arsey contributions - it was almost fun throwing spanners (and research) in the works. Re-focusing risk managment onto optimal outcomes rather than adverse outcomes my be more appropriate and lead to improvements in women's birth experiences. There is a good chapter in Normal Childbirth: evidence and debate (ed Soo Downe) about risk, safety etc. If our aim was to improve outcomes - ie. women's satisfaction with their birth experiences, increasing the normal birth rate etc, we may find the system starts to change in our favour. Looking at why things go well rather than why they go wrong. Education could focus on facilitating physiological birth and improving the birth experience and very importantly - information giving. Obviously midwives still need education in dealing with emergencies, but preventing emergencies should be given equal weighting. Ok, end of my opinionated and arsey contribution ; ) Rachel From: Mary Murphy [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] The Advertiser today... Date: Sun, 30 Oct 2005 10:26:53 +0800 Rachel, working in homebirths makes me very interested in risk management and education. I would appreciate hearing what you have to say, so rave on. Mary M There is kudo is being competent in the management of abnormal and emergencies. Unfortunately, there is not the same emphasis placed on the
Re: [ozmidwifery] Re:cervidil
Lisa We (Midwives) currently use prostin but there is a move afoot for us to commence using cervidil. For lots of reasons, we are not keen to go down this track and I am seeking info on what is currently in use around oz so am fully armed in time for our next meeting.and I must thank everyone who has answered this thread so far you have been most helpful. More info always gratefully accepted:) Cheers Alesa - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 7:51 PM Subject: Re: [ozmidwifery] Re:cervidil Midwives insert the cervidil there are no MO's. Ashford is the biggest private hospital in South Australia. Induction rate is also about 70% maybe more, for all the wrong reasons. What sort of results do you get with it? Lisa - Original Message - From: Alesa Koziol To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 6:47 PM Subject: Re: [ozmidwifery] Re:cervidil Thanks Lisa... do the midwives use it or is it inserted by MO?? And which state are you in? Cheers Alesa - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 4:58 PM Subject: Re: [ozmidwifery] Re:cervidil They use Cervidil at Ashford, It has quite an aggressive action provided it's inserted correctly. It's not easy to put in however being extremely awkward. It's almost impossible to place it in the posterior fornix. One Ob described it to a patient as a tampon. I found this very amusing as it's Barbie sized! Lisa - Original Message - From: Larissa Inns To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 3:58 PM Subject: [ozmidwifery] Re:cervidil I only know of a couple of private OB's who use it at one of our local private hospitals. Most choose not to use it because of the cost. Hugs,Larissa. My next question for the list is to ask of any sites where Midwives are using cervidil. Cheers Alesa
RE: [ozmidwifery] Re:cervidil
You might want to check these three sites: http://www.birthingnaturally.net/birthplan/intervention/cervidil.html http://www.midwiferytoday.com/articles/midwivescytotec.asp http://www.midwiferytoday.com/articles/midwivescytotec.asp Vedrana From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Alesa Koziol Sent: Wednesday, November 02, 2005 1:18 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Re:cervidil Lisa We (Midwives) currently use prostin but there is a move afoot for us to commence using cervidil. For lots of reasons, we are not keen to go down this track and I am seeking info on what is currently in use around oz so am fully armed in time for our next meeting.and I must thank everyone who has answered this thread so far you have been most helpful. More info always gratefully accepted:) Cheers Alesa - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 7:51 PM Subject: Re: [ozmidwifery] Re:cervidil Midwives insert the cervidil there are no MO's. Ashford is the biggest private hospital in South Australia. Induction rate is also about 70% maybe more, for all the wrong reasons. What sort of results do you get with it? Lisa - Original Message - From: Alesa Koziol To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 6:47 PM Subject: Re: [ozmidwifery] Re:cervidil Thanks Lisa... do the midwives use it or is it inserted by MO?? And which state are you in? Cheers Alesa - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 4:58 PM Subject: Re: [ozmidwifery] Re:cervidil They use Cervidil at Ashford, It has quite an aggressive action provided it's inserted correctly. It's not easy to put in however being extremely awkward. It's almost impossible to place it in the posterior fornix. One Ob described it to a patient as a tampon. I found this very amusing as it's Barbie sized! Lisa - Original Message - From: Larissa Inns To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 3:58 PM Subject: [ozmidwifery] Re:cervidil I only know of a couple of private OB's who use it at one of our local private hospitals. Most choose not to use it because of the cost. Hugs,Larissa. My next question for the list is to ask of any sites where Midwives are using cervidil. Cheers Alesa
Re: [ozmidwifery] ANF article
WA ANF members have to pay extra for the ANJ So can you tell me if we can access the article on the net ?Thanks Denise Hynd "Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled." Linda Hes - Original Message - From: Larissa Inns To: ozmidwifery@acegraphics.com.au Sent: Tuesday, November 01, 2005 9:57 AM Subject: [ozmidwifery] ANF article Those of you who are ANF members and receive the ANJ there is a great article (3 pages!) in this months issue by Fiona Armstrong titled "The fight to care" and it's all about women having the right to choose midwifery care. Well worth a read. Hugs, Larissa No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.362 / Virus Database: 267.12.7/156 - Release Date: 2/11/2005
Re: [ozmidwifery] The Advertiser today...
