RE: [ozmidwifery] We can make a difference (long)
Yep, anything for a couple of hours sleep, and reassurance bub has had something. People are still stuck in the 4/24 feeds even though 20 years ago we were told to feed on demand. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jo Watson Sent: Tuesday, 17 October 2006 11:01 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] We can make a difference (long) On 17/10/2006, at 8:45 AM, Heartlogic wrote: Many (if not all) words from health professionals are hypnotic, and wire their way into a woman's mind and experience. While I agree with this in relation to women and birth, I have to (in most cases) disagree with this in regards to breastfeeding advice and support. MOST of the women I look after postnatally just don't listen or don't believe the advice they recieve - they don't trust their bodies. It's like the birth experience has been owned by someone else, and now they are being asked to trust their body, and that baby knows what he's doing, wanting to be on the breast every hour, for example to get the milk in - and they just don't believe it.No amount of education seems to make much difference, sadly. Do these women get sick of us telling them that it's normal? Would they be happier if we said, well actually, you don't have enough milk, so we'll need to intervene and give formula? Just musing :) Jo -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] 2nd degree tears
I was wondering if any of you wise women know of any research to support not suturing 2nd degree tears. I know that Becky Reed from the Albany Practice in London has undertaken some research in this area, maybe someone on the list could direct me on how I would be able to obtain a copy of it. Thanks in advance Sonja
RE: [ozmidwifery] We can make a difference (long)
Thanks Wendy that is what I thought. So why is it that women are not asked if cord blood gases can be taken? Is this not the perfect opportunity to shift the focus? I never knew it was being done, nor have my clients. Why not? Is it not perceived to be important for the woman to know simply because she never sees it? Perplexed, Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] We can make a difference (long)
I don't know what the procedure for consent is at KEMH but all women there have cord blood gasses done routinely. During a workshop on CTG's held at KEMH last year I questioned what happens when a woman wants physiological 3rd stage but the tutor seemed unable to comprehend the issue and would not give me a satisfactory answer. I feel that the vast majority of women are unaware of the benefits of physiological 3rd stage and do not even consider this as part of their birth choices, I discuss this ante natally whenever possible with women who seem interested and occasionally they do request phys 3rd stage, but the docs argue against it and often frighten them out of this choice. In my experience, most women give very little thought to the placenta at all - if they do consider it, it is to ask about donating the blood (not an option in WA at the moment) or arranging to have it saved by one of the companies currently doing this. They do not seem to realise that it would be of benefit to their babies to recieve this at birth. Sue - Original Message - From: Philippa Scott [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 17, 2006 7:28 PM Subject: RE: [ozmidwifery] We can make a difference (long) Thanks Wendy that is what I thought. So why is it that women are not asked if cord blood gases can be taken? Is this not the perfect opportunity to shift the focus? I never knew it was being done, nor have my clients. Why not? Is it not perceived to be important for the woman to know simply because she never sees it? Perplexed, Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -- 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: 7.1.408 / Virus Database: 268.13.4/477 - Release Date: 16/10/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] introduction and VBAC question
Hi My name is Pernille. I have been lurking for a few days now and thought I would introduce myself. I am a doula and childbirth educator on the sunshine coast, but have only just finished my studies. Yeah, so still pretty new in the field but love every minute of it. I have a question about VBAC birthing. It seems that in hospital they want to do continues monitoring of the scar and babies heart beat with the belt and have needle in the arm just in case, as soon as women come in the door to give birth. But is this nessecery and is there any other way to safely monitor the woman without her being so resticted? Now I know there are lots of homebirth VBAC these days, and surely they must have other things they do...other signs they look for or just intermitted monitoring? Cheers from pernille -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.408 / Virus Database: 268.13.4/477 - Release Date: 16/10/2006
RE: [ozmidwifery] We can make a difference (long)
