[ozmidwifery] PPH
20061113-80# Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergo metrine in the management of the thirs stage of labor - Acta Obstetricia et Gynecologica Scandinavica , vol 85, no 11, 2006, pp 1310-1314 Fujimoto M; Takeuchi K; Sugimoto M; et al - (2006) Objectives. To determine the efficacy of intravenous oxytocin administration compared with intravenous methylergometrine administration for the prevention of postpartum hemorrhage (PPH), and the significance of administration at the end of the second stage of labor compared with that after the third stage. Methods. A prospective study was undertaken: two major groups (oxytocin group and methylergometrine group) of 438 women with singleton pregnancy and vaginal delivery were studied during a 15-month period. These two groups were subdivided into three subgroups: 1. intravenous injection (two minutes) group immediately after the delivery of the fetal anterior shoulder, 2. intravenous injection (two minutes) group immediately after the delivery of the placenta, and 3. drip infusion (20 min) group immediately after the delivery of the fetal head. In each group, quantitative postpartum blood loss, frequencies of blood loss 500 ml, and need of additional uterotonic treatment were evaluated. Results. As compared with methylergometrine, oxytocin administration was associated with a significant reduction in postpartum blood loss and in frequency of blood loss 500 ml. The risk of PPH was significantly reduced with intravenous injection of oxytocin after delivery of the fetal anterior shoulder, compared with intravenous injection of oxytocin after expulsion of the placenta (OR 0.33, 95%CI 0.11-0.98) and intravenous injection of methylergometrine after delivery of the fetal anterior shoulder (OR 0.31, 95%CI 0.11-0.85). Conclusions. Intravenous injection of 5 IU oxytocin immediately after delivery of fetal anterior shoulder is the treatment of choice for prevention of PPH in patients with natural course of labor. (6 references) (Author)
Re: [ozmidwifery] PPH levels soar
Jennifairy said
I wonder how many of these women had inductions (for eg)?
Ive also seen (during my student experiences, so have other current
students) some midwives doctors apply CCT without giving synt,
describing this as 'physiological' 3rd stage. There are lots of 'mixed
managements' of 3rd stage out there with no real evidence base, IMHO
once you do anything like pull on the cord its active management, but on
the 'coal face' there sometimes doesnt seem to be much consensus around
'reasonable' evidence-based 3rd stage management.
What Im pointing out is there is sometimes a gap bewteen what we think
we mean by a term ('active 3rd stage', for eg) what actually happens,
ie, how that is interpreted by the person doing the job, the term may
imply consistency but that doesnt fit reality
cheers.
..
I agree Jennifairy that there is a gap between good practice and what
actually happens. It isn't however because there research or knowledge
isn't there it's more because practitioners are happy to carry on in
ignorance without applying the correct skills and are able to get away with
it.
Lisa
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Re: [ozmidwifery] PPH levels soar
Four words, Kimmy, cord traction and induction! When will we learn to leave stuff alone? We had a massive "stastical blip" in emergency hysterectomies in Vic recently and there was much handwringing and exclamations of "Good lord how did that happen?!" It's not going away on it's own, people! : ( J - Original Message - From: Sue Cookson To: ozmidwifery@acegraphics.com.au Sent: Sunday, June 11, 2006 6:49 PM Subject: [ozmidwifery] PPH levels soar Hi,This article appeared in last week's Sydney Morning Herald.I think it's amazing and it appears that some of the information is incorrect in that the article states that NSW Health implemented active thrid stage and early cord clamping in 2002. Surely syntometrine and syntocinon have been used for many more years than just the last four, in which case this study is a real eye-opener if you believe we are stopping women from bleeding by using drugs in third stage.What do you think?Sue Transfusions soar for women giving birth Julie Robotham Medical EditorJune 3, 2006 RECORD numbers of NSW women need transfusions to treat massive blood loss after giving birth, in an epidemic that doctors say is threatening new mothers' health and fertility and sometimes their lives. The number of women diagnosed with post-partum hemorrhage has rocketed by nearly 30 per cent, and almost one in nine births was affected in 2002, compared to one in 12 in 1994, University of Sydney research has shown. Of those, the proportion whose condition was severe enough to warrant a blood transfusion increased sixfold, from 2 per cent to 12 per cent. "It's extremely important," said Ken Clark, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Bleeding was "still a very real cause of the death of women but also a great deal of [ill health] that has a tremendous impact on women and their families". In the worst cases mothers had to undergo emergency hysterectomies to save their lives, but even less dramatic surgery to clamp blood vessels or anaemia could be debilitating. "To have that on top of all the other stresses and strains of motherhood it's the last thing people need," Dr Clark said. The NSW findings are the first large-scale confirmation of the impression among individual doctors and hospitals across Australia that major bleeding is increasing. Carolyn Cameron, who led the statewide analysis, said neither the well-documented rise in caesarean section births nor the growing number of older mothers could explain the increase in hemorrhages. It was possible more borderline cases were being identified, but this alone was unlikely to account for the increase. "We have to search for something else. It's a mystery," said Ms Cameron, a research officer at the Centre for Perinatal Health Services Research. The group would now look at how many previous pregnancies women had and the length of their labours to see whether these offered clues to the reasons for hemorrhage - diagnosed when more than 500 millilitres of blood