Re: [ozmidwifery] vaginal breech
I've been present at (and caught!) some lovely breech births but also been present at: one tentorial tear, cactus baby, one fractured cervical spine, lifted up too early... cactus baby, one trapped head, dead baby. They were all living and well at the beginning of the birth. I don't agree at all with the idea of caesaring all breech babies but I have huge fears when I see inexperienced (and some who should be experienced) people stepping up to 'deliver' these babies. Monica - Original Message - From: Janet Fraser [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, August 14, 2006 5:28 PM Subject: Re: [ozmidwifery] vaginal breech They're also trying to avoid the dangers of managed breech birth - go figure! J - Original Message - From: Kristin Beckedahl To: ozmidwifery@acegraphics.com.au Sent: Monday, August 14, 2006 2:15 PM Subject: [ozmidwifery] vaginal breech Hi all, Why are breech (sometimes) routinely CS'd. What risks are they actually trying to avoid for the baby? Kristin -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] The weekend australian
I have known of this kind of elective intubation while still inutero- and attached to the placenta- only in a case where there was a known throat abnormality. The paeds wanted to have an airway before the connection to the placenta was lost... can't remember what the abnormality was, maybe a tumour? Anyhow, they did it, huge circus in theatre, baby t/f to NNICetc. Certainly not routine. Monica - Original Message - From: cath nolan [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, July 12, 2006 9:12 PM Subject: [ozmidwifery] The weekend australian There was an article in the careers section of last weekends Australian, that was an interesting read on c/section. The photo that went with it has me perplexed though.It appears to show a bub being born by caesarean, still in the abdomen but with an ET tube and sats monitor. It is lovely and pink and has a cord that doesn't appear to have been clamped. anyone have any ideas? Cath -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Episiotomy
I happened across this study today while researching forceps- it indicated the cutting an episiotomy when using forceps increases the chance of 3rd 4th degree tears. I don't think it specifies midline. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrievedb=PubMedlist_uids=15957996dopt=Abstract Monica - Original Message - From: Susan Cudlipp [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, June 20, 2006 12:55 AM Subject: Re: [ozmidwifery] Episiotomy Hi Alice This came to me but it was not me that posted the question, so don't know if you just maybe hit the wrong button? Sue. - Original Message - From: Alice Morgan [EMAIL PROTECTED] To: [EMAIL PROTECTED] Cc: ozmidwifery@acegraphics.com.au Sent: Monday, June 19, 2006 1:38 PM Subject: RE: [ozmidwifery] Episiotomy Hi Suzi, I have several studies that show thiscan't think of them all off the top of my head, but will find them for you and send you the info. I'll have to dig out my thesis (I've been somewhat pretending it doesn't exist at the moment). As a start, I think the recent (2005) JAMA published study talks about it, as do Thacker and Banta (1983) and Woolley (1995). There's also one that compares mediolateral and midline episiotomies (Thacker, 2000 from the British Medical Journal). Hope this helps as a start...I'll try to see what else I can find and send to you. Alice From: suzi and brett [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Episiotomy Date: Mon, 19 Jun 2006 09:28:24 +1000 Can anyone point me in the right direction for good evidence that episiotomys have an increased risk of extending to 3 or 4 th degree? or am i remembering - interpreting incorrectly and the best evidence that we have only conclude generally that restrictive epis. has lowered morbidity because the women mostly doesnt end up with as much truama as anticipated. Little discussion i am having with one of our doctors - who says mediolateral cut is not at an increased risk of extending, only midline. My arguement was that only fetal distress with no time to wait for streaching ( or well informed maternal request?) is the only reasons for episiotomy. Im sure if it was a slice down the eye of a penis and the posibility of the man having painful sex and other morbidity for the next year - some doctors may think twice. Love Suz x _ New year, new job - there's more than 100,00 jobs at SEEK http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=752315885_r=Jan05_tagline_m=EXT -- 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: 268.9.0/368 - Release Date: 16/06/2006 -- 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] ctg stuff
I agree... so often women in early labour present over and over, demanding intervention. The reasons for non intervention are explained very clearly, there is no ambiguity of information from midwives or medical staff... the risks of undesirable outcomes- forceps, c/s, fetal distress etc, being hooked up to drips and monitors (yes, policy for Syntocinon use at our place) but women still want it in the majority of cases. Once they make sure they can have an EDB and so 'won't feel' whatever intervention happens... bring it on. Very dispiriting. And if you try to hold out, the next thing that happens is that you're answering a complaint from the PAtient Representative as to why you cruelly withheld legitimate treatment. No wonder midwives and doctors get worn down. Monica - Original Message - From: Susan Cudlipp [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 11:46 PM Subject: Re: [ozmidwifery] ctg stuff Re: [ozmidwifery] ctg stuffMy point here was that this woman DID have this explained very carefully by a patient ob who did not want to induce her, and still she wanted it done. And we see so often those who come in time and time again trying very hard to get induced - some women will resort to all kinds of subterfuge, truly, and I have no idea why they are so keen to put themselves through the induction process, but they just want the pregnancy OVER. Sad Sue - Original Message - From: Roberta Quinn To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 4:24 PM Subject: RE: [ozmidwifery] ctg stuff From: Susan Cudlipp The reply was 'I DONT CARE- I WANT TO BE INDUCED' How can the ob refuse in this instance? In my experience, many women don't understand that being induced can result in a very different birthing experience for themselves and their babies. Perhaps rather than simply being told yes or no, a woman would change her mind about wanting to be induced (or the way she is induced) if she had all the facts. I also think due dates (particularly the dates calculated at early ultrasounds) can have a hugely negative psychological effect on a woman's willingness to wait for labour to start spontaneously. From: Justine Canes It is not until we have a full complement of choice from homebirth to elec c/s can we say that women are really making a choice. And that women are fully informed when making those choices. -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.9.0/368 - Release Date: 16/06/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] How long before synto is used?