When I talk with clients about this most have never considered it. We talk about the huge benefits to baby and look at risk management and plan B options. Almost all choose to have physiological 3rd stage unless PPH is obviously occurring or augmentation/induction occurred. When women are truly informed about this they will often choose to do what supports the baby. To take that away by not sharing with them the cost of policy seems so wrong to me. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Susan Cudlipp Sent: Tuesday, 17 October 2006 9:58 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] We can make a difference (long) I don't know what the procedure for consent is at KEMH but all women there have cord blood gasses done routinely. During a workshop on CTG's held at KEMH last year I questioned what happens when a woman wants physiological 3rd stage but the tutor seemed unable to comprehend the issue and would not give me a satisfactory answer. I feel that the vast majority of women are unaware of the benefits of physiological 3rd stage and do not even consider this as part of their birth choices, I discuss this ante natally whenever possible with women who seem interested and occasionally they do request phys 3rd stage, but the docs argue against it and often frighten them out of this choice. In my experience, most women give very little thought to the placenta at all - if they do consider it, it is to ask about donating the blood (not an option in WA at the moment) or arranging to have it saved by one of the companies currently doing this. They do not seem to realise that it would be of benefit to their babies to recieve this at birth. Sue - Original Message - From: Philippa Scott [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 17, 2006 7:28 PM Subject: RE: [ozmidwifery] We can make a difference (long) Thanks Wendy that is what I thought. So why is it that women are not asked if cord blood gases can be taken? Is this not the perfect opportunity to shift the focus? I never knew it was being done, nor have my clients. Why not? Is it not perceived to be important for the woman to know simply because she never sees it? Perplexed, Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -- 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: 7.1.408 / Virus Database: 268.13.4/477 - Release Date: 16/10/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] introduction and VBAC question
Hi and welcome, www.cares-sa.org.au www.birthrites.org These are both excellent places to find terrific information on all things VBAC. Yes there are alternatives. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Pernille Sent: Tuesday, 17 October 2006 10:02 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] introduction and VBAC question Hi My name is Pernille. I have been lurking for a few days now and thought I would introduce myself. I am a doula and childbirth educator on the sunshine coast, but have only just finished my studies. Yeah, so still pretty new in the field but love every minute of it. I have a question about VBAC birthing. It seems that in hospital they want to do continues monitoring of the scar and babies heart beat with the belt and have needle in the arm just in case, as soon as women come in the door to give birth. But is this nessecery and is there any other way to safely monitor the woman without her being so resticted? Now I know there are lots of homebirth VBAC these days, and surely they must have other things they do...other signs they look for or just intermitted monitoring? Cheers from pernille -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.408 / Virus Database: 268.13.4/477 - Release Date: 16/10/2006
Re: [ozmidwifery] cord blood gases
Melissa As reported by others already I have seen MANY babes born who were in good condition at birth with very poor gases. Do we tell parents that? I know your baby looks well but the blood gases that you 'consented?' to are suggesting otherwise. If the baby is in really poor condition can we console ourselves or the parents with the results of good cord blood gases? We recently had a big issue in this country where organs from babies and children who had sadly died were kept for medical research without consent. Many parents were outraged! I donot believe that you can take samples from a cord (any more than organs)and not get permission with your reasons for taking them, which in the end is purely to protect against litigation. My experience of inaccuracies would certainly not help me to feel protected by the results of any blood gases. Some of the reasons that I speculate for inaccuracies are in collection methods speed of analysis accuracy of the machine (we had one in theatre and one in labour ward and would get diffferent results on same blood from each machine.) Then goodness only knows what effect clinical practices in labour have on the results. Simply in practice I saw nothing that gave me faith in them as a useful tool and I am unable to sell them to parents when we are collecting evidence to protect us from future litigation. I am keeping out of the way of football so going off on one now! If we care for women to the very best of our ability, if we build a relationship with them and the trust and respect us they are much less likely to sue. Our efforts would be better placed here I think! Ultimately a no fault compensation scheme for parents of children with pregnancy/birth injuries would get away form us spending so much energy defending ourselves. I will post the references but have to type them up. Shelly - Original Message - From: Melissa Singer [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, October 16, 2006 4:24 AM Subject: Re: [ozmidwifery] cord blood gases Hi Shelley, I recently attended a advanced fetal assessment course at our tertiary hospital and all the pros for cord blood gases were presented. CTG's were discussed with pros and cons such as 80% show some abnormality but 80% of babies are not sick or acidotic. It was presented as one of certain diagnostic tools for fetal acidosis and therefore useful for litigation. You mentioned the results are inaccurate. I'd be very interested in hearing why they are inaccurate. We don't do them and I don't agree with routinely doing them so any more information would be helpful. Thanks Melissa - Original Message - From: michelle gascoigne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 14, 2006 10:39 PM Subject: Re: [ozmidwifery] cord blood gases Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it done. I will search out my references and post them seperately. Our debate was published in a midwifery mag here! Shelly Midwife - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 9:07 AM Subject: [ozmidwifery] cord blood gases Hi all, Just wondering how common it is for cord blood gases to be done in maternity units. I work in a small metro. hospital with a very busy maternity
Re: [ozmidwifery] cord blood gases
Naomi That was one of the big issues for us too! Hence the debate. Women are supposed to be informed antenatally. I know that they are being taken but women are seldom asked and seldom know. How dreadful! Shelly - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, October 16, 2006 8:57 AM Subject: Re: [ozmidwifery] cord blood gases Thanks everyone for your responses so far re cord blood gases. It will all be so helpful when we 'go into battle'. Shelly, you commented about letting the parents make the decision. This is one of our biggest areas of concern, as the medicos have made no mention of how informed consent will be obtained, and 'asking at the time', which was one response to this, is so very inappropriate. I truly despair at the interpretation of 'informed consent' that I regularly see at my place of work. Your references on this will be so useful. Naomi Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it done. I will search out my references and post them seperately. Our debate was published in a midwifery mag here! Shelly Midwife - Original Message - From: Naomi Wilkin [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 13, 2006 9:07 AM Subject: [ozmidwifery] cord blood gases Hi all, Just wondering how common it is for cord blood gases to be done in maternity units. I work in a small metro. hospital with a very busy maternity unit and our medical 'powers that be' are pushing for them to be done at every birth. Something we, the midwives, are very, very reluctant to do. I was also wondering if anyone knows of any research that may help us to prevent this from becoming a routine thing. Thanks Naomi. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- Internal Virus Database is out-of-date. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.12.12/461 - Release Date: 02/10/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.13.4/476 - Release Date: 14/10/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] oops lost c-secs refs!
Hi all, can someone link me to those 2 latest studies on c-sec? Journo with the BorderMail in Albury is interested in seeing them for her article on hb. I'm snowed under or I'd search myself. TIA, J For home birth information go to:Joyous Birth Australian home birth network and forums.http://www.joyousbirth.info/Or email: [EMAIL PROTECTED]
RE: [ozmidwifery] cord blood gases
Do you have any figures for the well babies with abnormal cord gases as this evidence would not support routine cord gases on all babies but anecdotal evidence such as this won't provide us with any support particularly when it could be the machine or operators. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of michelle gascoigne Sent: 18 October 2006 05:45 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Melissa As reported by others already I have seen MANY babes born who were in good condition at birth with very poor gases. Do we tell parents that? I know your baby looks well but the blood gases that you 'consented?' to are suggesting otherwise. If the baby is in really poor condition can we console ourselves or the parents with the results of good cord blood gases? We recently had a big issue in this country where organs from babies and children who had sadly died were kept for medical research without consent. Many parents were outraged! I donot believe that you can take samples from a cord (any more than organs)and not get permission with your reasons for taking them, which in the end is purely to protect against litigation. My experience of inaccuracies would certainly not help me to feel protected by the results of any blood gases. Some of the reasons that I speculate for inaccuracies are in collection methods speed of analysis accuracy of the machine (we had one in theatre and one in labour ward and would get diffferent results on same blood from each machine.) Then goodness only knows what effect clinical practices in labour have on the results. Simply in practice I saw nothing that gave me faith in them as a useful tool and I am unable to sell them to parents when we are collecting evidence to protect us