Dear All Sage words Tania. May seem corny, but I always come back to the fact that midwife means 'with woman' so if as a midwife you are 'with' hospital policies or 'with' pandering to Dr and non-evidence based protocols then where is the woman? Being 'with woman' is not utopia, it is appropriate practice and the right of every woman. As someone very interested in politics I liken this scenario to a politician that is hamstrung by their parties policies and so really cannot say he/she will represent the needs of their constituents, because at the end of the day they will only do it if it conforms to party policy! Perhaps more midwives need to do a Barnaby Joyce and cross the floor voting against the party for things they feel are important!!! I will never be a midwife but as an active consumer I know all about putting it all on the line. Women will lead the change but we also need brave midwives prepared to back women. JC -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] article FYI
This is interesting for me. I am currently writing my midwifery honours thesis on women's views about episiotomy (or trying to at least, unfortunately I am having great difficulty with participant recruitment). It's always nice to see more research backing up what I am saying. :) Alice (one of the first SA BMid grduate midwives) From: leanne wynne [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] article FYI Date: Wed, 02 Nov 2005 11:05:02 +1100 Unnecessary episiotomies Issue 22: 31 Oct 2005 Source: International Journal of Gynecology Obstetrics 2005; 91: 157-9 Researchers have questioned the continuing widespread use of routine episiotomy, after finding high rates at some centres in countries in South America, Asia, and Africa. Systematic reviews of published trials, including a Cochrane review, have suggested that episiotomies should not be performed routinely, because of the associated maternal morbidity. Some specialists have said that no more than 10 percent of nulliparous women delivering vaginally should need one, according to the researchers writing in the latest issue of the International Journal of Gynecology Obstetrics. But their study suggests that episiotomy rates are far higher than this at some hospitals. The researchers, from Uruguay and the USA, analyzed data on episiotomy rates for nulliparous and multiparous women at hospitals in Argentina, Brazil, Bolivia, Chile, the Democratic Republic of Congo, Ecuador, India, Tibet, Uruguay, Venezuela, and Zambia. The hospitals studied (from 1 to 13 per country) were part of the US National Institute of Child Health and Human Developments Global Network for Womens and Childrens Health Research. Rates above 90 percent Reporting their findings, the researchers say that episiotomy rates among nulliparous women were higher than 90 percent in all countries except Zambia (6.9 percent). Episiotomy rates for all vaginal births were higher than 20 percent in all countries except Zambia, and were as high as 80 percent in Brazil. The exception, Zambia, was unusual in having a lower rate for nulliparous women than for all vaginal births. The researchers, however, caution that the data for Zambia were obtained from only one hospital. They also advise against generalizing the findings beyond the centres studied. However, they say the data illustrate the widespread use of routine episiotomy in contradiction to the evidence questioning its efficacy. Unnecessary episiotomies, the researchers write, increase the risk of morbidity as indicated by the Cochrane review, including posterior perineal trauma, the need for suturing the perineal wound, and healing complications at 7 days. They conclude: Strategies should be developed to decrease episiotomy rates at a global level. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ REALESTATE: biggest buy/rent/share listings http://ninemsn.realestate.com.au -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] article FYI
Alice - are you looking for women who have had episiotomies? i may be able to help you can contact me off line my contact details have not changed [EMAIL PROTECTED] love suzi - Original Message - From: Alice Morgan [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 12:49 AM Subject: RE: [ozmidwifery] article FYI This is interesting for me. I am currently writing my midwifery honours thesis on women's views about episiotomy (or trying to at least, unfortunately I am having great difficulty with participant recruitment). It's always nice to see more research backing up what I am saying. :) Alice (one of the first SA BMid grduate midwives) From: leanne wynne [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] article FYI Date: Wed, 02 Nov 2005 11:05:02 +1100 Unnecessary episiotomies Issue 22: 31 Oct 2005 Source: International Journal of Gynecology Obstetrics 2005; 91: 157-9 Researchers have questioned the continuing widespread use of routine episiotomy, after finding high rates at some centres in countries in South America, Asia, and Africa. Systematic reviews of published trials, including a Cochrane review, have suggested that episiotomies should not be performed routinely, because of the associated maternal morbidity. Some specialists have said that no more than 10 percent of nulliparous women delivering vaginally should need one, according to the researchers writing in the latest issue of the International Journal of Gynecology Obstetrics. But their study suggests that episiotomy rates are far higher than this at some hospitals. The researchers, from Uruguay and the USA, analyzed data on episiotomy rates for nulliparous and multiparous women at hospitals in Argentina, Brazil, Bolivia, Chile, the Democratic Republic of Congo, Ecuador, India, Tibet, Uruguay, Venezuela, and Zambia. The hospitals studied (from 1 to 13 per country) were part of the US National Institute of Child Health and Human Development's Global Network for Women's and Children's Health Research. Rates above 90 percent Reporting their findings, the researchers say that episiotomy rates among nulliparous women were higher than 90 percent in all countries except Zambia (6.9 percent). Episiotomy rates for all vaginal births were higher than 20 percent in all countries except Zambia, and were as high as 80 percent in Brazil. The exception, Zambia, was unusual in having a lower rate for nulliparous women than for all vaginal births. The researchers, however, caution that the data for Zambia were obtained from only one hospital. They also advise against generalizing the findings beyond the centres studied. However, they say the data illustrate the widespread use of routine episiotomy. in contradiction to the evidence questioning its efficacy. Unnecessary episiotomies, the researchers write, increase the risk of morbidity as indicated by the Cochrane review, including posterior perineal trauma, the need for suturing the perineal wound, and healing complications at 7 days. They conclude: Strategies should be developed to decrease episiotomy rates at a global level. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ REALESTATE: biggest buy/rent/share listings http://ninemsn.realestate.com.au -- 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] article FYI