We have a system whereby women MUST be admitted to the ward after confirmed SROM. In passing I may say, of women who come in with ?SRM, fewer than half do have ROM so it isn't reasonable to expect Mum's opinion to be Gospel. After admission we have an ongoing battle with the medical staff to allow mums time to labour on their own. Durig the week it's not such a problem because the induction book is usually full (max 3 per day) but on the W/E (no booked IOL) the pressure is on to induce any who are sitting upstairs. We give them the option then but most of our clientele are crying out for induction and jump at the opportunity. We are supposed to be introducing a protocol where women may go home with term ROM to await labour but the Director has avowadly made it as difficult as possible in the hope that the midwives will cave and do immediate IOL. As a side note, I have recently been appointed acting CMC for Delivery Suite in our tertiary centre. I want to try to implement a caseload model during my tenure. Anyone who runs such a model, I would be very interested in learning the nitty gritty of how it is organised. Many thanks, Monica - Original Message - From: jo [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, June 15, 2006 8:26 PM Subject: RE: [ozmidwifery] How long before synto is used? I always find it amazing that what is happening to a woman's body (i.e SROM) is not believed and that she has to go in for 'confirmation'. Surely the woman would know and wouldn't need it confirmed - so the hosp needs evidence because women can't be trusted to tell the truth. Gggrr! The more I read about this the more frustrating it gets. I supported at a homebirth last year where SROM occurred at 36 weeks, mum new that midwife wouldn't deliver at home before 37 weeks. Got checked at hosp, signed herself out (they wanted her to stay until labour started and to birth there) bed rest for 8 days - constant water trickling - 37 +1 labour started - 4 hours, beautiful healthy baby born in lounge room. Times, clocks, protocols, policies, it's all a load of rubbish. Jo _ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of sally @ home Sent: Thursday, 15 June 2006 11:10 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] How long before synto is used? We wait up to 96 hours. If a woman rings with ?pre-labour SROM, we ask them to attend the unit for confirmation, either by history (checking pads) or spec if it looks inconclusive. We do an abdo palp, CTG then send her home with antibiotics to be commenced 18 hours after ROM. We ask to attend the unit daily for CTG. Usually the women will go into spontaneous labour but if they haven't by the 96 hours they come in for synt infusion. Sally - Original Message - From: Kelly @ mailto:[EMAIL PROTECTED] BellyBelly To: ozmidwifery@acegraphics.com.au Sent: Thursday, June 15, 2006 7:28 AM Subject: RE: [ozmidwifery] How long before synto is used? How frustrating then, that of the births I have been to, when there has been an ARM to induce labour, mum gets pressure for the drip after an hour, then they keep coming back in at periodic intervals of 30mins-1hr with more pressure for synto! It's a fight to keep them away! So would it be fair for a mum having an ARM to ask to have her waters broken and then go home, or will they not allow this? I get the impression that they want to keep you in, as I have asked many times if we can get out for a walk and the only thing you can do is walk the ward, and not leave it. Very frustrating if you are trying to get things going, as mum ends anxious about the whole thing especially when you have such an unrealistic time frame to get things going! Obviously some cases are different; I have seen ARM for things like post-dates baby, twins, and the recent one where there was cholestasis involved, which of course makes it different but frustrating when you don't have much info about, I think I need a good midwifery text or something similar as even on the internet mum found it hard to get any good information. She was only borderline for cholestasis, but the doctors were scaring her about what *could* happen and how they just don't understand the condition well enough. She had the drip up after only 2 hours despite regular 30 second contractions that were progressing. Just an assumption, but if they are worried about baby getting stressed from the labour - wouldn't the induced labour be more likely to stress baby? And the fact mum couldn't cope with the contractions as well and then had peth? The labour went quite quickly and it was all over in a few hours. Best Regards, Kelly Zantey Creator, http://www.bellybelly.com.au/ BellyBelly.com.au Gentle Solutions From Conception to Parenthood http://www.bellybelly.com.au/birth-support http://www.bellybelly.com.au/birth-support BellyBelly Birth Support -
Re: [ozmidwifery] Rx for PIH at 36/40
It depends on the severity of the PIH. Magnesium therapy has only a minor effect of BP, it is used to reduce the risk of fitting so is started when there is hyper-reflexivity (jumpiness) usually with deteriorating renal and/or liver function. There is a regime where I work, email me offlist if you want further particulars. It requires specialling, we get an ICU nurse for that part. Not because the Mg therapy is dangerous but because the woman's condition is usually at risk of serious deterioration by that point and we are not really fitted for detecting/ managing multi system failure (and don't want to be- if we did we'd be acute care nurses.) For more run of the mill PIH at 36 weeks we check blood values as indicated, use antihypertensives if necessary to prolong the pregnancy as long as possible and fetal movement charts and umbilical flow studies to assess fetal wellbeing and placental sufficiency; most mothers manage to get to term and labour and birth spontaneously. Is that what you're after? Monica - Original Message - From: Kristin Beckedahl [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, June 08, 2006 12:02 PM Subject: [ozmidwifery] Rx for PIH at 36/40 What is the usual Rx for PIH at this stage? I have heard about magnesium therapy - can anyone give me some dosage ideas? How is the Mg administered? What form is the Mg (phosphate/sulphate etc?) Thanks, K -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] PPH C/S
Who is doing the caesars to get such a huge loss? The usual blood loss for uncomplicated c/s where I work is 3-400mls, I think that is pretty well par for the course. Monica - Original Message - From: lyn lyn [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, April 02, 2006 11:28 AM Subject: Fw: [ozmidwifery] PPH C/S I have heard that a standard 100mls is lost with every c/s. How big was this womens pph. Its strange (or typical) how at a vaginal birth a women can loose 600mls and thats a considered pph but at a c/s 100mls is not. Lyn - Original Message - From: Nicole Carver To: ozmidwifery@acegraphics.com.au Sent: Saturday, April 01, 2006 6:44 PM Subject: RE: [ozmidwifery] PPH C/S Women also have PPH's at caesarean. Not sure if c/s would be safer. Perhaps she should see another ob for a second opinion. Nicole. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Kelly @ BellyBelly Sent: Saturday, April 01, 2006 4:27 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] PPH C/S Hello all, A woman on my forums has had two normal births of big babies - 11lb3oz and 13lb5oz and had a PPH with both. Her Ob is now recommending a c/s with her third bub and wants a scan at 34 weeks as a deciding factor of this. She wants a normal birth - is it okay just for her to say no without too much risk with PPH? Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Misoprostol
We use Misoprostol for PPH. It comes in the protocol after IM syntometrine and IDC and either concomitant with 40u Syntocinon infusion or before if no IV access- thus very useful in postnatal ward in the case of secondary haemorrhages. We use 4 tabs, PR, and find it very effective. We don't use it for cervical ripening etc but are just getting together a procedure to use it instead of Cervagem for 2nd trimester IOL for fetal deaths in utero. It is supposed to have far fewer side effects for the mothers than cervagem and have more rapid administration to delivery times. Monica - Original Message - From: Joy Cocks [EMAIL PROTECTED] To: Ozmidwifery ozmidwifery@acegraphics.com.au Sent: Monday, March 20, 2006 3:28 PM Subject: [ozmidwifery] Misoprostol I work in a very small hospital, covering acute, aged care, emergency, as well as midwifery. One of our GP obstetricians has requested that we have Misoprostol in stock (which we already have for acute patients) as all the hospitals now use it for post-partum bleeding. I would be interested to know how common this is as it is another off label use. I'm also concerned that it will then be a small step to use if for cervical ripening/IOL. I notice in Hale that it is a category L3 (moderately safe) whereas Ergometrine is L4 (possibly hazardous) in breastfeeding mothers. I'm remembering the olden days when Ergometrine tablets were used fairly routinely for women with incomplete 3rd stage or were passing clots - I don't remember the exact dose - but it was used over several days in reducing doses (I even had it myself 30 yrs ago!). Interested to hear any comments or research that anyone has regarding Misoprostol and post-partum bleeding (I'm assuming he means haemorrhage, not normal bleeding). Thanks, Joy Joy Cocks RN (Div 1) RM CBE IBCLC BRIGHT Vic 3741 email:[EMAIL PROTECTED] -- 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] on the subject of induction
- Original Message - From: adamnamy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, March 04, 2006 11:32 PM Subject: [ozmidwifery] on the subject of induction -snip- Is the failed induction-requiring C/s rate really around 50%? -snip- It certainly isn't where I work! In our tertiary level hospital we have about 100 IOL per month, of them fewer than 5 would be 'failed inductions.' We have a horrendously high CS rate of about 30%, that includes elective, emergency, prems, high risk, the lot. Our last stats from, I think 2003, showed IOLs resulting in CS at something like 32% Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] on the subject of induction
Actually what I said is that *where I work* the C/s rate from IOL is hardly distinguishable from the total C/S rate. That's in a tertiary hospital. I don't know where this mother is planning to have her baby but I would hope the risk of C/S would be far lower in a peripheral hospital. Monica - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, March 05, 2006 11:29 PM Subject: RE: [ozmidwifery] on the subject of induction Amy asks Is the failed induction-requiring C/s rate really around 50%? Monica replies no, IOLs resulting in CS at something like 32% Ooo-err! Not a ½ only 1/3. Still a lot of inductions result in C/s. I see Amy's dilemma. According to the medical advice she has ¼ chance of stillbirth if she doesn't have an early induction, 1/3 chance of C/S if she does. I can see why women would throw in the towel and choose elective C/S. At least it is a sure thing without the last minute drama. MM -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscrib -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] prison birthing