from future litigation. I am keeping out of the way of football so going off on one now! If we care for women to the very best of our ability, if we build a relationship with them and the trust and respect us they are much less likely to sue. Our efforts would be better placed here I think! Ultimately a no fault compensation scheme for parents of children with pregnancy/birth injuries would get away form us spending so much energy defending ourselves. I will post the references but have to type them up. Shelly - Original Message - From: Melissa Singer [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, October 16, 2006 4:24 AM Subject: Re: [ozmidwifery] cord blood gases Hi Shelley, I recently attended a advanced fetal assessment course at our tertiary hospital and all the pros for cord blood gases were presented. CTG's were discussed with pros and cons such as 80% show some abnormality but 80% of babies are not sick or acidotic. It was presented as one of certain diagnostic tools for fetal acidosis and therefore useful for litigation. You mentioned the results are inaccurate. I'd be very interested in hearing why they are inaccurate. We don't do them and I don't agree with routinely doing them so any more information would be helpful. Thanks Melissa - Original Message - From: michelle gascoigne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 14, 2006 10:39 PM Subject: Re: [ozmidwifery] cord blood gases Naomi In England we have seen in increase in 'fear' of litigation. Obstetrics in this country has always taken a huge chunk of the litigation for most hospitals . We now have in our country CNST (clinical neglegence scheme for trusts). Trusts are what groups of health care organisations are called. CNST is an insurance that Trusts pay into so that litigation claims can be paid when won. The CNST set out standards for trusts and depending on how well you achieve the standards determines the insurance premiums, which you can imagine are huge figures. The trouble is that CNST requirements for the standards to be met are not always sensible or in the best interests of women. Some standards like (cord blood sampling for ph post birth) are simply taken to record results in the notes which may protect against litigation in the future. I have a million issues with this practice! We had a university supervised professional debate about this issue in the Trust where I worked when it first became an issue. The midwives against and the Obs. for. We won the debate but the CNST requirements meant that we could save the Trust loads of money if we did them so they were introduced. Some of us still refused to do them. I would only do them if it was explained in full to the mother and father and they agreed. I gave it to them warts and all (like the obs openly admit that it is just to defend them in cases of litigation.). I did not make the decision the parents did. Needless to say when you tell them how inaccurate the results are and that neither they nor the baby will benfit from the results. Many choose not to have it
RE: [ozmidwifery] cord blood gases
Lisa, I am hoping you are still reading this list and can send me the references regarding the length of time before the results for cord gases deteriorate and not needing to put them on ice as I asked earlier. If you wish to email them to me off line that is OK and I will forward them to group. Thanks Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 13 October 2006 21:08 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] cord blood gases Hi all, Just wondering how common it is for cord blood gases to be done in maternity units. I work in a small metro. hospital with a very busy maternity unit and our medical 'powers that be' are pushing for them to be done at every birth. Something we, the midwives, are very, very reluctant to do. I was also wondering if anyone knows of any research that may help us to prevent this from becoming a routine thing. Thanks Naomi. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] cord blood gases
Still here Christine, holding my tongue very well :-) working on the undesirable thing. http://www.cs.nott.ac.uk/~jmg/papers/brjog-94.pdf This is very interesting as it analysed how gases were taken. http://www.clinchem.org/cgi/content/full/44/3/681 This is the extract from this study that showed no difference between room temp:- The first null hypothesis was that there was a difference between the two samples of each group, caused by the methodology of blood sampling and analysis. The data shown in Table 1 , however, indicate no significant differences between the two samples; therefore, the rejection of the null hypothesis implies high reproducibility of the method. The second null hypothesis suggested a difference between samples tested immediately and those tested after storage for 1 h in the refrigerator, caused by the effect of time and temperature. The data shown in Table 1 indicate no significant difference between the mean values of all analytes tested in both groups. The third null hypothesis suggested a difference between samples examined immediately and after storage of 1 h at room temperature, caused by the effect of time. However, the data shown reject this hypothesis and suggest that a period of 1 h has no effect on the analytes tested. The fourth null hypothesis was that temperature