is lost after a vaginal birth, or more than 750 millilitres after a caesarean. Blood loss - usually from the site where the placenta detaches - is currently the single largest cause of pregnancy-related death in Australia Between 1997 and 1999 - the most recent period for which figures are available - eight women died as a consequence, including two who refused transfusions for religious reasons. Ms Cameron's research, published in the Australian and New Zealand Journal of Public Health, was based on the medical records of more than 52,000 women who had a birth-related hemorrhage in NSW between 1994 and 2002. It is not yet clear whether the pattern has continued since 2002, when NSW Health recommended the use of drugs to expel the placenta and early clamping of the umbilical cord to limit bleeding. David Ellwood, professor of obstetrics and gynaecology at the Australian National University Medical School in Canberra, said: "All of the major hospitals around the country have been noticing an increase." Women who gave birth vaginally after a previous caesarean, or those carrying twins, might be at increased risk, he said. Rising birthweights might also contribute to the trend. Increasing transfusion numbers indicated that the severest bleeding was also rising, Professor Ellwood said - because doctors were reluctant to transfuse women with less serious hemorrhages. A group of maternity hospitals was researching women's recovery from birth hemorrhages to see whether they affected breastfeeding or triggered post-natal depression, he said. http://www.smh.com.au/news/national/transfusions-soar-for-women-giving-birth/2006/06/02/1148956546560.html#
[ozmidwifery] PPH levels soar
Hi, This article appeared in last week's Sydney Morning Herald. I think it's amazing and it appears that some of the information is incorrect in that the article states that NSW Health implemented active thrid stage and early cord clamping in 2002. Surely syntometrine and syntocinon have been used for many more years than just the last four, in which case this study is a real eye-opener if you believe we are stopping women from bleeding by using drugs in third stage. What do you think? Sue Transfusions soar for women giving birth Julie Robotham Medical Editor June 3, 2006 RECORD numbers of NSW women need transfusions to treat massive blood loss after giving birth, in an epidemic that doctors say is threatening new mothers' health and fertility and sometimes their lives. The number of women diagnosed with post-partum hemorrhage has rocketed by nearly 30 per cent, and almost one in nine births was affected in 2002, compared to one in 12 in 1994, University of Sydney research has shown. Of those, the proportion whose condition was severe enough to warrant a blood transfusion increased sixfold, from 2 per cent to 12 per cent. "It's extremely important," said Ken Clark, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Bleeding was "still a very real cause of the death of women but also a great deal of [ill health] that has a tremendous impact on women and their families". In the worst cases mothers had to undergo emergency hysterectomies to save their lives, but even less dramatic surgery to clamp blood vessels or anaemia could be debilitating. "To have that on top of all the other stresses and strains of motherhood it's the last thing people need," Dr Clark said. The NSW findings are the first large-scale confirmation of the impression among individual doctors and hospitals across Australia that major bleeding is increasing. Carolyn Cameron, who led the statewide analysis, said neither the well-documented rise in caesarean section births nor the growing number of older mothers could explain the increase in hemorrhages. It was possible more borderline cases were being identified, but this alone was unlikely to account for the increase. "We have to search for something else. It's a mystery," said Ms Cameron, a research officer at the Centre for Perinatal Health Services Research. The group would now look at how many previous pregnancies women had and the length of their labours to see whether these offered clues to the reasons for hemorrhage - diagnosed when more than 500 millilitres of blood is lost after a vaginal birth, or more than 750 millilitres after a caesarean. Blood loss - usually from the site where the placenta detaches - is currently the single largest cause of pregnancy-related death in Australia. Between 1997 and 1999 - the most recent period for which figures are available - eight women died as a consequence, including two who refused transfusions for religious reasons. Ms Cameron's research, published in the Australian and New Zealand Journal of Public Health, was based on the medical records of more than 52,000 women who had a birth-related hemorrhage in NSW between 1994 and 2002. It is not yet clear whether the pattern has continued since 2002, when NSW Health recommended the use of drugs to expel the placenta and early clamping of the umbilical cord to limit bleeding. David Ellwood, professor of obstetrics and gynaecology at the Australian National University Medical School in Canberra, said: "All of the major hospitals around the country have been noticing an increase." Women who gave birth vaginally after a previous caesarean, or those carrying twins, might be at increased risk, he said. Rising birthweights might also contribute to the trend. Increasing transfusion numbers indicated that the severest bleeding was also rising, Professor Ellwood said - because doctors were reluctant to transfuse women with less serious hemorrhages. A group of maternity hospitals was researching women's recovery from birth hemorrhages to see whether they affected breastfeeding or triggered post-natal depression, he said. http://www.smh.com.au/news/national/transfusions-soar-for-women-giving-birth/2006/06/02/1148956546560.html#
Re: [ozmidwifery] PPH levels soar