We used to have the women from Mulawa gaol in Sydney come to us. I never work in the clinics so I am not sure about their antenatal care but they always came to us when in labour- or of antenatal problems. Depending on their offence ( which, naturally, was not divulged to us), they had one or two prison officers with them who remained outside the room. I never saw or heard of anyone chained to a bed. There were very occasionally women who were handcuffed because they had a history of absconding or because their offences and gaol history were so dire they were considered to be a physical threat to staff. In that case they were required to have a female prison officer within the room in order to assure the midwives' safety. I must emphasise that that was very rare- maybe two or three cases in the ten years I have been in this delivery suite. They had the same length of stay in hospital as anyone else (approx 3 days postpartum) then mother went back to prison and baby was cared for according to the arrangements sorted out before the birth, sometimes family members, sometimes foster care. Is this what you were after? Some time last year pregnant women were moved to another facility (? near Windsor) so we don't see them anymore. Monica - Original Message - From: adamnamy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, February 08, 2006 1:21 PM Subject: [ozmidwifery] prison birthing Do any of you midwives out there know how birth happens for pregnant women in Australian prisons? Are they transferred to hospital or are they required to stay in the prison health service. I have been reading an Amnesty report of the abuses of pregnant and laboring women in the US (it is available through Sheila Kitzinger’s website for anyone who is interested). I am keen to know what similarities exist for Australian women. I thought fetal monitoring and a drip was bad enough-try giving birth being chained to a bed-not knowing how long you can cuddle your baby for before she is removed! That breaks my heart. Amy _ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Emily Sent: Wednesday, February 08, 2006 8:10 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] yoga video hi everyone funny photo attached that shows what happens if your baby doesnt get enough food ! i found this while looking for photos for an infant nutrition seminar im doing for uni next week. does anyone still have that short movie of the yoga mum where the baby crawls up and has a feed while shes upside down?? id love to include that :) if anyone has it they can send it direct to me at [EMAIL PROTECTED] thanks emily _ Brings words and photos together (easily) with HYPERLINK http://us.rd.yahoo.com/mail_us/taglines/PMDEF3/*http:/photomail.mail.yahoo. comPhotoMail - it's free and works with Yahoo! Mail. -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 267.15.2/252 - Release Date: 2/6/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 267.15.2/253 - Release Date: 2/7/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Westmead, Sydney
Hi Nicola, I don't know who she spoke to at Westmead but I can't believe she couldn't be seen until March. At Westmead the following is available: Team midwives, midwifery clinics, GP shared care, high risk clinics, young mothers clinic, various language clinics, ordinary drs clinics or private OB. (No private midwives, mourn.) I can give you the phone number for the clinic and the name of the manager there if you message me privately. They book-in every Friday and she may have to wait a few weeks but I would expect it would be before Christmas. Gook luck! Monica - Original Message - From: Nicola Morley [EMAIL PROTECTED] To: Ozmidwifery ozmidwifery@acegraphics.com.au Sent: Monday, November 21, 2005 5:24 PM Subject: [ozmidwifery] Westmead, Sydney Does anyone know the current options for delivering at Westmead? I am rather frustrated with my brother's girlfriend's GP who seems to be handling her unexpected pregnancy rather haphazardly. She is only 21, and knows nothing, the baby being unplanned. He told her the 12 weeks NT u/s was compulsory. Then when she said she wanted to deliver at Blacktown, he told her she wasn't allowed to because she was closer geographically to Westmead. He gave her a general hospital enquiry number and told her to ring the hospital. She did and they told her they couldn't see her until March (she is due in May). She has no idea whether she spoke to an antenatal clinic or to the team midwife program (is that still running? I was booked in there when we lived in Sydney). They are planning to move up her (Central Coast) before the birth, so I suggested they just booked in up here to the community midwives, and just travel for appointments until they move, but the doctor told her again that she *had* to go to Westmead. She is worried about not seeing anyone until March (no wonder, first pregnancy and all) except this GP. But she won't listen to my suggestions and thinks she has to do exactly what her GP tells her. I wanted to at least clarify what the delivery options at Westmead are so I can have a talk with her about who she talked to who told her March, etc. Thoughts? Suggestions? Nicola Morley Trainee Doula -- 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] Strep B screening
Nicola wrote: Can I ask a personal question on this one? Last birth (January 2003, Gosford Hospital Community Midwives) I was given intravenous antibiotics automatically because I had been StrpB positive in the previous pregnancy. I wasn't retested. I am pregnant again - will I be automatically assumed to have Strep B again? will I be tested again? Is it even possible to be clear now even if I have been Strep B positive in the past or am I hoping in vain to avoid the treatment? It only bothers me because I like to spend a LOT of labour on my hands and knees and I found the drip in my hand very uncomfortable. If it is inevitable to have them again, what is the best plan of action? To stay home as long as possible? To ask for the drip in my forearm instead of the back of my hand? Any other suggestions. I will of course talk about it with the midwives when I book in next week, but just wondering in the meantime, seeing the topic has come up here! When you were GBS positive, was it a uninary or vaginal infection? Urinary is more serious because it is a systemic infection while vaginal colonisation can be transient. If it was vaginal you would be within your rights to request re testing before treatment. Of course you can decline testing and treatment if you want to. If IV antibiotics are recommended and you're OK with it you could specify that you want to cannula in your forearm rather than the back of your hand and have it bunged and covered so it's less likely to catch on stuff. You shouldn't need a fluid line as benzyl penicillin (AB of choice) can be given by IV push. Jenny wrote: Many years ago I saw a baby become ill subsequently die of GBS pneumonia. The baby was term perfectly welll at birth, within an hour of birth started having apnoeic attacks and four hours later was shocked gravely ill. I have seen the same, perfectly well breast feeding baby, dead six hours later from fulminating GBS meningitis. It is sobering to realise what can happen. Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Information re vbac
Hi, I know this has been discussed before but I can't find the refs and when I searched Medline I couldn't find just what I was looking for. I have a mum who has had 2 previous lscs (one for primip breech, the other just for maternal request.) She now wishes to try for a vaginal birth this time and would like objective stats on the risks. We have had women who have had vaginal births after two and even three lscs but she doesn't want anecdotes, she is after black and white figures. I can't find exactly what she's looking for, anyone able to help? Many thanks, Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
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.
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.
Re: [ozmidwifery] Obs first visits
Where I work women are booked in by midwives. There are about a thousand questions asked, covering physical, medical, gynaecological, obstetric, social and psychiatric history and a check of weight and height and BMI. Models of care are discussed at this appointment which is purely administrative. The choices are: midwives clinic, team midwifery programme, doctor's clinic, high risk doctor's clinic,GP shared care and private obstetric care. If the woman chooses (and there is room available) to go to the midwives clinic/ TMP they do not see a doctor unless the midwife identifies problems. All women not going to a private OB have a risk assessment file review within a couple of weeks of booking in but this involves the registrar looking over the file only. There is no listening to FHR at this appt. Women have previously been to GP to get a referral to book in. Many have had an early USS. They are offered a dating USS if haven't already had one, given forms for booking in bloods if not already done and as many of our women book in around 20 weeks they are offered morphology scans. The waiting list in house for these is many weeks so often they are advised to have them externally. If there is indication for Amnio or mother requests it that would be an indication for referral to obs. registrar or consultant to discuss. The regime for ANC has recently changed here and it is now, roughly: Book in about 12-14 weeks. Next visit (or book in) around 20 weeks. " " about 26 weeks. " " " 32 then 36 then 39/40 then 41 assess Cx at this visit, offer IOL from 41+3. This is probably way more information than you wanted! Hope it helps. Monica - Original Message - From: Sonja Barry To: ozmidwifery@acegraphics.com.au Sent: Saturday, October 22, 2005 11:02 AM Subject: [ozmidwifery] Obs first visits Dear all, I am hoping for some information about midwifery/maternity units that don't require women to be seen by an obstetrician at any stagethroughout their pregnancy. Info I need is do the midwives listen for heart sounds etc, do they see a GP, or is this all quite irrelevant and thus no needs to do any of these checks? Some places call this a first visit, whilst others may use these checks to "allow" women access to birth centres etc. I hope this makes sense. Regards Sonja
Re: [ozmidwifery] developmental hip dysplasia
Kylie, As others have said, checking for clicky hips is part of a normal neonatal check whether performed by a midwife or a paediatrician or early childhood nurse. Where I work it is done by the midwife at birth and by a paed prior to discharge unless the parents are unwilling to wait (paeds are often delayed by events in the special care nurseries etc.) In this case the parents are advised to visit their local doctor within the week to check not only the hips but also the heart as some congenital heart problems cannot be picked up before 4 or so days. If mothers go home early and choose not to have another check by LMO things can be missed even after two checks in hospital. Some hip problems are hard to pick up anyhow. If the baby presented as a frank breech, hip ultrasounds are organised by some paediatricians as a routine investigation- this is denounced by many as an unnecessary test; overservicing in fact. The most noticeable thing, often, is the extra skin fold on the affected leg which can often be seen when the baby is laying on her stomach. This is sometimes seen by the parents rather than any health care professional. I send my warmest best wishes for your little one, good luck. Monica - Original Message - From: Kylie Carberry To: ozmidwifery@acegraphics.com.au Sent: Saturday, September 17, 2005 8:33 AM Subject: [ozmidwifery] developmental hip dysplasia Hi eveyone, I am just wondering if anyone can enlighten me a little on my 18 month old daughter just-diagnosed developmental hip dysplasia. I am still in disbelief that this was not picked up when she was first born and my paediatrician agreed. To make things worse he told us that in Wollongong Hospital (where she was born) they used to have a paediatrician who did a routine check for DDH on all of the newborns and all were picked up. To cut costs the IAHS got rid of this service and according to my paed one or two children are now overlooked. What angers me is that even with treatment, because she is older, my daughter will face the possibiliity of having ongoing hip problems. If anyone has any info on this condition (stories you've heard etc) I would greatly appreciate it if you could get in touch with me. Also, what is the general procedure for the testing the hips and do you guys think a paediatric examination should be routine? Thanks so much for having a read of my email, Kylie Carberry [EMAIL PROTECTED] -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] IOL and C/s...