had an effect on the test results. The data shown in Table 1 also reject this hypothesis and suggest that temperature alone does not affect the tested variables. Thanks Lisa Barrett - Original Message - From: Christine Holliday [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 18, 2006 8:54 AM Subject: RE: [ozmidwifery] cord blood gases Lisa, I am hoping you are still reading this list and can send me the references regarding the length of time before the results for cord gases deteriorate and not needing to put them on ice as I asked earlier. If you wish to email them to me off line that is OK and I will forward them to group. Thanks Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 13 October 2006 21:08 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] cord blood gases Hi all, Just wondering how common it is for cord blood gases to be done in maternity units. I work in a small metro. hospital with a very busy maternity unit and our medical 'powers that be' are pushing for them to be done at every birth. Something we, the midwives, are very, very reluctant to do. I was also wondering if anyone knows of any research that may help us to prevent this from becoming a routine thing. Thanks Naomi. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list
[ozmidwifery] Doulas in QLD, VIC NSW
See below, she would like me to circulate this. -Original Message- From: Mark Catherine Romeo [mailto:[EMAIL PROTECTED] Sent: Wednesday, October 18, 2006 1:06 PM To: [EMAIL PROTECTED] Subject: bookings Hi Kelly, We are launching an On-line Nanny agency on the 20th of November and we have a dedicated section for Doulas. If you are interested on being listed for free, could you please let me know. I will be in Victoria for Interviews between the 6th of November and the 10th of November. We do not have set rates, we advertise the rates that you choose. Kindly yours, Catherine Romeo The web site is ebump.com.au Happiness is a state of mind. Dont compare yourself to other people, compare yourself to who you could be. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] La Trobe Post Natal Care Study
Anyone heard about this? From one of my members I just attended a focus group at Geelong Hossy to discuss options for future postnatal care. The study is being carried out throughout Victoria to determine what women really want. It was quite interesting - there were a range of women there (with children and without) and we had an interesting chat. They presented 4 options for postnatal care. Basically the options varied the number of days in hossy, and the number of visits by the dom midwives, but option 2 was a pearler... 1 night hossy, 2 nights hotel, and 1 dom visit (for vaginal birth) How rocking would that option be in the public system!! WOOHO! Anyway, what we basically came up with as a group was that we wanted complete flexibility, and after the first night in hossy we wanted to make a decision then as to what we wanted from that point. Ahhh women - so easy to please Has anyone else been involved in this research study? Best Regards, Kelly Zantey Creator,BellyBelly.com.au Conception, Pregnancy, Birth and Baby BellyBelly Birth Support
[ozmidwifery] Risks of Elective Caesarean Sept 06
In case you havent seen it yet, read below. I also hear there is another study just come out or about too, about maternal mortality rates which had found that mothers were 4 times more likely to die if they had a c/section, compared with a normal birth. It broke down cause of death by %: Voluntary C-Sections Result in More Baby Deaths LARGE STUDY shows significant evidence Article published in the New York Times By NICHOLAS BAKALAR Published: September 5, 2006 A recent study of nearly six million births has found that the risk of death to newborns delivered by voluntary Caesarean section is much higher than previously believed. Researchers have found that the neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births, while the rate for vaginal delivery is 0.62 deaths per 1,000. Their findings were published in this month's issue of Birth: Issues in Perinatal Care. The percentage of Caesarean births in the United States increased to 29.1 percent in 2004 from 20.7 percent in 1996, according to background information in the report. Mortality in Caesarean deliveries has consistently been about 1½ times that of vaginal delivery, but it had been assumed that the difference was due to the higher risk profile of mothers who undergo the operation. This study, according to the authors, is the first to examine the risk of Caesarean delivery among low-risk mothers who have no known medical reason for the operation. Congenital malformations were the leading cause of neonatal death regardless of the type of delivery. But the risk in first Caesarean deliveries persisted even when deaths from congenital malformation were excluded from the calculation. Intrauterine hypoxia lack of oxygen can be both a reason for performing a Caesarean section and a cause of death, but even eliminating those deaths left a neonatal mortality rate for Caesarean deliveries in the cases studied at more than twice that for vaginal births. Neonatal deaths are rare for low-risk women on the order of about one death per 1,000 live births but even after we adjusted for socioeconomic and medical risk factors, the difference persisted, said