alice as a grad of unisa (1st year) going into the hospital system i was rather horrified that we were expected to cut episiotomies i can however say that i have not cut one thus far although i am only in my first year out. good luck with your theisis. regards sharon - Original Message - From: Alice Morgan [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 12:49 AM Subject: RE: [ozmidwifery] article FYI This is interesting for me. I am currently writing my midwifery honours thesis on women's views about episiotomy (or trying to at least, unfortunately I am having great difficulty with participant recruitment). It's always nice to see more research backing up what I am saying. :) Alice (one of the first SA BMid grduate midwives) From: leanne wynne [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] article FYI Date: Wed, 02 Nov 2005 11:05:02 +1100 Unnecessary episiotomies Issue 22: 31 Oct 2005 Source: International Journal of Gynecology Obstetrics 2005; 91: 157-9 Researchers have questioned the continuing widespread use of routine episiotomy, after finding high rates at some centres in countries in South America, Asia, and Africa. Systematic reviews of published trials, including a Cochrane review, have suggested that episiotomies should not be performed routinely, because of the associated maternal morbidity. Some specialists have said that no more than 10 percent of nulliparous women delivering vaginally should need one, according to the researchers writing in the latest issue of the International Journal of Gynecology Obstetrics. But their study suggests that episiotomy rates are far higher than this at some hospitals. The researchers, from Uruguay and the USA, analyzed data on episiotomy rates for nulliparous and multiparous women at hospitals in Argentina, Brazil, Bolivia, Chile, the Democratic Republic of Congo, Ecuador, India, Tibet, Uruguay, Venezuela, and Zambia. The hospitals studied (from 1 to 13 per country) were part of the US National Institute of Child Health and Human Development's Global Network for Women's and Children's Health Research. Rates above 90 percent Reporting their findings, the researchers say that episiotomy rates among nulliparous women were higher than 90 percent in all countries except Zambia (6.9 percent). Episiotomy rates for all vaginal births were higher than 20 percent in all countries except Zambia, and were as high as 80 percent in Brazil. The exception, Zambia, was unusual in having a lower rate for nulliparous women than for all vaginal births. The researchers, however, caution that the data for Zambia were obtained from only one hospital. They also advise against generalizing the findings beyond the centres studied. However, they say the data illustrate the widespread use of routine episiotomy. in contradiction to the evidence questioning its efficacy. Unnecessary episiotomies, the researchers write, increase the risk of morbidity as indicated by the Cochrane review, including posterior perineal trauma, the need for suturing the perineal wound, and healing complications at 7 days. They conclude: Strategies should be developed to decrease episiotomy rates at a global level. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ REALESTATE: biggest buy/rent/share listings http://ninemsn.realestate.com.au -- 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] ANF article
try the anf web site at www.anf.org.au but I think it is only editorials and clinical updates that are on line. In Vic it is part of our subsciption so you need to get onto your branch although maybe we pay extra for the privilage. In Vic we pay $449 / year for those working > 24 hours per week. Andrea Quanchi On 03/11/2005, at 12:45 AM, Denise Hynd wrote: WA ANF members have to pay extra for the ANJ So can you tell me if we can access the article on the net ? Thanks Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. — Linda Hes x-tad-bigger- Original Message -/x-tad-bigger x-tad-biggerFrom:/x-tad-biggerx-tad-bigger /x-tad-biggerx-tad-biggerLarissa Inns/x-tad-biggerx-tad-bigger /x-tad-bigger x-tad-biggerTo:/x-tad-biggerx-tad-bigger /x-tad-biggerx-tad-biggerozmidwifery@acegraphics.com.au/x-tad-biggerx-tad-bigger /x-tad-bigger x-tad-biggerSent:/x-tad-biggerx-tad-bigger Tuesday, November 01, 2005 9:57 AM/x-tad-bigger x-tad-biggerSubject:/x-tad-biggerx-tad-bigger [ozmidwifery] ANF article/x-tad-bigger Those of you who are ANF members and receive the ANJ there is a great article (3 pages!) in this months issue by Fiona Armstrong titled The fight to care and it's all about women having the right to choose midwifery care. Well worth a read. Hugs, Larissa No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.362 / Virus Database: 267.12.7/156 - Release Date: 2/11/2005
Re: [ozmidwifery] Re:cervidil
In case you haven't seen it, Alesa, I must tell you what Henci Goer says about Cerv. Pros: Somewhat reduces the caesarean rate compared with straight oxytocin inductions with an unripe cervix. Cervidil can be removed if it causes problems. Cons: Can cause uterine HSS and foetal distress. I don't understand why major hospitals express concern over their induction rates like it's somehow spontaneously and magically occurring. RWH here in Melbourne does public handwringing about it periodically. There is a cure. How about we just don't induce for dates any more? (Not suggesting you're part of that, Alesa, just adding my 2c ; ) ) J
[ozmidwifery] re: hospital based midwife
I have been a keen reader of the ozmidwifery site for some time, and have always admired and respected the dedication, knowledge, and passion for achieving a normal birth, that is continually portrayed on the site by homebirth midwives. It was therefore, with great disappointment that I watched the criticism unfold recently regarding the skills/practice of hospital based midwives (or supposed lack there of!!). Comments like this appear arrogant and serve only to cause division within a profession striving to provide optimal outcomes regardless of where a woman chooses to birth. Time for a reality check. We are living in a 21st century society, not Utopia. There will always be women who are unable, for many reasons, to birth safely in the familiar environment of home, or supported in a birth centre model. For these women, thankfully, there are a dedicated group of midwives willing to care for them in a hospital environment. We do not need the care we provide undermined and devalued by midwives who consider themselves elitists in the area of childbirth. Instead, what is required is a unity within the profession and mutual respect for the work we each do. At what point in the evolution of midwifery practice was there a hierarchical system introduced which relegated hospital based midwives to the bottom of the pyramid, and elevated home birth midwives to the top of the pyramid I find comments such as "deskilled and desensitised to the realities of birth" and "often lack confidence in their own midwifery skills" extremely offensive and unprofessional. Criticism was also aimed at emphasis for hospital based midwives being on education in CTG interpretation, resuscitation and emergencies. As a hospital based midwife caring for high risk women with pregnancy complications (as well as uncomplicated pregnancy and childbirth), it would be grossly negligent of the midwife to not be competent in skills such as CTG interpretation, resuscitation and obstetric emergencies. If I was a woman birthing in a hospital environment, I would expect this level of education and expertise from my midwife. Regardless of your area of practice, be proud of where you work and the care you provide, but appreciate the unique skills and knowledge of other midwives who choose a different practice setting than your own. Hospital Based Midwife. I wanted to respond to this because it touches something I've felt for a while. I've been a lurker on this list for ages but not a contributor because, despite many years as a midwife (and I use the term advisedly, I don't consider myself an obstetric nurse) I've had the impression from the language used on this forum that the work I do and even the women I look after is somehow not as valuable or important as community based midwifery or birth centre care. I don't for a moment think that this is the stated position of most of the contributors to this list. But to a hospital based midwife it certainly can come across that way. I've never been accused of being a shrinking violet butI haven't cared to expose myself here, to dismissive comments about the place I choose to workor the people I work with. Not all hospital midwives do their 8 or 10 hour shift and ignore it for the rest of the day. People are people. I have had atrocious handovers of care from the midwife on the shift before me. I have also had atrocious handovers of care, or refusal to share antenatal findings, from homebirth midwives bringing women into hospital. Women who come to the place where I work come from a wide cross section of the community. Many come from countries where English is not the first language.Some are highly educated, some are illiterate. There are early attenders and women having their fourth child in successionwithout booking in or having any antenatal care. Not to put too fine a point on it, not all families are committed to providing thebest start for their babies. As midwives we give care to all these women, the best we can. I joined this list in the hope of learning more and gaining support for some of the difficult times and knotty questions that arise. I've learned heaps and am so glad I joined; getting different viewpoints from the ones I encounter every day has been so valuable and opened my mind to many new things. But I can't say I've been confident that I would receive support, I came to the conclusion long ago that my placeof work would overshadow what I had to say and I do not feelinclined to apologise for the fact that not only do I work in a hospital Delivery Suite, I even feel satisfactin and joy in much of what I do. Another hospital midwife