- Original Message - From: Sally-Anne Brown To: ozmidwifery@acegraphics.com.au Sent: Tuesday, September 13, 2005 7:37 AM Subject: Re: [ozmidwifery] IOL and C/s... -snip- They have studied two groups a) IOL and b) spontaneous labour. The results show a slight difference in the two groups of about 1.5% higher in the IOL group compared with the spont labour group. In both groups the results show (approx) 60% c/section rate - not the 30-50% c/section rate often spoken of. -snip- Have I understood this correctly? In this study, women who are induced *and have an EDB* have a 60% c/s rate?? I find this mind boggling. I work in a tertiary hospital with many high risk pregnancies, in the Delivery Suite. Our statistics are (from memory, I don't have them at home) 80% of primips overall(spontaneous and IOL) choose to have EDB. Overall, 60% normal birth, 29% LSCS, others instrumental, primips. This includes elective C/S for breech etc. That's not exactly correct but pretty close. I thought these figures were bad. How do they get such a high c/s rate just from EDB? Or have I misunderstood? Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] hemihypertrophy question
I'm sure you've excluded it Kylie but you don't mention it so I thought I would just suggest checking for congenital dislocation of her hip- a cousin had that and it wasn't picked up until she was seen to throw her ;leg out with each step.(Unless that's what hemihypertrophy is, in which case I am going to feel very stupid.) Monica - Original Message - From: Kylie Carberry To: ozmidwifery@acegraphics.com.au Sent: Tuesday, September 13, 2005 1:43 PM Subject: [ozmidwifery] hemihypertrophy question Hi Everyone, I was in need of some information in regard to my 18 month old daughter, Poppy, and although I have a doctors appt it is not until tomorrow afternoon and I thought someone on this list may have some info on what I am looking for... Poppy was diagnosed with urinary reflux at about seven weeks following a renal scan. The scan was recommended as I had a two vessel cord which was apparent at my 18 week scan during pregnancy. After several UTI's and assciated kidney infections (despite antib's), she has been booked in for surgery to correct the 'faulty' ureters that are causing the reflux. Since about 10 months old when she began to walk around furniture we have noticed Poppy kind of limps...she kind of throws her left leg out as she is walking. We thought we'd wait until walking was fully established until worrying - after all she has one thing wrong and what parent wants to think there could be something else. Anyway she has now been walking unaided for about 2 months and I was starting to worry because of the still obvious limp she has. I laid her down the other day and when I put her legs out in front was astonished that the right is actually 2 cm longer than the left. It all made sense and we couldn't believe we overlooked it. Whilst awaiting for xrays to come back I have done some internet research and I believe you call this condition hemihypertrophy. Now I suddenly panicked when I saw that this could be related to a kidney cancer called Wilms' tumor. My initial panic subsided and I began to think if she did have this Wilms surely they would have picked it up somewhere over the last year and a half amidst the numerous nuclear kidney scans and ultrasounds she has had. I am praying that I am right and it is just a case of one leg being longer for growth reasons, but does anyone think it could be related to the urinary problem? Could they have overlooked it during all of the tests? Any info or thoughts would be truly appreciated... best wishes Kylie Carberry -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Twin births
Hi all, I'm just curious to hear what the proportion of vaginal births to CS is in other hospitals? I work in a tertiary, high risk Delivery Suite but vaginal birth is accepted as the default option for twins as long as the presenting twin is cephalic unless there is some problem that would indicate LSCS even in a singleton ( Placenta praevia etc). Also a comment I read, can't remember from whom, with in the last week or so about 38 weeks being the cut off date for twins- ours regularly go over 40 weeks in the absence of problems- and mostly, there aren't problems.Even our prem twins are born vaginally as the default option. I thought this was commonplace nowadays- no? Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] caseload
Hi everyone, We are having huge renovations where I work, just as well, we might even get more than one shower for our ten birth rooms- but apart from that, the Powers that be are considering caseload midwifery in the future. This was very exciting until they spelt ouy what they have in mind. I thought I'd present it here and ask if this is how others manage it? The plan is for teams of two midwives, booking eight women per month between them. There are to be no designated days off except annual leave and the midwives are to be on call 24/7. You aren't at the hospital all the time of course, only to do antenatal appts either at hosp or in mother's home, to be called in for labours and manage post natal care. Time not on call would have to be negotiated with other teams, for special events. The pay is envisaged as being base rate + 25% paid as a salary. this would result in me [it's all about me ; ) ] losing about $5000 a year. Is this how other caseload models work? I'm very disappointed; much as I love midwifery, I have a (very busy and demanding) life outside work as well. I can't be on call my entire life. Hoping to hear other arrangements, Monica By the way, on a purely personal note, some months ago I ranted about a complaint which had then been investigated and exonerated three times and was up to the NSW Midwives board to investigate my fitness to continue practicing- I heard today, I'm OK!! Completely vindicated and acted within the practice of a reasonable midwife, making correct judgement calls etc- I can't say what a relief it is as the woman making the complaint has made no secret of her desire to have me charged with murder, struck off, etc- I really feared that even though I acted within the hospital policies and procedures etc I was in danger of losing everything, just so the HCCC and the Area Health Service could get her off their backs. Especially with the witch hunts that have been going on over cases in Camden and Cambelltown. I'm so happy! I can continue to be a midwife! Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] caseload
Thanks everyone for the answers, The union hasn't been involved yet. The midwife who is doing the preliminary planning has worked in caseload models apparently but in the UK. I should think the principles would be the same though. I remember talking to a midwife from around Bristol some years ago who worked in a caseload model and her remuneration was about 3 pounds, a dizzying amount when you took the exchange rate into account. Does the rate of 4 per month per midwife ring true? That makes only 40-44 women per year (allowing for reduced bookings for annual leave). We have 4300 women a year, say 60% (2500) were low risk (it's a referral hospital near the Children's hospital so lots of high risk from all over the state as well who would not be eligable I assume) that would mean about 20 teams of 3 or 30 teams of 2, 60 midwives anyhow. There's still need to be a reasonable core of midwives covering high risk and inpatients, surely? How does that work? Say one of your women comes into preterm labour? Sometimes they niggle in and out of birth suite for several weeks before the baby is born. How do you manage that? The planning so far hasn't addressed this kind of thing. Maybe because we see so much of this my perspective is skewed. Please don't flame me! We get an average of 20 prem labourers/ preterm ROM transferred to us every week and many booking in with us because of known fetal abnormalities needing early surgical intervention and 'poor obstetric history' (usually multiple mid trimester loss) so that's a big part of the background for us, as well as a large number of healthy, well, normal mothers and babies. I guess the awful ones stick in your mind because they are so, well, awful. Thanks for any input, Monica - Original Message - From: Judy Chapman [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, April 06, 2005 1:04 PM Subject: Re: [ozmidwifery] caseload Monica, Congratulations on remaining a midwife. I can't answer the caseload question but it sounds like the pay is a rip off. When I was in the teams at Mackay we were all level 2 clinical midwives for a start. Don't know what the formula for the salary was but the shift work needs to be recognised as well as the 24 hour call plus some for the disruption of your home life. How has your union responded? Cheers Judy --- mh [EMAIL PROTECTED] wrote: Hi everyone, We are having huge renovations where I work, just as well, we might even get more than one shower for our ten birth rooms- but apart from that, the Powers that be are considering caseload midwifery in the future. This was very exciting until they spelt ouy what they have in mind. I thought I'd present it here and ask if this is how others manage it? The plan is for teams of two midwives, booking eight women per month between them. There are to be no designated days off except annual leave and the midwives are to be on call 24/7. You aren't at the hospital all the time of course, only to do antenatal appts either at hosp or in mother's home, to be called in for labours and manage post natal care. Time not on call would have to be negotiated with other teams, for special events. The pay is envisaged as being base rate + 25% paid as a salary. this would result in me [it's all about me ; ) ] losing about $5000 a year. Is this how other caseload models work? I'm very disappointed; much as I love midwifery, I have a (very busy and demanding) life outside work as well. I can't be on call my entire life. Hoping to hear other arrangements, Monica By the way, on a purely personal note, some months ago I ranted about a complaint which had then been investigated and exonerated three times and was up to the NSW Midwives board to investigate my fitness to continue practicing- I heard today, I'm OK!! Completely vindicated and acted within the practice of a reasonable midwife, making correct judgement calls etc- I can't say what a relief it is as the woman making the complaint has made no secret of her desire to have me charged with murder, struck off, etc- I really feared that even though I acted within the hospital policies and procedures etc I was in danger of losing everything, just so the HCCC and the Area Health Service could get her off their backs. Especially with the witch hunts that have been going on over cases in Camden and Cambelltown. I'm so happy! I can continue to be a midwife! Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Find local movie times and trailers on Yahoo! Movies. http://au.movies.yahoo.com -- 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] Brisbane hospitals alleged discriminatory employment