I know that homeopaths believe that the same thing you give to fix a symptom can cause that symptom in a well person, or given in the wrong dose for the individual. This is how they prove a homeopathic treatment. I don't know if I have explained that very well... Here is a link about homeopathic proving http://www.hpathy.com/research/shere-proving-homeopathy.asp Jo At 6:49 PM +1000 11/6/06, Sue Cookson wrote: Hi, This article appeared in last week's Sydney Morning Herald. I think it's amazing and it appears that some of the information is incorrect in that the article states that NSW Health implemented active thrid stage and early cord clamping in 2002. Surely syntometrine and syntocinon have been used for many more years than just the last four, in which case this study is a real eye-opener if you believe we are stopping women from bleeding by using drugs in third stage. What do you think? Sue Transfusions soar for women giving birth Julie Robotham Medical Editor June 3, 2006 RECORD numbers of NSW women need transfusions to treat massive blood loss after giving birth, in an epidemic that doctors say is threatening new mothers' health and fertility and sometimes their lives. The number of women diagnosed with post-partum hemorrhage has rocketed by nearly 30 per cent, and almost one in nine births was affected in 2002, compared to one in 12 in 1994, University of Sydney research has shown. Of those, the proportion whose condition was severe enough to warrant a blood transfusion increased sixfold, from 2 per cent to 12 per cent. It's extremely important, said Ken Clark, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Bleeding was still a very real cause of the death of women but also a great deal of [ill health] that has a tremendous impact on women and their families. In the worst cases mothers had to undergo emergency hysterectomies to save their lives, but even less dramatic surgery to clamp blood vessels or anaemia could be debilitating. To have that on top of all the other stresses and strains of motherhood it's the last thing people need, Dr Clark said. The NSW findings are the first large-scale confirmation of the impression among individual doctors and hospitals across Australia that major bleeding is increasing. Carolyn Cameron, who led the statewide analysis, said neither the well-documented rise in caesarean section births nor the growing number of older mothers could explain the increase in hemorrhages. It was possible more borderline cases were being identified, but this alone was unlikely to account for the increase. We have to search for something else. It's a mystery, said Ms Cameron, a research officer at the Centre for Perinatal Health Services Research. The group would now look at how many previous pregnancies women had and the length of their labours to see whether these offered clues to the reasons for hemorrhage - diagnosed when more than 500 millilitres of blood is lost after a vaginal birth, or more than 750 millilitres after a caesarean. Blood loss - usually from the site where the placenta detaches - is currently the single largest cause of pregnancy-related death in Australia. Between 1997 and 1999 - the most recent period for which figures are available - eight women died as a consequence, including two who refused transfusions for religious reasons. Ms Cameron's research, published in the Australian and New Zealand Journal of Public Health, was based on the medical records of more than 52,000 women who had a birth-related hemorrhage in NSW between 1994 and 2002. It is not yet clear whether the pattern has continued since 2002, when NSW Health recommended the use of drugs to expel the placenta and early clamping of the umbilical cord to limit bleeding. David Ellwood, professor of obstetrics and gynaecology at the Australian National University Medical School in Canberra, said: All of the major hospitals around the country have been noticing an increase. Women who gave birth vaginally after a previous caesarean, or those carrying twins, might be at increased risk, he said. Rising birthweights might also contribute to the trend. Increasing transfusion numbers indicated that the severest bleeding was also rising, Professor Ellwood said - because doctors were reluctant to transfuse women with less serious hemorrhages. A group of maternity hospitals was researching women's recovery from birth hemorrhages to see whether they affected breastfeeding or triggered post-natal depression, he said. http://www.smh.com.au/news/national/transfusions-soar-for-women-giving-birth/2006/06/02/1148956546560.htmlhttp://www.smh.com.au/news/national/transfusions-soar-for-women-giving-birth/2006/06/02/1148956546560.html# -- Jo Bourne Virtual Artists Pty Ltd -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] PPH levels soar
Yeah, sucking on a piece of placenta is said to be a great way to stop bleeding. Even though I'm vegetarian I would have given it a go rather than go to hosp. Lost 1500mls after first baby's birth, after cord traction which ended with cord in registrars hand and placenta inside - manual removal, blood transfusion uuugg would've eaten a horse to avoid that again! Jo -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jo Bourne Sent: Sunday, 11 June 2006 9:10 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] PPH levels soar I know that homeopaths believe that the same thing you give to fix a symptom can cause that symptom in a well person, or given in the wrong dose for the individual. This is how they prove a homeopathic treatment. I don't know if I have explained that very well... Here is a link about homeopathic proving http://www.hpathy.com/research/shere-proving-homeopathy.asp Jo At 6:49 PM +1000 11/6/06, Sue Cookson wrote: Hi, This article appeared in last week's Sydney Morning Herald. I think it's amazing and it appears that some of the information is incorrect in that the article states that NSW Health implemented active thrid stage and early cord clamping in 2002. Surely syntometrine and syntocinon have been used for many more years than just the last four, in which case this study is a real eye-opener if you believe we are stopping women from bleeding by using drugs in third stage. What do you think? Sue Transfusions soar for women giving birth Julie Robotham Medical Editor June 3, 2006 RECORD numbers of NSW women need transfusions to treat massive blood loss after giving birth, in an epidemic that doctors say is threatening new mothers' health and fertility