[ozmidwifery] episi research
A huge part of women's view is the language used around tearing and episiotomy and the lack of positive language for womens vagina in birth, ie capacity to stretch and recover. I see the language around tearing such as mutilating uncontrolled etc whereas episis are seen as controlled, neat straight etc. In a society where we trust surgery so much - just look at the cesarean section rates - episi fits into this. In classes i teach women to think about the capacity of their vaginas and perineums in birth and find positive ways of discussing this. I also talk about tearing along a muscle line as more able to heal well than a cut through it. I always say it may be easier for me to suture an episiotomy but I am not the one who has to sit on it and feel it for the rest of my life - so it should never be about what is good for the perosn managing the birth (although unfortunalty it most often is). It is inetresting that people always ask well can I say no, why do they think someone else has the right to cut into their vaginas when there is no research to support this as a routine practive!!! Any way I could go on for ever about this issue... I am finishing my Phd at the moment and have just cut out a chapter looking at womens worries around their vaginas in birth and a feminist discussion around episis etc, I found my other chapters were big enough and the women in my study didnt really talk much about worrys of tearing. I wonder why you are having trouble recruiting, i am happy to chat to you off line about this it is great to see this type of research being done Belinda Alice Morgan wrote: This is interesting for me. I am currently writing my midwifery honours thesis on women's views about episiotomy (or trying to at least, unfortunately I am having great difficulty with participant recruitment). It's always nice to see more research backing up what I am saying. :) Alice (one of the first SA BMid grduate midwives) From: leanne wynne [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] article FYI Date: Wed, 02 Nov 2005 11:05:02 +1100 Unnecessary episiotomies Issue 22: 31 Oct 2005 Source: International Journal of Gynecology Obstetrics 2005; 91: 157-9 Researchers have questioned the continuing widespread use of routine episiotomy, after finding high rates at some centres in countries in South America, Asia, and Africa. Systematic reviews of published trials, including a Cochrane review, have suggested that episiotomies should not be performed routinely, because of the associated maternal morbidity. Some specialists have said that no more than 10 percent of nulliparous women delivering vaginally should need one, according to the researchers writing in the latest issue of the International Journal of Gynecology Obstetrics. But their study suggests that episiotomy rates are far higher than this at some hospitals. The researchers, from Uruguay and the USA, analyzed data on episiotomy rates for nulliparous and multiparous women at hospitals in Argentina, Brazil, Bolivia, Chile, the Democratic Republic of Congo, Ecuador, India, Tibet, Uruguay, Venezuela, and Zambia. The hospitals studied (from 1 to 13 per country) were part of the US National Institute of Child Health and Human Development’s Global Network for Women’s and Children’s Health Research. Rates above 90 percent Reporting their findings, the researchers say that episiotomy rates among nulliparous women were higher than 90 percent in all countries except Zambia (6.9 percent). Episiotomy rates for all vaginal births were higher than 20 percent in all countries except Zambia, and were as high as 80 percent in Brazil. The exception, Zambia, was unusual in having a lower rate for nulliparous women than for all vaginal births. The researchers, however, caution that the data for Zambia were obtained from only one hospital. They also advise against generalizing the findings beyond the centres studied. However, they say the data “illustrate the widespread use of routine episiotomy… in contradiction to the evidence questioning its efficacy.” Unnecessary episiotomies, the researchers write, increase the risk of morbidity as indicated by the Cochrane review, including posterior perineal trauma, the need for suturing the perineal wound, and healing complications at 7 days. They conclude: “Strategies should be developed to decrease episiotomy rates at a global level.” Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ REALESTATE: biggest buy/rent/share listings http://ninemsn.realestate.com.au -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to
Re: [ozmidwifery] Re:cervidil
Alesa Koziol wrote: Lisa We (Midwives) currently use prostin but there is a move afoot for us to commence using cervidil. For lots of reasons, we are not keen to go down this track and I am seeking info on what is currently in use around oz so am fully armed in time for our next meeting.and I must thank everyone who has answered this thread so far you have been most helpful. More info always gratefully accepted:) Cheers Alesa I thought the reason *to* use cervidil was because it releases the prostaglandin slower, and more uniform, and that it can be removed immediately if hyperstimulation occurs. Prostin gel is 1 - 2 mg right there and then, and is rather a lot harder (and undignified for the woman) to remove if something goes wrong. Jo
[ozmidwifery] hospital midwives
I have not felt personally criticized as a hospital midwife, I also feel very strongly about the problems women face when entering hospital systems for birth care. I guess i get defensive at times however, as I think others have, when hospital midwives are set up as the polemic opposites of homebirth based ones. I know there are so many instances of hospital midwives providing anything but women centered care, the system is fraught with midwifery apathy as much as womens - not so much apathy but lack of knowledge or trust in getting care that centers on their own needs. The problem is, the birth activists, the women fighting these systems of instiutionalsied abuse of women, the women putting their own passions and lives on the line are not always community based, they are often hospital based midwives struggling feeling isolated and disrespected. The problem is also the lack of support one gets from women or positive birth that you can enjoy in the home setting. I am lucky enough to experience the joy of homebirth and the satisfaction of a joyful hospital birth. It is the women in hospitals who are (most often) being traumatized without often perceiving that as being related to their birth experiences. It is from this base that I try to circumvent or limit the processes that lead to such traumas and end up being marginalsied, abused etc in this process and this is by other midwives and doctors. I believe it is good for us to air our differences and lament the problems - aiming to change them or find ways to make birth better For the hospital midwives who dont feel they will be supported on this list I do not believe that this will be the case, this list often results in heated and passionate debates which is /all/ good, we are passionate people working in difficult circumstances, everyone has a right to believe what they believe but not everyone has to agree, I think we mostly end up in respectful debate people just sometimes take things personally because we are so used to getting defensive- our hackles rise quickly Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] episi research - Attn Alice Morgan