- Original Message - From: sharon -snip- if a registered nurse wants to she may hand in her general registration and only be a midwife. This is not an option in NSW at least, I and many other midwives were looking forward to giving up a qualification we do not feel we can do justice to any more (24 years away from working as a nurse...) but the new legislation specifically prohibits this. Monica
[ozmidwifery] PPH
There were some references a while ago about the WHO defininf a PPH as being over 1000 mls. As we are being required to go the most extreme lengths to treat PPHs of 500mls or more, even if not causing any symptoms and bleeding is settling, I would love some evidence to suggest this is overkill. Can anyone point me to the WHO document? Thanks, Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] PPH
Hi all, I sent this yesterday but it didn't come through to me at least so apologies if it's a repeat. There were some references a while ago about the WHO defininition of a PPH as being over 1000 mls. As we are now being required to go the most extreme lengths to treat PPHs of 500mls or more, even if not causing any symptoms and bleeding is settling, I would love some evidence to suggest this is overkill. Can anyone point me to the WHO document? Thanks, Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Analgesia post LUSCS
Where I work (large teaching hospital, dedicated 24hr Pain Management Team, painrelief protocols codified by anaesthetic dept and adhered to by all from VMO down,) if LSCS was performed under epidural the women frequently have a bolus of Morphine down the EDB catheter prior to it being removed at the end of surgery. They are then managed with excellent pain relief with panadol and anti- inflammatories. There is a general ban on narcotics for 24 hrs but if necessary more analgesia would be arranged by the on site anaesthetic registrar after examination. Others who had a GA (and maybe a spinal) have a IV PCA using either Morphine or Fentanyl with the dosage and lockout time set by the anaesthetist at time of op but altered by on call anaesthetist if necessary (rare). This stays for maybe 2 days. They also have regular panadol and usually Voltaren. All, unless asthmatic etc, have PR Voltaren before leaving the op theatre. Some also have reguar Endone but I can't remember which circumstances- I'm usually in Delivery. The level of pain control seems fantastic, especially when contrasted with the 3/24 Pethidine I was given after an emergency LSCS 15 years ago. Then, I could barely move and it was only by grim determination that I was able to look after my daughter. (and bloodymindedness- no one else was having my baby!) Now they are up and around, moving slowly but quite easily and able to get in and out of bed with none of the agony I recall. Hope that helps, Monica - Original Message - From: Cheryl LHK [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, March 02, 2005 9:23 AM Subject: [ozmidwifery] Analgesia post LUSCS Not exactly natural birth I know, but can you give me some ideas of what your doctors/obst's order for analgesia days1-2 post LUSCS? Small hospital, and each doctor tends to have his own ideas, and sometimes we end up with all kinds of concoctions!! It doesn't make me very happy when I come onto night-duty, find women teary, in pain with nothing more than Panadol some days! But I'm the first to admit that since I haven't a a LUSCS (three NVB's) I tend to keep up the pain relief because I think it must be very, VERY painful having major abdo surgery then up and learning about a baby as well. Is the LUSCS recovery period any more or less painful than other abdo surgery? Thanks in advance. Cheryl -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Fw: [MatCoWA] FW: Vexatious notification to child safety after women refuses birth advice
Denise and all, snip To sum up a.. women have the right to informed choice b.. Practitioners are well protected if they follow the legal requirements (bold mine, snipped from Jenny Gamble's reply) I don't know anything about this case but could not let this statement pass as it is no longer true. Even when following hospital and Dept of Health guidelines to the letter, it is possible to be the target of malicious and vexatious complaints and allegations by health consumers. Each allegation has to be researched and answered and the health consumer has many avenues available to him or her if the ones used first do not yield the desired result. When answering these complaints/ allegations, the health worker is required to prove her innocence, in any other court proceeding there is a presumption of innocence and the need to prove guilt. In my own case I have been exonerated by three different enquiries over three years, one being a coroners inquiry ( not one required by the circumstances but petitioned for by the patient when other enquiries failed to find me at fault.) Although there is documentary eviodence to show that I acted at all times within the policies and protocols and guidelines of the hospital and the NSW Dept of Health, I am now in the middle of an investigation of my right to practice as a midwife, because of unsubstantiated and malicious allegations made by an unhappy client. (Without going in to too many details, a baby was born at 21 wks gestation, 390g, no respiratory effort but heart rate present. Baby was given comfort but not resuscitated after discussionby Feto Maternal specialist with mother before the birth. Now wants me charged with murder.) I take grave issue with the statement that if we follow legal requirements we'll be all right. Even if in the end, we don't lose our livelihood (or house), the toll of years of uncertainty, investigation after investigation, loss of confidence and peace of mind cannot be calculated. This is the root cause of such defensive practice as we deplore. No one who has not been through this kind of thing, or supported someone who has, can realise how devastating it can be, or how it destroys one's faiththat the women and families we work with,will deal fairly with us, as I truly believe midwives as a group deal with their clients. Monica
Re: [ozmidwifery] gestational diabetes and antenatal ebm
They're not assigned to BF or AF. Just that if they're BF an d for some reason change their mind at any time during the (I think) 1st year, or use a comp etc, they use the one supplied which is unidentified (I think). You can look it up if you google TRiGR. I heard an inservice on it which didn't sound at all unethical. They are trying to promote BF but the fact of the metter is that in the real world the majority of mothers do comp with something at least once during their breastfeeding experience and many do wean to a bottle and formula. It is these they are trying to catch. Monica - Original Message - From: Nicole Carver [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 2:23 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Unfortunately, they seem to be signing people up before they have their babies, to be in a RCT between cow's milk and non-cow's milk based formulas. A bit dodgy ethically to me! Does anyone else know more about this? Nicole C - Original Message - From: Sandra J. Eales [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 2:00 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Marilyn There might not be much on expressing antenatally, but there is quite a bit of research on the increased risk of children developing type1 diabetes if they are exposed to cow's milk. In fact I heard just the other night on the news that there is a multi centre study going on - they were trying to recruit pregnant women or babies where one parent was diabetic.. hoping to follow 6000 kids. I don't recall the details of where it was being done though. Sandra - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 10:56 AM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Way to go Denise, I totally agree. However, am part of a working group for BFHI reaccreditation and was asked to find the evidence. So, I was just wondering if there was some that I had missed. marilyn - Original Message - From: Denise Fisher [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, November 16, 2004 3:41 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Hi Marilyn I won't swear to it but I don't know that there is any research out there on this practice. However to give newborns their own mother's milk is kinda natural and not really something that we need research to prove is a good thing do we? Wouldn't it be more to the point to ask those who are giving newborns something other than breastmilk to come up with the evidence to prove that what they are doing is not detrimental?? I'd like to see that ... could have them running around in circles for years trying to find anything to support that practice as opposed to giving mother's own colostrum. All you really need proof of is that expressing antenatally won't put a mother into preterm labor, which it won't and I'm sure you'll find plenty out there on that - then ensure that the mothers know how to store and transport their milk safely when the time comes. There's lots more than just giving breastmilk though that can stabilise the newborn's glucose levels quickly and efficiently - starting with undisturbed skin-to-skin on mother's chest from the moment of birthing. I really do implore everyone to think long and hard before scampering around trying to find research articles to prove what is normal and natural while practices using what is detrimental to birthing/breastfeeding/whatever continue without questioning. Please consider looking the perpetrators in the eye and saying First, do no harm! - your practice is not 'normal' - prove to me that it is doing no harm!! Cheers Denise *** Denise Fisher Health e-Learning http://www.health-e-learning.com [EMAIL PROTECTED] -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- 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] gestational diabetes and antenatal ebm