and sometimes their lives. The number of women diagnosed with post-partum hemorrhage has rocketed by nearly 30 per cent, and almost one in nine births was affected in 2002, compared to one in 12 in 1994, University of Sydney research has shown. Of those, the proportion whose condition was severe enough to warrant a blood transfusion increased sixfold, from 2 per cent to 12 per cent. It's extremely important, said Ken Clark, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Bleeding was still a very real cause of the death of women but also a great deal of [ill health] that has a tremendous impact on women and their families. In the worst cases mothers had to undergo emergency hysterectomies to save their lives, but even less dramatic surgery to clamp blood vessels or anaemia could be debilitating. To have that on top of all the other stresses and strains of motherhood Š it's the last thing people need, Dr Clark said. The NSW findings are the first large-scale confirmation of the impression among individual doctors and hospitals across Australia that major bleeding is increasing. Carolyn Cameron, who led the statewide analysis, said neither the well-documented rise in caesarean section births nor the growing number of older mothers could explain the increase in hemorrhages. It was possible more borderline cases were being identified, but this alone was unlikely to account for the increase. We have to search for something else. It's a mystery, said Ms Cameron, a research officer at the Centre for Perinatal Health Services Research. The group would now look at how many previous pregnancies women had and the length of their labours to see whether these offered clues to the reasons for hemorrhage - diagnosed when more than 500 millilitres of blood is lost after a vaginal birth, or more than 750 millilitres after a caesarean. Blood loss - usually from the site where the placenta detaches - is currently the single largest cause of pregnancy-related death in Australia. Between 1997 and 1999 - the most recent period for which figures are available - eight women died as a consequence, including two who refused transfusions for religious reasons. Ms Cameron's research, published in the Australian and New Zealand Journal of Public Health, was based on the medical records of more than 52,000 women who had a birth-related hemorrhage in NSW between 1994 and 2002. It is not yet clear whether the pattern has continued since 2002, when NSW Health recommended the use of drugs to expel the placenta and early clamping of the umbilical cord to limit bleeding. David Ellwood, professor of obstetrics and gynaecology at the Australian National University Medical School in Canberra, said: All of the major hospitals around the country have been noticing an increase. Women who gave birth vaginally after a previous caesarean, or those carrying twins, might be at increased risk, he said. Rising birthweights might also contribute to the trend. Increasing transfusion numbers indicated that the severest bleeding was also rising, Professor Ellwood said - because doctors were reluctant to transfuse women with less serious hemorrhages. A group
RE: [ozmidwifery] PPH levels soar
They were using syntometerine for all women except those with high BP, when synto was given, back in 1986 where I did mid in NSW, and we were considered pretty low intervention. I have noticed an increase in PPH, and a large increase in morbidity. More women are ending up in HDU. Not as many blood transfusions, but lower Hb's acceptable. It is scary. Maureen -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of jo Sent: Sunday, 11 June 2006 9:26 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] PPH levels soar Yeah, sucking on a piece of placenta is said to be a great way to stop bleeding. Even though I'm vegetarian I would have given it a go rather than go to hosp. Lost 1500mls after first baby's birth, after cord traction which ended with cord in registrars hand and placenta inside - manual removal, blood transfusion uuugg would've eaten a horse to avoid that again! Jo -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jo Bourne Sent: Sunday, 11 June 2006 9:10 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] PPH levels soar I know that homeopaths believe that the same thing you give to fix a symptom can cause that symptom in a well person, or given in the wrong dose for the individual. This is how they prove a homeopathic treatment. I don't know if I have explained that very well... Here is a link about homeopathic proving http://www.hpathy.com/research/shere-proving-homeopathy.asp Jo At 6:49 PM +1000 11/6/06, Sue Cookson wrote: Hi, This article appeared in last week's Sydney Morning Herald. I think it's amazing and it appears that some of the information is incorrect in that the article states that NSW Health implemented active thrid stage and early cord clamping in 2002. Surely syntometrine and syntocinon have been used for many more years than just the last four, in which case this study is a real eye-opener if you believe we are stopping women from bleeding by using drugs in third stage. What do you think? Sue Transfusions soar for women giving birth Julie Robotham Medical Editor June 3, 2006 RECORD numbers of NSW women need transfusions to treat massive blood loss after giving birth, in an epidemic that doctors say is threatening new mothers' health and fertility and sometimes their lives. The number of women diagnosed with post-partum hemorrhage has rocketed by nearly 30 per cent, and almost one in nine births was affected in 2002, compared to one in 12 in 1994, University of Sydney research has shown. Of those, the proportion whose condition was severe enough to warrant a blood transfusion increased sixfold, from 2 per cent to 12 per cent. It's extremely important, said Ken Clark, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Bleeding was still a very real cause of the death of women but also a great deal of [ill health] that has a tremendous impact on women and their families. In the worst cases mothers had to undergo emergency hysterectomies to save their lives, but even less dramatic surgery to clamp blood vessels or anaemia could be