Hi Alice, I noted you're having difficulties accessing participants. I can help you with that! Email me : ) Janet -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] re: hospital based midwife
It is sad to hear yet another hospital midwife feeling under attack. It can be argued that hospital midwives have an even greater role to play in changing the maternity service and catering for women's needs. I turned down the chance of working as an independent in the UK because I believed that the women in hospital needed me more. They were birthing in a strange environment amongst strangers, many in vulnerable social situations. The statistics demonstrated the poor chances these women had of avoiding an instrumental birth or c-section. It is because most women give birth in hospitals, and because the statistics for physiological birth are shocking - that hospital midwives are so important. It is time we asked ourselves how we can improve these outcomes for women and increase satisfaction rates. Many of us are, and as I have said, I have come across far more motivated midwives in the Australian hospital system than the UK. Let's not kid ourselves that there is not a lot to fight for if we do not want to end up as obstetric nurses. We are prevented in many ways from making our own clinical judgements by guidelines, policies etc. We are prevented from developing and maintaining midwifery skills such as waterbirth, suturing, full spectrum care - in some hospitals even catching the baby. It is only by acknowledging our position and refusing to accept that over 30% of women (fit and healthly by global comparison) are unable to give birth without an operation. By looking at our own contribution to individual care and to the midwifery profession. By standing together as midwives regardless of where we practise that we can start to change things for ourselves and the women we care for. We need to stop taking discussion and debate personally and take a leaf out of the drs book. Discuss, question, debate and learn. I am pleased that this debate has drawn some lurkers out to provide us with their valuable perspective we would otherwise have been ignorant of. Rachel - another hospital midwife From: mariet [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] re: hospital based midwife Date: Fri, 4 Nov 2005 10:30:49 +1100 I wanted to respond to this because it touches something I've felt for a while. I've been a lurker on this list for ages but not a contributor because, despite many years as a midwife (and I use the term advisedly, I don't consider myself an obstetric nurse) I've had the impression from the language used on this forum that the work I do and even the women I look after is somehow not as valuable or important as community based midwifery or birth centre care. I don't for a moment think that this is the stated position of most of the contributors to this list. But to a hospital based midwife it certainly can come across that way. I've never been accused of being a shrinking violet but I haven't cared to expose myself here, to dismissive comments about the place I choose to work or the people I work with. Not all hospital midwives do their 8 or 10 hour shift and ignore it for the rest of the day. People are people. I have had atrocious handovers of care from the midwife on the shift before me. I have also had atrocious handovers of care, or refusal to share antenatal findings, from homebirth midwives bringing women into hospital. Women who come to the place where I work come from a wide cross section of the community. Many come from countries where English is not the first language. Some are highly educated, some are illiterate. There are early attenders and women having their fourth child in succession without booking in or having any antenatal care. Not to put too fine a point on it, not all families are committed to providing the best start for their babies. As midwives we give care to all these women, the best we can. I joined this list in the hope of learning more and gaining support for some of the difficult times and knotty questions that arise. I've learned heaps and am so glad I joined; getting different viewpoints from the ones I encounter every day has been so valuable and opened my mind to many new things. But I can't say I've been confident that I would receive support, I came to the conclusion long ago that my place of work would overshadow what I had to say and I do not feel inclined to apologise for the fact that not only do I work in a hospital Delivery Suite, I even feel satisfactin and joy in much of what I do. Another hospital midwife _ Be the first to hear what's new at MSN - sign up to our free newsletters! http://www.msn.co.uk/newsletters -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Re:cervidil
hi Jo, the reason's that cervidil has been promoted as better than prostin is as you've said: it releases prostin more slowly and it can be more easily removed. Reality seems to be, ( and the cervidil company figures agrees with this) if correctly inserted it can cause hyperstimulation after a few hours as it has a constant release. Prostin gel however works in a curve so peaks after two to three hours then wears off. It isn't that difficult to get most prostin gel out if however cervidil is removed once the hyperstimulation is happening the removal doesn't seem to have much effect. Lisa - Original Message - From: JoFromOz To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 1:06 PM Subject: Re: [ozmidwifery] Re:cervidil Alesa Koziol wrote: Lisa We (Midwives) currently use prostin but there is a move afoot for us to commence using cervidil. For lots of reasons, we are not keen to go down this track and I am seeking info on what is currently in use around oz so am fully armed in time for our next meeting.and I must thank everyone who has answered this thread so far you have been most helpful. More info always gratefully accepted:) Cheers Alesa I thought the reason *to* use cervidil was because it releases the prostaglandin slower, and more uniform, and that it can be removed immediately if hyperstimulation occurs. Prostin gel is 1 - 2 mg right there and then, and is rather a lot harder (and undignified for the woman) to remove if something goes wrong.Jo
RE: [ozmidwifery] episi research