This is the TRiGR trial; it's multi centred, co-ordinated from I think Norway- a Scandinavian country anyhow. We are participating where I work though we haven't had any mothers come through yet. It sounds really fascinating but it's a 10 year follow up so no good looking for immediate information. Monica - Original Message - From: Sandra J. Eales [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 2:00 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Marilyn There might not be much on expressing antenatally, but there is quite a bit of research on the increased risk of children developing type1 diabetes if they are exposed to cow's milk. In fact I heard just the other night on the news that there is a multi centre study going on - they were trying to recruit pregnant women or babies where one parent was diabetic.. hoping to follow 6000 kids. I don't recall the details of where it was being done though. Sandra - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, November 18, 2004 10:56 AM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Way to go Denise, I totally agree. However, am part of a working group for BFHI reaccreditation and was asked to find the evidence. So, I was just wondering if there was some that I had missed. marilyn - Original Message - From: Denise Fisher [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, November 16, 2004 3:41 PM Subject: Re: [ozmidwifery] gestational diabetes and antenatal ebm Hi Marilyn I won't swear to it but I don't know that there is any research out there on this practice. However to give newborns their own mother's milk is kinda natural and not really something that we need research to prove is a good thing do we? Wouldn't it be more to the point to ask those who are giving newborns something other than breastmilk to come up with the evidence to prove that what they are doing is not detrimental?? I'd like to see that ... could have them running around in circles for years trying to find anything to support that practice as opposed to giving mother's own colostrum. All you really need proof of is that expressing antenatally won't put a mother into preterm labor, which it won't and I'm sure you'll find plenty out there on that - then ensure that the mothers know how to store and transport their milk safely when the time comes. There's lots more than just giving breastmilk though that can stabilise the newborn's glucose levels quickly and efficiently - starting with undisturbed skin-to-skin on mother's chest from the moment of birthing. I really do implore everyone to think long and hard before scampering around trying to find research articles to prove what is normal and natural while practices using what is detrimental to birthing/breastfeeding/whatever continue without questioning. Please consider looking the perpetrators in the eye and saying First, do no harm! - your practice is not 'normal' - prove to me that it is doing no harm!! Cheers Denise *** Denise Fisher Health e-Learning http://www.health-e-learning.com [EMAIL PROTECTED] -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- 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] Epidurals
From a different perspective, we have used a PCA (Fentanyl) in labour when the mother has requested more painrelief than IM Morphine and an epidural is contraindicated, eg this week- fetal death in utero at 26 weeks, mother septic with bordeline then deteriorating coags. Labour induced with Cervagem over 36 hrs then further 24 hrs of Syntocinon. Mother could not cope with pain and circumstances any longer. This situation is infrequent. I have never seen them used with a viable baby. Monica - Original Message - From: sally To: [EMAIL PROTECTED] Sent: Thursday, November 04, 2004 9:32 PM Subject: Re: [ozmidwifery] Epidurals My Goodness!!! A PCA in labour, that's absolutely appalling. Sally - Original Message - From: Michelle Windsor To: [EMAIL PROTECTED] Sent: Thursday, November 04, 2004 9:29 PM Subject: [ozmidwifery] Epidurals While on the subject of epidurals I read an article recently about a study involving ewes which had epidurals during their labour. They wouldn't mother their young. A new term I learnt this year while doing a short contract in a private hospitalwas the "cold epidural" - the epidural you have put in prior to the start of your induction! Not sure how common this is in other places. Of course if there is any problem getting the epidural in you can always have a PCA of morphine. You can imagine the results of that - one very "stoned" mother totally uninterested in her narcotised baby. Sad but true. Cheers Michelle Find local movie times and trailers on Yahoo! Movies.
Re: [ozmidwifery] admission ctg and the furphy of litigation(LONG) (even longer reply)
Justine, For the past two and a half years I have been pursued by a woman who sincerely believes she has grounds for complaint. I can't go into the details of the case because of patient confidentiality (not that it has stopped this woman slandering me in national papers, on network radio, etc) but it has been investigated four times now, three times coming to the conclusion that there is no case to answer and the last (HCCC) not yet completed. It has been dismissed as vexatious by the coroner. This case has caused me the most profound distress. It has destroyed my peace of mind, damaged my relationship with my partner and children because I can't think of anything else and is losing me my career because I cannot continue to put myself in the path of this kind of event in the future. There is virtually no protection for health professionals against allegations from unhappy consumers. I am sorry if that sounds harsh but it is true. In any other court, one is considered innocent until proven guilty; in these cases, an unhappy health consumer can make any kind of allegation, it need not be backed up by any kind of evidence, and the health professional has to prove that it did not happen. It makes no difference if one has followed hospital procedure or protocol. It makes no difference that (in my case) the woman was fully advised and consulted at the time and agreed with the course of action taken- she now says she was not consulted and it comes to my word against hers. It makes no difference to have the most complete documentation (I was lucky, I had only the one lady to look after and wrote contemporaneous notes every ten minutes). Basically, as the Investigator from the HCCC told me engagingly, as long as this woman wants to bring complaints and allegations against me, the HCCC can pursue me 'to the grave.' This may seem off topic but it may give some insight into why some midwives and Obstetricians act in other than evidence based ways. I cannot describe what this case has done to me. I've been a midwife for 22 years and confidently expected to remain one until I retire. Not now. And though I can't leave the profession I love until this case is at least through the present investigation, I make sure that I practice defensively and will continue to do so. This means not always doing what 'best practice' suggests, rather it is doing what is not going to have me on the receiving end of another complaint. Unfortunately, as soon as this case is resolved, I am leaving midwifery. I believe I am a good midwife. I have the unfailing support of my peers at work, of my manager, the OBs, the Stream director and the director of clinical management; everyone who could give me support, has done so. It isn't enough to keep me here because they have all admitted that anyone can bring a case for any reason, justified or not. It isn't being in the wrong that is so devastating in these events. You might not realise the time and effort that goes into answering these complaints. I am fortunate in that I am covered by the hospital's guidelines, policies and protocols and my own comprehensive notes but even so, I am a mess after spending three weeks solid answering the most detailed and in some cases, insulting questions. (eg, Ms X stated you told her to sit and watch her baby die. Please respond.) This is because of beaurocracy gone mad, political correctness and the rights of the consumer completely over-riding the rights of the care provider, even when no one has done anything wrong or other than best Practice according to Australian and international standards. So pity help anyone who practices according to evidence if it is not supported by the lawyers who proscecute these cases, and you won't find many people being sued or complained against for recording a CTG whereas there are all too many precedents for being sued for failing to record one. Monica (who is in a fragile state and apologises if this post was incoherent.) - Original Message - From: Justine Caines [EMAIL PROTECTED] To: OzMid List [EMAIL PROTECTED] Sent: Saturday, September 18, 2004 10:40 PM Subject: Re: [ozmidwifery] admission ctg and the furphy of litigation(LONG) Hi All Is there something I am missing re admission CTG's and CTG's in general? I see the whole issue of their use in reducing litigation as spurious. Is it true that only around 10% of hypoxic events can be attributed to labour and that the vast majority of damage cannot be linked to a certain time (ie the event could of taken place at 31 wks while Mum was washing up at home) Although my hat goes off to each and every one of you that work in these sick systems with a profession (Obstetrics) that epitomises misogyny midwives still have a responsibility to try and claw back normal birth and I would think challenging these ridiculous protocols as an important part. I agree working with women is very important and there is an
Re: [ozmidwifery] admission ctg
Marilyn- Unfortunately, being enlightened in one area of practice doesn't guarantee enlightenment in others. This was his (very commendable) idiosyncracy; in other ways he was dismissive of others' points of view, paternalistic, inclined to do the opposite of whatever was suggested... it was a happy day for us to see a change of directors. I guess no one is all bad... or all good. We thought no one could be worse, to work with, I mean, but his successor, while easier to get along with, doesn't seem to have the same fire for reducing intervention. Oh well. The grass is always greener- Monica - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Saturday, September 18, 2004 11:23 PM Subject: Re: [ozmidwifery] admission ctg Monica: I think your Director needs to do a nationwide lecture tour on both admission ctg's and vbac. marilyn - Original Message - From: mh [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, September 17, 2004 4:22 AM Subject: [ozmidwifery] admission ctg I work in a high risk 'Delivery Suite' in a tertiary hospital where we have frequent antenatal transfers for reasons of our own level 3 nursery. Also, because of our proximity to the state's primary Children's hospital we have antenatal transfers of care so women whose babies have particularly bad abnormalities which can be treated surgically can have their babies as close to this facility as possible. So our clientele is heavily skewed towards high risk pregnancies and extremely anxious mothers and partners. The decision was made, however, many years ago, to forgo routine admission traces in the Delivery Suite. There has to be a particular reason for doing a ctg trace on admission and they are audited frequently. I hold no brief for our long time director of Delivery Suite (now replaced) but one thing he consistently did was to try to limit the use of *routine* ctgs and also to push (very aggressively) VBAC in our hospital, so that we have a 70% success rate. It was sold to the other OG's that admission traces, per se, increased the likelihood of a C/S by I forget the rate, ?40%. We are so conservative in other areas of practice I had thought this must be the norm everywhere- is it not? How many places do routine admission traces? I would be very interested to see a cross section Monica -- 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.