debilitating. To have that on top of all the other stresses and strains of motherhood Š it's the last thing people need, Dr Clark said. The NSW findings are the first large-scale confirmation of the impression among individual doctors and hospitals across Australia that major bleeding is increasing. Carolyn Cameron, who led the statewide analysis, said neither the well-documented rise in caesarean section births nor the growing number of older mothers could explain the increase in hemorrhages. It was possible more borderline cases were being identified, but this alone was unlikely to account for the increase. We have to search for something else. It's a mystery, said Ms Cameron, a research officer at the Centre for Perinatal Health Services Research. The group would now look at how many previous pregnancies women had and the length of their labours to see whether these offered clues to the reasons for hemorrhage - diagnosed when more than 500 millilitres of blood is lost after a vaginal birth, or more than 750 millilitres after a caesarean. Blood loss - usually from the site where the placenta detaches - is currently the single largest cause of pregnancy-related death in Australia. Between 1997 and 1999 - the most recent period for which figures are available - eight women died as a consequence, including two who refused transfusions for religious reasons. Ms Cameron's research, published in the Australian and New Zealand Journal of Public Health, was based on the medical records of more than 52,000 women who had a birth-related hemorrhage in NSW between 1994 and 2002. It is not yet clear whether the pattern has continued since 2002, when NSW Health recommended the use of drugs to expel the placenta and early clamping of the umbilical cord to limit bleeding. David Ellwood
Re: [ozmidwifery] PPH levels soar
Sue Cookson wrote:
Hi,
This article appeared in last week's Sydney Morning Herald.
I think it's amazing and it appears that some of the information is
incorrect in that the article states that NSW Health implemented
active thrid stage and early cord clamping in 2002. Surely
syntometrine and syntocinon have been used for many more years than
just the last four, in which case this study is a real eye-opener if
you believe we are stopping women from bleeding by using drugs in
third stage.
What do you think?
Sue
I wonder how many of these women had inductions (for eg)?
Ive also seen (during my student experiences, so have other current
students) some midwives doctors apply CCT without giving synt,
describing this as 'physiological' 3rd stage. There are lots of 'mixed
managements' of 3rd stage out there with no real evidence base, IMHO
once you do anything like pull on the cord its active management, but on
the 'coal face' there sometimes doesnt seem to be much consensus around
'reasonable' evidence-based 3rd stage management.
What Im pointing out is there is sometimes a gap bewteen what we think
we mean by a term ('active 3rd stage', for eg) what actually happens,
ie, how that is interpreted by the person doing the job, the term may
imply consistency but that doesnt fit reality
cheers.
--
Jennifairy Gillett RM
Midwife in Private Practice
Women’s Health Teaching Associate
ITShare volunteer – Santos Project Co-ordinator
ITShare SA Inc - http://itshare.org.au/
ITShare SA provides computer systems to individuals groups, created
from donated hardware and opensource software
--
This mailing list is sponsored by ACE Graphics.
Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] PPH C/S
I found this on the internet (a herbal tea company website, specialising in pregnancy) - which might be of interest; I have passed it onto the woman as well: Alfalfa, with its deep root system, contains many essential nutrients including trace minerals, chlorophyll and vitamin K, a nutrient necessary for blood clotting. Many midwives advise drinking mild tasting alfalfa tea or taking alfalfa tablets during the last trimester of pregnancy to decrease postpartum bleeding or chance of hemorrhaging. Alfalfa also increases breast milk, as alfalfa hay is fed daily to milking goats and other dairy animals. Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Honey Acharya Sent: Monday, 3 April 2006 10:03 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] PPH C/S Its all about what she wants and is prepared to do to get it. very true I say this a lot lately! - Original Message - From: Andrea Quanchi To: ozmidwifery@acegraphics.com.au Sent: Monday, April 03, 2006 9:48 AM Subject: Re: [ozmidwifery] PPH C/S the things is that if her babies are that big imagine how big her placentas are, probably the size of a dinner plate instead of a bread and butter plate. It makes sense that a large placental site will bleed more than a little one but its whether the woman is symptomatic or not that matters. If she does not cope with the amount of blood she lost then it is an issue and she needs to look at alternatives rather than go inyo it and just let the same thing happen again like the proverbial ostrich. If it is just that the doctor is uncomfortable with the blood loss but she is physiologically fine then find another care giver and save him the grey hair. Its all about what she wants and is prepared to do to get it. Andrea Quanchi On 03/04/2006, at 10:14 AM, Robyn Dempsey wrote: I feel that if this woman has had such large babies, what a wonderful pelvis she must have! Good on her! Rather than promoting a c-section, perhaps look at her diet...does she just grow big bubs, or does she over indulge in the sugary foods? If PPH is the worry, perhaps a discussion around a managed 3rd stage, or syntocinon if there are any signs of excessive bleeding. I've had many women with large babies, doesn't mean they will have a PPH, simply that they grow bigger bubs, and have a pelvis to fit them thru. Cheers Robyn D - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: 01 April, 2006 4:26 PM 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
Re: [ozmidwifery] PPH C/S