What kind of participant input are you looking for. I had an episiotomy with my first child (under obs care) then none in my subsequent three births and no tearing either. The explanation I got about epis. was very different from obs to midwives (surprise surprise) In a nutshell obs scared the daylights out of me with horror outcomes if I would tear as opposed tothe benefits of a cut. Midwives were very concerned about getting babies out without tearing or cutting, but explained that a tear is better in the long run. feel free to email me offline. Kylie Carberry From: Belinda [EMAIL PROTECTED]Reply-To: ozmidwifery@acegraphics.com.auTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] episi researchDate: Thu, 03 Nov 2005 12:31:37 +1030A huge part of women's view is the language used around tearing and episiotomy and the lack of positive language for womens vagina in birth, ie capacity to stretch and recover. I see the language around tearing such as mutilating uncontrolled etc whereas episis are seen as controlled, neat straight etc. In a society where we trust surgery so much - just look at the cesarean section rates - episi fits into this. In classes i teach women to think about the capacity of their vaginas and perineums in birth and find positive ways of discussing this. I also talk about tearing along a muscle line as more able to heal well than a cut through it. I always say it may be easier for me to suture an episiotomy but I am not the one who has to sit on it and feel it for the rest of my life - so it should never be about what is good for the perosn managing the birth (although unfortunalty it most often is). It is inetresting that people always ask well can I say no, why do they think someone else has the right to cut into their vaginas when there is no research to support this as a routine practive!!! Any way I could go on for ever about this issue...I am finishing my Phd at the moment and have just cut out a chapter looking at womens worries around their vaginas in birth and a feminist discussion around episis etc, I found my other chapters were big enough and the women in my study didnt really talk much about worrys of tearing.I wonder why you are having trouble recruiting, i am happy to chat to you off line about thisit is great to see this type of research being doneBelindaAlice Morgan wrote:This is interesting for me. I am currently writing my midwifery honours thesis on women's views about episiotomy (or trying to at least, unfortunately I am having great difficulty with participant recruitment). It's always nice to see more research backing up what I am saying.:) Alice (one of the first SA BMid grduate midwives)From: "leanne wynne" [EMAIL PROTECTED]Reply-To: ozmidwifery@acegraphics.com.auTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] article FYIDate: Wed, 02 Nov 2005 11:05:02 +1100Unnecessary episiotomiesIssue 22: 31 Oct 2005Source: International Journal of Gynecology Obstetrics 2005; 91: 157-9Researchers have questioned the continuing widespread use of routine episiotomy, after finding high rates at some centres in countries in South America, Asia, and Africa.Systematic reviews of published trials, including a Cochrane review, have suggested that episiotomies should not be performed routinely, because of the associated maternal morbidity.Some specialists have said that no more than 10 percent of nulliparous women delivering vaginally should need one, according to the researchers writing in the latest issue of the International Journal of Gynecology Obstetrics.But their study suggests that episiotomy rates are far higher than this at some hospitals. The researchers, from Uruguay and the USA, analyzed data on episiotomy rates for nulliparous and multiparous women at hospitals in Argentina, Brazil, Bolivia, Chile, the Democratic Republic of Congo, Ecuador, India, Tibet, Uruguay, Venezuela, and Zambia.The hospitals studied (from 1 to 13 per country) were part of the US National Institute of Child Health and Human Developments Global Network for Womens and Childrens Health Research.Rates above 90 percentReporting their findings, the researchers say that episiotomy rates among nulliparous women were higher than 90 percent in all countries except Zambia (6.9 percent).Episiotomy rates for all vaginal births were higher than 20 percent in all countries except Zambia, and were as high as 80 percent in Brazil. The exception, Zambia, was unusual in having a lower rate for nulliparous women than for all vaginal births. The researchers, however, caution that the data for Zambia were obtained from only one hospital.They also advise against generalizing the findings beyond the centres studied. However, they say the data illustrate the widespread use of routine episiotomy in contradiction to the evidence questioning its efficacy.Unnecessary episiotomies, the researchers write, increase the risk of morbidity as indicated by the Cochrane review, including posterior perineal
RE: [ozmidwifery] re: hospital based midwife
Absolutely Rachel, I am only too aware that I have chosen the 'easy way out' by making the conscious decision not to practice in the hospital system, and you are right, those women who enter into a system that is fragmented and fear-based, definitely need woman centred midwives who are willing to put themselves on the line for the rights of the women in their care. I'm slightly disturbed by what appears a growing trend not to identify ourselves if our opinions or ideas vary from that of the general feel of the list at the time. I've always felt safe here, despite the fact that I am in the minority based on my place of work. We don't need to always agree, spirited conversation and debate is one of the ways I think we can all learn and become more educated...none of us know it all, I'm the first to admit that! However, there is something slightly offputting, and I must say it's hard to respond in a personal manner, when the poster won't even put a first name to their post. I'm happy to own my ideas and opinions, and to be supported or otherwise as a result of sharing them publically... Tania -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of wump fish Sent: Thursday, 3 November 2005 2:25 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] re: hospital based midwife It is sad to hear yet another hospital midwife feeling under attack. It can be argued that hospital midwives have an even greater role to play in changing the maternity service and catering for women's needs. I turned down the chance of working as an independent in the UK because I believed that the women in hospital needed me more. They were birthing in a strange environment amongst strangers, many in vulnerable social situations. The statistics demonstrated the poor chances these women had of avoiding an instrumental birth or c-section. It is because most women give birth in hospitals, and because the statistics for physiological birth are shocking - that hospital midwives are so important. It is time we asked ourselves how we can improve these outcomes for women and increase satisfaction rates. Many of us are, and as I have said, I have come across far more motivated midwives in the Australian hospital system than the UK. Let's not kid ourselves that there is not a lot to fight for if we do not want to end up as obstetric nurses. We are prevented in many ways from making our own clinical judgements by guidelines, policies etc. We are prevented from developing and maintaining midwifery skills such as waterbirth, suturing, full spectrum care - in some hospitals even catching the baby. It is only by acknowledging our position and refusing to accept that over 30% of women (fit and healthly by global comparison) are unable to give birth without an operation. By looking at our own contribution to individual care and to the midwifery profession. By standing together as midwives regardless of where we practise that we can start to change things for ourselves and the women we care for. We need to stop taking discussion and debate personally and take a leaf out of the drs book. Discuss, question, debate and learn. I am pleased that this debate has drawn some lurkers out to provide us with their valuable perspective we would otherwise have been ignorant of. Rachel - another hospital midwife From: mariet [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] re: hospital based midwife Date: Fri, 4 Nov 2005 10:30:49 +1100 I wanted to respond to this because it touches something I've felt for a while. I've been a lurker on this list for ages but not a contributor because, despite many years as a midwife (and I use the term advisedly, I don't consider myself an obstetric nurse) I've had the impression from the language used on this forum that the work I do and even the women I look after is somehow not as valuable or important as community based midwifery or birth centre care. I don't for a moment think that this is the stated position of most of the contributors to this list. But to a hospital based midwife it certainly can come across that way. I've never been accused of being a shrinking violet but I haven't cared to expose myself here, to dismissive comments about the place I choose to work or the people I work with. Not all hospital midwives do their 8 or 10 hour shift and ignore it for the rest of the day. People are people. I have had atrocious handovers of care from the midwife on the shift before me. I have also had atrocious handovers of care, or refusal to share antenatal findings, from homebirth midwives bringing women into hospital. Women who come to the place where I work come from a wide cross section of the community. Many come from countries where English is not the first language. Some are highly educated, some are illiterate. There are early attenders and