[ozmidwifery] admission ctg
I work in a high risk 'Delivery Suite' in a tertiary hospital where we have frequent antenatal transfers for reasons of our own level 3 nursery. Also, because of our proximity to the state's primary Children's hospital we have antenatal transfers of care so women whose babies have particularly bad abnormalities which can be treated surgically can have their babies as close to this facility as possible. So our clientele is heavily skewed towards high risk pregnancies and extremely anxious mothers and partners. The decision was made, however, many years ago, to forgo routine admission traces in the Delivery Suite. There has to be a particular reason for doing a ctg trace on admission and they are audited frequently. I hold no brief for our long time director of Delivery Suite (now replaced) but one thing he consistently did was to try to limit the use of *routine* ctgs and also to push (very aggressively) VBAC in our hospital, so that we have a 70% success rate. It was sold to the other OG's that admission traces, per se, increased the likelihood of a C/S by I forget the rate, ?40%. We are so conservative in other areas of practice I had thought this must be the norm everywhere- is it not? How many places do routine admission traces? I would be very interested to see a cross section Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] caesarean section
I was in fact reading the Maternal Deaths report at work today, the most recent complete one (94-96); over the past 30 years maternal deaths have decreased but hit a steady patch over the lastfew triennial periods. As Marilyn says, many were extremely ill, to the point where one must wonder at their choosing to embark on or maintain a pregnancy; some had reappearance of malignancy (particularly Ca Breast and Malignant Melanoma); some refused treatment early in the disease process (PIH, other hypertensive states); some had catastrophic haemorrhages and infections particularlu Gp A Streptococcus Pyogenes (what's that? never heard of it). There were a surprising number of amniotic fluidembolism, occurring in women not necessarily given induction agents which surprised the examining panel also.Many had LSCS and subsequently died but it would be hard to attribute death solely or even largely because of that. It's very interesting reading. For that triennium, maternal death Australia wide was 13/100,000; in 1964-66 it was about 40/100,000 and even in 1970 it was 30/100,000. Monica - Original Message - From: Marilyn Kleidon To: [EMAIL PROTECTED] Sent: Tuesday, June 01, 2004 1:37 AM Subject: Re: [ozmidwifery] caesarean section MIchelle: I would urge you to go actually read the case studies around these maternal mortality stats. The studies are also on the web site, at least they were because I downloaded them a couple of years ago. What I found/interpreted were many very ill women with various cardiovascular disorders plus women with rapidly escalating pre-eclampsi/eclampsia and one immediate postpartum eclamptic seizure (after an NVB and early d/c). For most of the women who died it would seem to me that caesarean birth was their only option for surviving childbirth, in another time they would probably not attempted to conceive. In thinking about this I have wondered for a while how this increasing maternal mortalityis related to the increasing c/s rate, simply because these women were true cases of needing c/s in other words they were definetly not elective c/s nor did any of the cases represent unnecessary c/s, at least not to my mind. I now think there is an indirect link. Perhaps, in the ether of the promotion of the choice and safety of caesarean birth women who otherwise would have considered themselves too ill to undergo pregnancy and childbirth consider childbearing a possibility and then it becomes a probability. I am sure there are other possibilities. marilyn - Original Message - From: Michelle Windsor To: [EMAIL PROTECTED] Sent: Sunday, May 30, 2004 6:52 AM Subject: [ozmidwifery] caesarean section Hi, I'm new to the list but had to add a bit to the caesarean section issue. Doing an assignment last year we had to analyse some perinatal statistics (Qld). In the last 30 years the maternal mortality rate has slowly and steadily increased (figures up to 1996) and while they didn't give a breakdown on the maternal deaths, surely this has to be due to the slow but steady increase in caesarean section? It is unbelievable that in 30 years of medical advances that more women are dying - and no one is looking for the cause. I didn't see the 60 minutes program, but was there any mention of the increased maternalmortality with caesareans? Michelle Find local movie times and trailers on Yahoo! Movies.
Re: [ozmidwifery] VBAC/ twins/lotus
Sorry, should have been more clear. I am accustomed to EDB meaning epidural block and EDC for expected date of confinement- archaic I guess but there you go. Monica - Original Message - From: Mary Murphy To: [EMAIL PROTECTED] Sent: Saturday, February 28, 2004 10:10 PM Subject: Re: [ozmidwifery] VBAC/ twins/lotus Please, what is EDB? We use those initials for Expected Date of Birth. What state are you in Monica? Thanks, MM Where I work, twins are encouraged but not forced to have epidurals and EDB is used liberally whether VBAC or not... I remember when I was a student (20yrs) they were thingy about EDB in VBAC but not for at least the past 15 years- no increase in rupture etc. What is the reason for limiting them in VBAC? Just out of curiosity. As our policy is VBAC regardless of mothers wishes, in such a case we wouldplan an attempt at least for a labour at term, especially after a previous normal birth. Monica .