We have just recently had 2 women have hysterectomy's following LCSC for control of bleeding. In both cases the lower segment was very thin and suturing was almost impossible. So LSCS do not necessarily save women from PPH and it is known that women who have LSCS have a greater blood loss anyway. Initially anyway. Katy. - Original Message - From: Melissa Singer To: ozmidwifery@acegraphics.com.au Sent: Saturday, April 01, 2006 8:52 PM Subject: Re: [ozmidwifery] PPH C/S Maybe the thinking is should she have another large PPH there is already direct access to the uterus to clamp hemorrhaging vessels? It seems Obs are always suggesting a C/S for one reason or another. I think it is OK for her to say no, there are protocols and procedures to follow for anyone with high risk of PPH and usually if they are followed and she is birthing in a place where there is 24hr theatre immediately available it should be reasonable. But that said I don't know how large her previous pph's were, if she was compromise etc Melissa - Original Message - From: Nicole Carver To: ozmidwifery@acegraphics.com.au Sent: Saturday, April 01, 2006 4:44 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]On Behalf Of Kelly @ BellyBellySent: Saturday, April 01, 2006 4:27 PMTo: ozmidwifery@acegraphics.com.auSubject: [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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support __ NOD32 1.1467 (20060402) Information __This message was checked by NOD32 antivirus system.http://www.eset.com
Re: [ozmidwifery] PPH C/S
I feel that if this woman has had such large babies, what a wonderful pelvis she must have! Good on her! Rather than promoting a c-section, perhaps look at her diet...does she just grow big bubs, or does she over indulge in the sugary foods? If PPH is the worry, perhaps a discussion around a managed 3rd stage, or syntocinon if there are any signs of excessive bleeding. I've had many women with large babies, doesn't mean they will have a PPH, simply that they grow bigger bubs, and have a pelvis to fit them thru. Cheers Robyn D - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: 01 April, 2006 4:26 PM 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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
Re: [ozmidwifery] PPH C/S
the things is that if her babies are that big imagine how big her placentas are, probably the size of a dinner plate instead of a bread and butter plate. It makes sense that a large placental site will bleed more than a little one but its whether the woman is symptomatic or not that matters. If she does not cope with the amount of blood she lost then it is an issue and she needs to look at alternatives rather than go inyo it and just let the same thing happen again like the proverbial ostrich. If it is just that the doctor is uncomfortable with the blood loss but she is physiologically fine then find another care giver and save him the grey hair.Its all about what she wants and is prepared to do to get it. Andrea QuanchiOn 03/04/2006, at 10:14 AM, Robyn Dempsey wrote:I feel that if this woman has had such large babies, what a wonderful pelvis she must have! Good on her! Rather than promoting a c-section, perhaps look at her diet...does she just grow big bubs, or does she over indulge in the sugary foods? If PPH is the worry, perhaps a discussion around a managed 3rd stage, or syntocinon if there are any signs of excessive bleeding. I've had many women with large babies, doesn't mean they will have a PPH, simply that they grow bigger bubs, and have a pelvis to fit them thru. CheersRobyn D- Original Message -From: Kelly @ BellyBellyTo: ozmidwifery@acegraphics.com.auSent: 01 April, 2006 4:26 PMSubject: [ozmidwifery] PPH C/SHello 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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
Re: [ozmidwifery] PPH C/S
"Its all about what she wants and is prepared to do to get it." very true I say this a lot lately! - Original Message - From: Andrea Quanchi To: ozmidwifery@acegraphics.com.au Sent: Monday, April 03, 2006 9:48 AM Subject: Re: [ozmidwifery] PPH C/S the things is that if her babies are that big imagine how big her placentas are, probably the size of a dinner plate instead of a bread and butter plate. It makes sense that a large placental site will bleed more than a little one but its whether the woman is symptomatic or not that matters. If she does not cope with the amount of blood she lost then it is an issue and she needs to look at alternatives rather than go inyo it and just let the same thing happen again like the proverbial ostrich. If it is just that the doctor is uncomfortable with the blood loss but she is physiologically fine then find another care giver and save him the grey hair. Its all about what she wants and is prepared to do to get it. Andrea Quanchi On 03/04/2006, at 10:14 AM, Robyn Dempsey wrote: I feel that if this woman has had such large babies, what a wonderful pelvis she must have! Good on her! Rather than promoting a c-section, perhaps look at her diet...does she just grow big bubs, or does she over indulge in the sugary foods? If PPH is the worry, perhaps a discussion around a managed 3rd stage, or syntocinon if there are any signs of excessive bleeding. I've had many women with large babies, doesn't mean they will have a PPH, simply that they grow bigger bubs, and have a pelvis to fit them thru. Cheers Robyn D - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: 01 April, 2006 4:26 PM 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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
Re: [ozmidwifery] PPH C/S
Maybe the thinking is should she have another large PPH there is already direct access to the uterus to clamp hemorrhaging vessels? It seems Obs are always suggesting a C/S for one reason or another. I think it is OK for her to say no, there are protocols and procedures to follow for anyone with high risk of PPH and usually if they are followed and she is birthing in a place where there is 24hr theatre immediately available it should be reasonable. But that said I don't know how large her previous pph's were, if she was compromise etc Melissa - Original Message - From: Nicole Carver To: ozmidwifery@acegraphics.com.au Sent: Saturday, April 01, 2006 4:44 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]On Behalf Of Kelly @ BellyBellySent: Saturday, April 01, 2006 4:27 PMTo: ozmidwifery@acegraphics.com.auSubject: [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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