Marian F. MacDorman, a statistician with the Centers for Disease Control and Prevention and the lead author of the study. This is nothing to get people really alarmed, but it is of concern given that we're seeing a rapid increase in Caesarean births to women with no risks, Dr. MacDorman said. Part of the reason for the increased mortality may be that labor, unpleasant as it sometimes is for the mother, is beneficial to the baby in releasing hormones that promote healthy lung function. The physical compression of the baby during labor is also useful in removing fluid from the lungs and helping the baby prepare to breathe air. The researchers suggest that other risks of Caesarean delivery, like possible cuts to the baby during the operation or delayed establishment of breast-feeding, may also contribute to the increased death rate. The study included 5,762,037 live births and 11,897 infant deaths in the United States from 1998 through 2001, a sample large enough to draw statistically significant conclusions even though neonatal death is a rare event. There were 311,927 Caesarean deliveries among low-risk women in the analysis. The authors acknowledge that the study has certain limitations, including concerns about the accuracy of medical information reported on birth certificates. That data is highly reliable for information like method of delivery and birth weight, but may underreport individual medical risk factors. It is possible, though unlikely, that the Caesarean birth group was inherently at higher risk, the authors said. Dr. Michael H. Malloy, a co-author of the article and a professor of pediatrics at the University of Texas Medical Branch at Galveston, said that doctors might want to consider these findings in advising their patients. Despite attempts to control for a number of factors that might have accounted for a greater risk in mortality associated with C-sections, we continued to observe enough risk to prompt concern, he said. When obstetricians review this information, perhaps it will promote greater discussion within the obstetrical community about the pros and cons of offering C-sections for convenience and promote more research into understanding why this increased risk persists. Best Regards, Kelly Zantey Creator,BellyBelly.com.au Conception, Pregnancy, Birth and Baby BellyBelly Birth Support __._,_.___ Yahoo! Groups Links To visit your group on the web, go to: http://au.groups.yahoo.com/group/ozbirthing/ To unsubscribe from this group, send an email to: [EMAIL PROTECTED] Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service. __,_._,___
RE: [ozmidwifery] Risks of Elective Caesarean Sept 06
group on the web, go to: http://au.groups.yahoo.com/group/ozbirthing/ To unsubscribe from this group, send an email to: [EMAIL PROTECTED] Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service. __,_._,___ __ NOD32 1.1808 (20061017) Information __ This message was checked by NOD32 antivirus system. http://www.eset.com
RE: [ozmidwifery] Risks of Elective Caesarean Sept 06
to the increased death rate. The study included 5,762,037 live births and 11,897 infant deaths in the United States from 1998 through 2001, a sample large enough to draw statistically significant conclusions even though neonatal death is a rare event. There were 311,927 Caesarean deliveries among low-risk women in the analysis. The authors acknowledge that the study has certain limitations, including concerns about the accuracy of medical information reported on birth certificates. That data is highly reliable for information like method of delivery and birth weight, but may underreport individual medical risk factors. It is possible, though unlikely, that the Caesarean birth group was inherently at higher risk, the authors said. Dr. Michael H. Malloy, a co-author of the article and a professor of pediatrics at the University of Texas Medical Branch at Galveston, said that doctors might want to consider these findings in advising their patients. Despite attempts to control for a number of factors that might have accounted for a greater risk in mortality associated with C-sections, we continued to observe enough risk to prompt concern, he said. When obstetricians review this information, perhaps it will promote greater discussion within the obstetrical community about the pros and cons of offering C-sections for convenience and promote more research into understanding why this increased risk persists. Best Regards, Kelly Zantey Creator,BellyBelly.com.au Conception, Pregnancy, Birth and Baby BellyBelly Birth Support __._,_.___ Yahoo! Groups Links To visit your group on the web, go to: http://au.groups.yahoo.com/group/ozbirthing/ To unsubscribe from this group, send an email to: [EMAIL PROTECTED] Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service. __,_._,___ __ NOD32 1.1808 (20061017) Information __ This message was checked by NOD32 antivirus system. http://www.eset.com
RE: [ozmidwifery] cord blood gases