Re: [ozmidwifery] re: hospital based midwife
It seems that there are those who feel a midwife working in a hospital setting has sold her/his sole to the devil for doing so. But they are the ones on the front line so to speak who fight every day for the rights of birthing women, without them it would be worse. Yes there are lots of problems in every hospital in regards to care of women, but the fact is women do birth in hospitals and we need our best, most passionate midwives there standing beside them or all is lost and it will all become obstectrics care under doctors sole control with ob nurses. If no one has the passion to work in the hospitals who's left??? We are never going to get anywhere if its so easy for external forces to cause us to turn on each other so easily United we stand, divided we fall??? Yes there are going to be differences of opinion which we are all entitled to express, thats what I love about the country we live in. But we must have one goal and that is to get and give the absolute best care for women and their families no mater whether they turn up at a Birthing Centre, Hospital, in their own home or where ever. We must fight to be the worlds BEST place to have a child and make every pregnant women wish they could birth here no matter where she goes in Australia. This is the first time I have ever written anything on here so as you can tell this has sparked an interest in me. And I hope it makes sence! Amanda - Original Message - From: wump fish [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 2:25 PM Subject: RE: [ozmidwifery] re: hospital based midwife It is sad to hear yet another hospital midwife feeling under attack. It can be argued that hospital midwives have an even greater role to play in changing the maternity service and catering for women's needs. I turned down the chance of working as an independent in the UK because I believed that the women in hospital needed me more. They were birthing in a strange environment amongst strangers, many in vulnerable social situations. The statistics demonstrated the poor chances these women had of avoiding an instrumental birth or c-section. It is because most women give birth in hospitals, and because the statistics for physiological birth are shocking - that hospital midwives are so important. It is time we asked ourselves how we can improve these outcomes for women and increase satisfaction rates. Many of us are, and as I have said, I have come across far more motivated midwives in the Australian hospital system than the UK. Let's not kid ourselves that there is not a lot to fight for if we do not want to end up as obstetric nurses. We are prevented in many ways from making our own clinical judgements by guidelines, policies etc. We are prevented from developing and maintaining midwifery skills such as waterbirth, suturing, full spectrum care - in some hospitals even catching the baby. It is only by acknowledging our position and refusing to accept that over 30% of women (fit and healthly by global comparison) are unable to give birth without an operation. By looking at our own contribution to individual care and to the midwifery profession. By standing together as midwives regardless of where we practise that we can start to change things for ourselves and the women we care for. We need to stop taking discussion and debate personally and take a leaf out of the drs book. Discuss, question, debate and learn. I am pleased that this debate has drawn some lurkers out to provide us with their valuable perspective we would otherwise have been ignorant of. Rachel - another hospital midwife From: mariet [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] re: hospital based midwife Date: Fri, 4 Nov 2005 10:30:49 +1100 I wanted to respond to this because it touches something I've felt for a while. I've been a lurker on this list for ages but not a contributor because, despite many years as a midwife (and I use the term advisedly, I don't consider myself an obstetric nurse) I've had the impression from the language used on this forum that the work I do and even the women I look after is somehow not as valuable or important as community based midwifery or birth centre care. I don't for a moment think that this is the stated position of most of the contributors to this list. But to a hospital based midwife it certainly can come across that way. I've never been accused of being a shrinking violet but I haven't cared to expose myself here, to dismissive comments about the place I choose to work or the people I work with. Not all hospital midwives do their 8 or 10 hour shift and ignore it for the rest of the day. People are people. I have had atrocious handovers of care from the midwife on the shift before me. I have also had atrocious handovers of care, or refusal to share
Re: [ozmidwifery] The Advertiser today...
Perhaps today with women in a hospital setting means to help her by standing inbetween 'hospital policy', or 'the doctors' and the mother. Which I have seen countless times, with my own experiences and looking in from the outside? Amanda - Original Message - From: Justine Caines [EMAIL PROTECTED] To: OzMid List ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 12:28 AM Subject: Re: [ozmidwifery] The Advertiser today... Dear All Sage words Tania. May seem corny, but I always come back to the fact that midwife means 'with woman' so if as a midwife you are 'with' hospital policies or 'with' pandering to Dr and non-evidence based protocols then where is the woman? Being 'with woman' is not utopia, it is appropriate practice and the right of every woman. As someone very interested in politics I liken this scenario to a politician that is hamstrung by their parties policies and so really cannot say he/she will represent the needs of their constituents, because at the end of the day they will only do it if it conforms to party policy! Perhaps more midwives need to do a Barnaby Joyce and cross the floor voting against the party for things they feel are important!!! I will never be a midwife but as an active consumer I know all about putting it all on the line. Women will lead the change but we also need brave midwives prepared to back women. JC -- 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: 7.1.362 / Virus Database: 267.12.6/152 - Release Date: 10/31/2005 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.362 / Virus Database: 267.12.6/152 - Release Date: 10/31/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Re:cervidil