Re: [ozmidwifery] PPH C/S
Kelly @ BellyBelly wrote: 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 She would be better advised to follow a gestational diabetic diet. Gloria in Vancouver, BC
Re: [ozmidwifery] PPH C/S
Dear Kelly Re PPH: It would be interesting to find out if this woman was induced or had active management in last 2 births. Her body may not repond well to the syntoIf she can get onto a good homeopath 'Ustilago Maidus' is excellent for prevention of pph but must havedosage determinedby qualified homeopath. Have seen this used very effectively in a small number of women for abt 10 yrs wherewoman has hada previous pph and none with remedy. It is not one of the regular homeopathics used. Newtons Pharmacy in Sydney stock it and will do postal orders if her homeopath does not stock it. Re ? G.D Diet sounds good as Gloria has suggested and if she has G.D and is doing her BSL's and they are high . the Australian Bush Flower essence Peach Flowered Tea Tree is excellent. I have seen a number of women over the years who are on insulin (sliding scale used to determine dose) for G.D use the essence and within 2-5 days have reduced BSL's and have not required andmore insulin for the remainder of the pregnancy. It could be this womanis tall and a little longer herself and hasbig bubs one woman I know all her bubs are 11-13 pounds and she has never had GD, always normal vaginal births and peri intact everytime. Kind Regards Sally-Anne - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: Saturday, April 01, 2006 4:26 PM 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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.385 / Virus Database: 268.3.4/299 - Release Date: 31/03/2006 No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.385 / Virus Database: 268.3.4/299 - Release Date: 31/03/2006
RE: [ozmidwifery] PPH C/S
Thanks Sally-Anne, I will pose this to her and let you know J Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Sally-Anne Brown Sent: Sunday, 2 April 2006 9:00 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] PPH C/S Dear Kelly Re PPH: It would be interesting to find out if this woman was induced or had active management in last 2 births. Her body may not repond well to the syntoIf she can get onto a good homeopath 'Ustilago Maidus' is excellent for prevention of pph but must havedosage determinedby qualified homeopath. Have seen this used very effectively in a small number of women for abt 10 yrs wherewoman has hada previous pph and none with remedy. It is not one of the regular homeopathics used. Newtons Pharmacy in Sydney stock it and will do postal orders if her homeopath does not stock it. Re ? G.D Diet sounds good as Gloria has suggested and if she has G.D and is doing her BSL's and they are high . the Australian Bush Flower essence Peach Flowered Tea Tree is excellent. I have seen a number of women over the years who are on insulin (sliding scale used to determine dose) for G.D use the essence and within 2-5 days have reduced BSL's and have not required andmore insulin for the remainder of the pregnancy. It could be this womanis tall and a little longer herself and hasbig bubs one woman I know all her bubs are 11-13 pounds and she has never had GD, always normal vaginal births and peri intact everytime. Kind Regards Sally-Anne - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: Saturday, April 01, 2006 4:26 PM 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 No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.385 / Virus Database: 268.3.4/299 - Release Date: 31/03/2006
Fw: [ozmidwifery] PPH C/S
I have heard that a standard 100mls is lost with every c/s. Howbig was this womenspph.Its strange (or typical) howat 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]On Behalf Of Kelly @ BellyBellySent: Saturday, April 01, 2006 4:27 PMTo: ozmidwifery@acegraphics.com.auSubject: [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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
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] PPH C/S
I think it's because allthe liquor is measured in with the blood loss in the suction bottles at a C/S. It totals 1000mls but 50% of it is probably not blood, that isjust the ETBL documented as total fluid loss. It's difficult/impossible to differentiate theblood from liquor/body fluidso theyall get totalled in. The women aren't all symptomatic of a PPh post C/S are they ? Then you'd worry. With kind regardsBrenda Manning www.themidwife.com.au - Original Message - From: Mh To: ozmidwifery@acegraphics.com.au Sent: Sunday, April 02, 2006 4:21 PM Subject: 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.auSent: Sunday, April 02, 2006 11:28 AMSubject: Fw: [ozmidwifery] PPH C/SI 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 CarverTo: ozmidwifery@acegraphics.com.auSent: Saturday, April 01, 2006 6:44 PMSubject: RE: [ozmidwifery] PPH C/SWomen 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] PPH C/S
There is liquor mixed in the blood at a vaginal birth too. Estimating/weighing blood loss is always going to be inaccurate. I have never seen anyone weight the abdominal packs after a C/S Is this usual practice? mm From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of brendamanning Sent: Sunday, 2 April 2006 2:46 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] PPH C/S I think it's because allthe liquor is measured in with the blood loss in the suction bottles at a C/S. It totals 1000mls but 50% of it is probably not blood, that isjust the ETBL documented as total fluid loss. It's difficult/impossible to differentiate theblood from liquor/body fluidso theyall get totalled in. The women aren't all symptomatic of a PPh post C/S are they ? Then you'd worry. With kind regards Brenda Manning www.themidwife.com.au - Original Message - From: Mh To: ozmidwifery@acegraphics.com.au Sent: Sunday, April 02, 2006 4:21 PM Subject: 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:owner-ozmidwifery@acegraphics.com.au]On 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.