Thanks for sending these, don't hold your tongue for too long. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 18 October 2006 09:42 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Still here Christine, holding my tongue very well :-) working on the undesirable thing. http://www.cs.nott.ac.uk/~jmg/papers/brjog-94.pdf This is very interesting as it analysed how gases were taken. http://www.clinchem.org/cgi/content/full/44/3/681 This is the extract from this study that showed no difference between room temp:- The first null hypothesis was that there was a difference between the two samples of each group, caused by the methodology of blood sampling and analysis. The data shown in Table 1 , however, indicate no significant differences between the two samples; therefore, the rejection of the null hypothesis implies high reproducibility of the method. The second null hypothesis suggested a difference between samples tested immediately and those tested after storage for 1 h in the refrigerator, caused by the effect of time and temperature. The data shown in Table 1 indicate no significant difference between the mean values of all analytes tested in both groups. The third null hypothesis suggested a difference between samples examined immediately and after storage of 1 h at room temperature, caused by the effect of time. However, the data shown reject this hypothesis and suggest that a period of 1 h has no effect on the analytes tested. The fourth null hypothesis was that temperature had an effect on the test results. The data shown in Table 1 also reject this hypothesis and suggest that temperature alone does not affect the tested variables. Thanks Lisa Barrett - Original Message - From: Christine Holliday [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 18, 2006 8:54 AM Subject: RE: [ozmidwifery] cord blood gases Lisa, I am hoping you are still reading this list and can send me the references regarding the length of time before the results for cord gases deteriorate and not needing to put them on ice as I asked earlier. If you wish to email them to me off line that is OK and I will forward them to group. Thanks Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lisa Barrett Sent: 13 October 2006 21:08 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases We do these only if we suspect some fetal compromise during labour or an unexpected problem at birth, the suggestion that they are done at every birth is a defensive issue and indeed I have found that the results often support your actions during labour i.e. in not intervening sooner and I try and do them if I think there may be a problem of some sort, sorry this is vague. If you are busy a good trick is to use two clamps on the cord to hold the blood in the cord and if you take it within 30 mins and get it in ice and to the labs the results are still OK to use. Of course you cannot do this with a physiological 3rd stage but I can't think you would need cord gases if all was well enough for a physiological 3rd stage. It is a defensive issue to do them at all. It is only ever to cover yourself even if it's to back up not intervening. Why would you suspect fetal compromise in labour that wasn't proven by fetal compromise at birth and then what would a gas achieve. Either you were right or wrong. If you are busy a good trick is to get someone else to care for the other women at the time of birth so you don't have to put the cord blood on ice. Better still don't do one. If all doesn't go well and you have a baby needing resus, all the research tells us not to cut the cord, the way that a compromised baby still is getting oxygen. To do a procedure you should have evidence to back up it's necessity. There is none for blood gas. Just as there is none for continuous monitoring. It's practice in fear and no good to anybody. Lisa Barrett I am not a supporter of doing them at every birth as it is another distraction from caring for the mother and baby but it is helpful to support your care and the results can influence the treatment/care of a baby making the care more appropriate. Christine -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Naomi Wilkin Sent: 13 October 2006 17:37 To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] cord blood gases Hi all, Just wondering how common it is for cord blood gases to be done in maternity units. I work in a small metro. hospital with a very busy maternity unit and our medical 'powers that be' are pushing for them to be done at every birth. Something we, the midwives, are very, very reluctant to do. I was also wondering if anyone knows of any research that may help us to
[ozmidwifery] CS Paper from Birth was risks of elective cesarean sept 06
Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with No Indicated Risk, United States, 1998-2001 Birth Cohorts Marian F. MacDorman, PhD1, Eugene Declercq, PhD2, Fay Menacker, DrPH, CPNP1, and Michael H. Malloy, MD, MS3 ABSTRACT: Background: The percentage of United States' births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37-41 weeks' gestation) women with no indicated medical risks or complications. Methods: National linked birth and infant death data for the 1998-2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006) The percentage of United States' births delivered by cesarean section has increased substantially in recent years, from 20.7 percent in 1996 to 29.1 percent in 2004 (1,2). The cesarean delivery rate has increased rapidly even among women considered to be at low risk based on the Healthy People 2010 criteria (i.e., women with a full-term, singleton infant in vertex presentation) (3,4). Much of the overall increase is due to a substantial rise in primary cesarean section rates, from 