Hi Alesa, We are using cervidil at Mackay Base (Queensland). I personally haven't had much experience with it as I mostly work at the birth centre, but the feed back from the other midwives that I've heard so far has been positive. They feel that it is less invasive than Prostins, as it can be put in and left for 12-18hrs (our prostin regimen is every six hours for 3 doses) so less VE's for the woman. They also think it seems to work quite well with primips, getting them into labour more successfully than prostins. I'm not sure about the hyperstimulation. Some of the midwives are putting it in here, but apparently it is quite difficult as you have to make a loop and put the cervidil around the cervix. Cheers MichelleAlesa Koziol [EMAIL PROTECTED] wrote: Lisa We (Midwives) currently use prostin but there is a move afoot for us to commence using cervidil. For lots of reasons, we are not keen to go down this track and I am seeking info on what is currently in use around oz so am fully armed in time for our next meeting.and I must thank everyone who has answered this thread so far you have been most helpful. More info always gratefully accepted:) Cheers Alesa - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 7:51 PM Subject: Re: [ozmidwifery] Re:cervidil Midwives insert the cervidil there are no MO's. Ashford is the biggest private hospital in South Australia. Induction rate is also about 70% maybe more, for all the wrong reasons. What sort of results do you get with it? Lisa - Original Message - From: Alesa Koziol To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 6:47 PM Subject: Re: [ozmidwifery] Re:cervidil Thanks Lisa... do the midwives use it or is it inserted by MO?? And which state are you in? Cheers Alesa - Original Message - From: Lisa Barrett To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 4:58 PM Subject: Re: [ozmidwifery] Re:cervidil They use Cervidil at Ashford, It has quite an aggressive action provided it's inserted correctly. It's not easy to put in however being extremely awkward. It's almost impossible to place it in the posterior fornix. One Ob described it to a patient as a tampon. I found this very amusing as it's Barbie sized! Lisa - Original Message - From: Larissa Inns To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 02, 2005 3:58 PM Subject: [ozmidwifery] Re:cervidil I only know of a couple of private OB's who use it at one of our local private hospitals. Most choose not to use it because of the cost. Hugs,Larissa. My next question for the list is to ask of any sites where Midwives are using cervidil. Cheers Alesa Do you Yahoo!? Yahoo! Photos: Now with unlimited storage
Re: [ozmidwifery] re: hospital based midwife
I mean soul (NOT FOOT!!!) amazing what screaming children will do to your brain!! amanda - Original Message - From: Synnes [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 4:26 PM Subject: Re: [ozmidwifery] re: hospital based midwife It seems that there are those who feel a midwife working in a hospital setting has sold her/his sole to the devil for doing so. But they are the ones on the front line so to speak who fight every day for the rights of birthing women, without them it would be worse. Yes there are lots of problems in every hospital in regards to care of women, but the fact is women do birth in hospitals and we need our best, most passionate midwives there standing beside them or all is lost and it will all become obstectrics care under doctors sole control with ob nurses. If no one has the passion to work in the hospitals who's left??? We are never going to get anywhere if its so easy for external forces to cause us to turn on each other so easily United we stand, divided we fall??? Yes there are going to be differences of opinion which we are all entitled to express, thats what I love about the country we live in. But we must have one goal and that is to get and give the absolute best care for women and their families no mater whether they turn up at a Birthing Centre, Hospital, in their own home or where ever. We must fight to be the worlds BEST place to have a child and make every pregnant women wish they could birth here no matter where she goes in Australia. This is the first time I have ever written anything on here so as you can tell this has sparked an interest in me. And I hope it makes sence! Amanda - Original Message - From: wump fish [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 03, 2005 2:25 PM Subject: RE: [ozmidwifery] re: hospital based midwife It is sad to hear yet another hospital midwife feeling under attack. It can be argued that hospital midwives have an even greater role to play in changing the maternity service and catering for women's needs. I turned down the chance of working as an independent in the UK because I believed that the women in hospital needed me more. They were birthing in a strange environment amongst strangers, many in vulnerable social situations. The statistics demonstrated the poor chances these women had of avoiding an instrumental birth or c-section. It is because most women give birth in hospitals, and because the statistics for physiological birth are shocking - that hospital midwives are so important. It is time we asked ourselves how we can improve these outcomes for women and increase satisfaction rates. Many of us are, and as I have said, I have come across far more motivated midwives in the Australian hospital system than the UK. Let's not kid ourselves that there is not a lot to fight for if we do not want to end up as obstetric nurses. We are prevented in many ways from making our own clinical judgements by guidelines, policies etc. We are prevented from developing and maintaining midwifery skills such as waterbirth, suturing, full spectrum care - in some hospitals even catching the baby. It is only by acknowledging our position and refusing to accept that over 30% of women (fit and healthly by global comparison) are unable to give birth without an operation. By looking at our own contribution to individual care and to the midwifery profession. By standing together as midwives regardless of where we practise that we can start to change things for ourselves and the women we care for. We need to stop taking discussion and debate personally and take a leaf out of the drs book. Discuss, question, debate and learn. I am pleased that this debate has drawn some lurkers out to provide us with their valuable perspective we would otherwise have been ignorant of. Rachel - another hospital midwife From: mariet [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] re: hospital based midwife Date: Fri, 4 Nov 2005 10:30:49 +1100 I wanted to respond to this because it touches something I've felt for a while. I've been a lurker on this list for ages but not a contributor because, despite many years as a midwife (and I use the term advisedly, I don't consider myself an obstetric nurse) I've had the impression from the language used on this forum that the work I do and even the women I look after is somehow not as valuable or important as community based midwifery or birth centre care. I don't for a moment think that this is the stated position of most of the contributors to this list. But to a hospital based midwife it certainly can come across that way. I've never been accused of being a shrinking violet but I haven't cared to expose myself here, to dismissive comments about the place I choose to
[ozmidwifery] Postnatal Depression in Nambucca Heads
FYI Helen ALL IN THE MIND: Getting the Regional Blues - post natal depression and therural mumSaturday 5 November, 1.30pm, Radio NationalNambucca Heads is a beautiful seaside town on the mid north coast of NSW.But despite the tranquil environment, figures for post-natal depression innew mothers are astronomical. Early research suggests half of new motherssuffer post-natal depression - five times the rate of their city sisters.Given 15% unemployment, limited medical help and a claustrophobic andwatchful social environment, you can see possible reasons for these highrates. Liz Keen investigates the incidence, diagnosis and treatment ofpost-natal depression in Nambucca. http://www.abc.net.au/rn/science/mind/
[ozmidwifery] Home Gender Prediction Kit
Hello all, Ive just been approached by a Journalist for a QLD newspaper asking about a product recently released in the US which can apparently test for the gender of a baby from 5 weeks of pregnancy. I was asked to comment and also asked if there was anyone else who might be able to make a strong comment, either for or against this sort of product and what it might result in i.e. more terminations? More gender anxiety? A big seller? If anyone knows of someone who would be relevant to comment about gender testing, please let me know or forward this email to them and I will pass on the details of the journalist. Best Regards, Kelly Zantey Director, www.bellybelly.com.au www.toys4tikes.com.au Gentle Solutions For Conception, Pregnancy, Birth Baby Australian Little Tikes Specialists