Re: [ozmidwifery] VBAC/ twins/lotus
I know the statistics show an increased risk of uterine rupture when using Syntocinon infusion after previous uterine surgery. Certainly it is better to labour spontaneously. As I mentioned before, where I work (teaching hospital, Sydney) there is an almost bullying insistence on attempting VBAC and merely failing to spontaneously labour is not an acceptable reason for a repeat LSCS. It may sound as if I advocate repeat caesars but I don't, I just find it objectionable when women's preferences and wishes are totally disregarded. On the other hand, the majority of our VBAC women do have successful vaginal births, something like 70%- so maybe the ends justify the means? It is awful to be looking after a woman who makes it very clear that the circumstances she is in are totally opposed to her wishes and to feel like an accomplice in the removal of her authority over herself. I don't know if I've made that very clear. It's like some people are with breastfeeding- you can do whatever you like as long as it's what I think you should do. Anyway, to get back to the epidural and uterine rupture, I haven't seen very many and some had blocks and some didn't but the other signs- bright pv bleeding, non reassuring ctg, changed uterine activity etc, preceded or occurred with the pain especially where there was a uterine scar. I hadn't realized the fear of wound dehiscence was still a factor in availability of epidurals. Monica - Original Message - From: Mary Murphy To: [EMAIL PROTECTED] Sent: Monday, March 01, 2004 2:39 PM Subject: Re: [ozmidwifery] VBAC/ twins/lotus Syntocinon infusion has been linked with greater risk of rupture. I am a bit restrictive with the women I care for... Go into labour spontaneously, labour birth. Otherwise have a repeat C/S. It helps their resolve too. There is too much research data pointing to inductions and augmentations increasing the risks of rupture for me to be comfortable with it. MM I think once we switched to lower dose epidural medication it became acceptable to combine epidurals with VBAC, even with Sytocinon infusion Kirsten - Original Message - From: Judy Chapman To: [EMAIL PROTECTED] Sent: Sunday, February 29, 2004 5:09 PM Subject: Re: [ozmidwifery] VBAC/ twins/lotus The last few places I have worked also used epidurals with VBAC. Just need to monitor properly. In the old days they said an epidural could not be used as the woman would not have the pain cues to impending uterine rupture. At least that is what I was told. Cheers Judy mh [EMAIL PROTECTED] wrote: Where I work, twins are encouraged but not forced to have epidurals and EDB is used liberally whether VBAC or not... I remember when I was a student (20yrs) they were thingy about EDB in VBAC but not for at least the past 15 years- no increase in rupture etc. What is the reason for limiting them in VBAC? Just out of curiosity. As our policy is VBAC regardless of mothers wishes, in such a case we would plan an attempt at least for a labour at term, especially after a previous normal birth. Monica - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Saturday, February 28, 2004 1:01 PM Subject: Re: [ozmidwifery] VBAC/ twins/lotus Where I work, twins automatically have epidurals, and epidurals are contraindicated in VBAC's... I can look it up for you on Monday though - I have the weekend off. Jo Original Message From: Mary Murphy To: list Sent: Saturday, February 28, 2004 9:42 AM Subject: [ozmidwifery] VBAC/ twins/lotus So far I have had no reports of studies or data re Lotus. there are lots of pictures, anecdotal experiences, but no data. Is it out there? or is it so infrequent that no one has done the work. As we would expect, the baby in question is healthy non septic. Re VBAC: Another midwife's client had a C/S for her first birth, a vaginal birth for her second and is now pregnant with twins. She wants to have a vaginal birth with her twins later this year. What do you know about the policies in hospitals for this situation? All feedback gratefully accepted. thanks, Mary M -- Babies are Born... Pizzas are delivered. Find local movie times and trailers on Yahoo! Movies. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] VBAC/ twins/lotus
Where I work, twins are encouraged but not forced to have epidurals and EDB is used liberally whether VBAC or not... I remember when I was a student (20yrs) they were thingy about EDB in VBAC but not for at least the past 15 years- no increase in rupture etc. What is the reason for limiting them in VBAC? Just out of curiosity. As our policy is VBAC regardless of mothers wishes, in such a case we wouldplan an attempt at least for a labour at term, especially after a previous normal birth. Monica - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Saturday, February 28, 2004 1:01 PM Subject: Re: [ozmidwifery] VBAC/ twins/lotus Where I work, twins automatically have epidurals, and epidurals are contraindicated in VBAC's... I can look it up for you on Monday though - I have the weekend off. Jo Original Message From: Mary MurphyTo: listSent: Saturday, February 28, 2004 9:42 AMSubject: [ozmidwifery] VBAC/ twins/lotus So far I have had no reports of studies or data re Lotus. there are lots of pictures, anecdotal experiences, but no data. Is it out there? or is it so infrequent that no one has done the work. As we would expect, the baby in question is healthy non septic. Re VBAC: Another midwife's client had a C/S for her first birth, a vaginal birth for her second and is now pregnant with twins. She wants to have a vaginal birth with her twins later this year. What do you know about the policies in hospitals for this situation? All feedback gratefully accepted. thanks, Mary M -- Babies are Born... Pizzas are delivered.
Re: [ozmidwifery] Doulas in the Blue Mountains
I don't know about doulas etc in the area but last week I worked there and would hesitate to recommend it to a new mother- the private paed are very keen on comping and in general seemed to undermine breastfeeding. That is only on the basis of one shift but I was quite shocked while I was there. Monica - Original Message - From: Melissah Scott @ Spilt Art To: [EMAIL PROTECTED] Sent: Sunday, February 15, 2004 7:10 PM Subject: [ozmidwifery] Doulas in the Blue Mountains I have someone who is about 18 weeks pregnant and fairly recently moved to the blue mountians (Katoomba) She is unsure of where to birth at the moment and is concidering birthing at nepean private to make use of her private health insurance. She is hoping to stay in hospital for about 5 or so days, and at nepean private her husband can stay with her. She wants to stay in for a few days because she is nervous about being able to breastfeed and take care of her bub, as she feels she has not much idea of what she is doing. So I sugested to her that maybe a doula could be of great benifit to her by the way of childbirth info, birthing and post natal care/advice etc. She is quite interested in talking to some doulas in the area. So, I thought Id try to get together a list of Doulas in the area to pass on to her. If anyone is interested, could you please either reply or email me directly with all your details [EMAIL PROTECTED] I know your around Abby, but I cant find your contact details. Thanks! Melissah www.Splitart.com
Re: [ozmidwifery] Intervention
Hi all, I agree with what you say Mary but I was astonished to see this message here at all. It is part of one I sent a couple of weeks ago. I have not re-sent it and when I checked the message source it had an amail address which is not mine: [EMAIL PROTECTED] I am not a member of the democrats, nationals or anyother party. Below is pasted the return path; I can only assume this is from some virus; either that or someone (who would want to?) is corrupting messages and addresses from this list. Dunno why anyone would. Better be extra vigilant with the virus-checker- have just checked this computer and it's ok. Monica ***** Return-Path: [EMAIL PROTECTED] Received: from francis (c211-28-148-129.rochd1.qld.optusnet.com.au [211.28.148.129]) by mail009.syd.optusnet.com.au (8.11.6p2/8.11.6) with SMTP id h6VMs6n00500; Fri, 1 Aug 2003 08:54:06 +1000 Date: Fri, 1 Aug 2003 08:54:06 +1000 Message-Id: [EMAIL PROTECTED] From: mh [EMAIL PROTECTED] Subject: [ozmidwifery] Different kind of intervention MIME-Version: 1.0 Content-Type: multipart/mixed; boundary=--MDBZC37JCIXZHK - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: list [EMAIL PROTECTED] Sent: Friday, August 01, 2003 11:14 AM Subject: [ozmidwifery] Intervention Monica wrote: the women I work with have such a different focus from what is often described here- they want intervention, they want it now!! Our very competitive VBAC rate and lscs rate (for a tertiary referral hospital) are in defiance of our women's wishes. Hi Monica, that is the disadvantage of having an Australia wide medical model instead of a midwifery model. Women are full of fear when they think about labour and birth. The medical model only reinforces that fear and the impersonal nature of our larger ante-natal clinics increases their sense of alienation. Tthe midwifery model gives a woman a sense of empowerment and while she may in the end need/want medical intervention, her sense of self has been strengthened and she makes an informed decision rather than one based on just in case. Everyone throws up their hands and says but that wouldn't work in our hospital. It can, but no one is willing to put themselve out there and do it.. neither hospital administrations or health depts or obstet/midwifery depts. the landscape would look so much different and the outcomes would improve immensely. Cheers, MM -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Different kind of intervention
Hello all, I've sometimes felt a little alienated from many on this list, mainly because the women I work with have such a different focus from what is often described here- they want intervention, they want it now!! Our very competitive VBAC rate and lscs rate (for a tertiary referral hospital) are in defiance of our women's wishes. It is another kind of paternalism- denying women their request for a repeat lscs because our medical heirachy very much believes and pushes VBAC, regardless of previous experiences, regardless of informed requests, based purely on Drs wishes. But that's not actually what I'm wanting feedback on today (though I'd be interested in knowing if this lack of concern with mothers wishes is widespread...) When I went to work on Thursday night, there was a memo there discussing use of Syntocinon infusions and restricting augmented and induced labours to 3-4 contraction in 10 minutes, REGARDLESS OF INTENSITY so they may be 4 tightenings and there you go, can't turn up the synto, failed inductions all over the place, huge increase in c/s for failure to progress. That's one thing but the memo went on to suggest that in the case of spontaneous labour, if the contractions are more than we like, ie more than the 3-4 in 10, we should consider tocolytics. Is this the policy any where else?? We are being asked to interfere, say in a multip's labour who comes in in transition, contracting tumultuously as they sometimes do. For the reason that it doesn't fit our definition of acceptable labour. This is not an OB initiative, it was put out by the CMC with no consultation with Drs or midwives. The CMOs are as taken aback as we are. I'd love to hear if anywhere else does this. That little gift shop is getting closer every day, I swear. 9-5, can't kill or maim anyone, unlikely to be sued- very tempting. Monica -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