14.6 percent in 1996 to 20.6 percent in 2004 (1,2). The growth in primary cesareans is of particular concern because, due to a precipitous drop in the rate of vaginal birth after previous cesarean (VBAC), now at the all-time low of 9.2 percent, a woman who has a primary cesarean section has a greater than 90 percent chance of having a subsequent cesarean delivery, thus elevating the overall cesarean rate even further (1,5). Since vital statistics data on cesarean sections began to be collected (1989), the infant mortality rate in the United States for total cesarean deliveries has consistently been approximately 1.5 times that for vaginal deliveries (6). It was assumed that this mortality differential was due to a higher risk profile for cesarean births, since the indication for cesarean section would likely constitute a risk factor for mortality. A variety of studies have examined neonatal mortality for cesarean and vaginal births for special populations, such as low-birthweight or preterm births (7-10), breech births (8,11), and multiple births (12-14). However, no study known to us has attempted to examine this relationship for term births with no known risk factors or indications. The examination of the relationship between method of delivery and infant mortality for low-risk women has assumed greater urgency, given the recent controversy over elective primary cesarean deliveries and the rapid increase in those deliveries (15,16). This paper uses a previously developed methodology to identify births with no indicated risk (17). These are births that, in addition to meeting the Healthy People 2010 criteria for low risk, have no reported medical risk factors or complications of labor and/or delivery identified on the birth certificate. These no indicated risk women experienced a 49 percent increase in the odds of cesarean delivery from 1996 to 2001, after statistical adjustment for maternal age, race, education, birthweight, and parity (17). This study extends the previous analysis of the group with no indicated risk to examine birth outcomes in the form of infant and neonatal mortality in the United States by method of delivery (i.e., vaginal or primary cesarean). Methods Go to: ChooseTop of pageMethods ResultsDiscussion and conclusion...References The 1998-2001 birth cohort national linked birth/infant death data sets were analyzed to examine infant and neonatal mortality for women with no indicated risk. These data sets link the birth record to the infant death record for each infant who dies in the United States. The purpose of the linkage is to use the many additional variables available from the birth
[ozmidwifery] Maternal complications with multiple CS
Nisenblat, Victoria MD 1; Barak, Shlomi MD 1; Griness, Ofra Barnett PhD 2; Degani, Simon MD 1; Ohel, Gonen MD 1; Gonen, Ron MD 1 Institution From the (1)Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, and the (2)Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Title Maternal Complications Associated With Multiple Cesarean Deliveries.[Article] Source Obstetrics Gynecology. 108(1):21-26, July 2006. Abstract OBJECTIVE: The claim that a planned repeat cesarean delivery is safer than a trial of labor after cesarean may not be applicable to women who desire larger families. The aim of this study was to assess maternal complications after multiple cesarean deliveries. METHODS: The records of women who underwent two or more planned cesarean deliveries between 2000 and 2005 were reviewed. We compared maternal complications occurring in 277 women after three or more cesarean deliveries (multiple-cesarean group) with those occurring in 491 women after second cesarean delivery (second-cesarean group). RESULTS: Excessive blood loss (7.9% versus 3.3%; P .005), difficult delivery of the neonate (5.1% versus 0.2%; P .001), and dense adhesions (46.1% versus 25.6%; P .001) were significantly more common in the multiple-cesarean group. Placenta accreta (1.4%) and hysterectomy (1.1%) were more common, but not significantly so, in the multiple-cesarean group. The proportion of women having any major complication was higher in the multiple-cesarean group, 8.7% versus 4.3% (P = .013), and increased with the delivery index number: 4.3%, 7.5%, and 12.5% for second, third, and fourth or more cesarean delivery, respectively (P for trend = .004). CONCLUSION: Multiple cesarean deliveries are associated with more difficult surgery and increased blood loss compared with a second planned cesarean delivery. The risk of major complications increases with cesarean delivery number. LEVEL OF EVIDENCE: II-2 (C) 2006 The American College of Obstetricians and Gynecologists DOI Number 10.1097/01.AOG.222380.11069.11 Results Manager Results Fields Result Format Actions Selected Results All on this page All in this set (1-519) and/or Range: Citation (Title,Author,Source) Citation + Abstract Citation + Abstract + Subject Headings Complete Reference Ovid BRS/Tagged Reprint/Medlars Brief (Titles) Display Direct Export Include Search History Sort Keys Primary: - Author Title Journal Name Date of Publication Ascending Descending Secondary: - Author Title Journal Name Date of Publication Ascending Descending Copyright (c) 2000-2006 Ovid Technologies, Inc. Version: rel10.3.2, SourceID 1.12052.1.159 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