[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
Re: [ozmidwifery] PPH C/S
She CAN always say no. How bad were the other PPH's? Enough to really comprimise her? She is probably at risk of another but it might still happen if she has a CS. Cheers Judy --- Kelly @ BellyBelly [EMAIL PROTECTED] wrote: 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, 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 - http://www.bellybelly.com.au/birth-support On yahoo!7 Avatars: Dress up like your Dancing with the Stars favourites! http://au.avatars.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] PPH C/S
Title: Message In Effective Care there is some information about how active management can actually contribute to PPH. 2001 edition. It could be something she would like to consider. I think her biggest battles will lie in the VBA2C and big babies. There have been two recent studies which support vbac in both instancesI will see if I can find them. Jo -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Kelly @ BellyBellySent: Saturday, April 01, 2006 3:57 PMTo: ozmidwifery@acegraphics.com.auSubject: [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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support --No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.385 / Virus Database: 268.3.3/298 - Release Date: 3/30/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.385 / Virus Database: 268.3.3/298 - Release Date: 3/30/2006
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]On Behalf Of Kelly @ BellyBellySent: Saturday, April 01, 2006 4:27 PMTo: ozmidwifery@acegraphics.com.auSubject: [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 ZanteyCreator, BellyBelly.com.au Gentle Solutions From Conception to ParenthoodBellyBelly Birth Support - http://www.bellybelly.com.au/birth-support
RE: [ozmidwifery] PPH risks
Title: Message WE had a CARES member once who had PPH with all of her babes and all were actively managed. She then read in Effective Guide that active management can in fact cause PPH in some cases. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of EmilySent: Friday, November 18, 2005 9:26 AMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] PPH risks hi everyonedoes anyone know of any evidence on the volume of PPHs averted by active management? the big studies 'show' (whether flawed or not) that active management decreases the risk of PPH, but id like to know how much of this decrease is in the minor PPH range 500mL-1000mL which isnt likely to be symptomatic or adversely affect the woman anyway. another thing i find amazing is that physiological management 'isnt allowed' because of the increased risk of PPH, yet an emergency caesarean is associated with a 9 times increased risk of PPH !! and elective caesarean with a 4 times increased risk. an episiotomy is associated with a 5 times increased risk. yet these are never used as reasons why we shouldnt use such interventions. it is just accepted as part of the process. but any risk associated with leaving things alone is seen as unacceptable(reference http://www.show.scot.nhs.uk/sign/guidelines/sogap/sogap4.html)! :(emily Yahoo! FareChase - Search multiple travel sites in one click. --Internal Virus Database is out-of-date.Checked by AVG Free Edition.Version: 7.1.362 / Virus Database: 267.12.8/162 - Release Date: 11/5/2005 -- Internal Virus Database is out-of-date. Checked by AVG Free Edition. Version: 7.1.362 / Virus Database: 267.12.8/162 - Release Date: 11/5/2005
Re: [ozmidwifery] PPH risks
Dear Emily, I think the research does not quite say that it reduces PPH's but reduces the overall blood loss, especially if there is a PPH i.e. instead of loosing 1000mls you may only loose 700mls but an active third stageit does not prevent a PPH. RegardsAnne ClarkeQueensland - Original Message - From: Emily To: ozmidwifery@acegraphics.com.au Sent: Friday, November 18, 2005 8:56 AM Subject: [ozmidwifery] PPH risks hi everyonedoes anyone know of any evidence on the volume of PPHs averted by active management? the big studies 'show' (whether flawed or not) that active management decreases the risk of PPH, but id like to know how much of this decrease is in the minor PPH range 500mL-1000mL which isnt likely to be symptomatic or adversely affect the woman anyway. another thing i find amazing is that physiological management 'isnt allowed' because of the increased risk of PPH, yet an emergency caesarean is associated with a 9 times increased risk of PPH !! and elective caesarean with a 4 times increased risk. an episiotomy is associated with a 5 times increased risk. yet these are never used as reasons why we shouldnt use such interventions. it is just accepted as part of the process. but any risk associated with leaving things alone is seen as unacceptable(reference http://www.show.scot.nhs.uk/sign/guidelines/sogap/sogap4.html)! :(emily Yahoo! FareChase - Search multiple travel sites in one click.
Re: [ozmidwifery] PPH risks
Hi, I think you will find what you are looking for in the Hinchingbrooke trial. The results make very interesting reading. If you type it into a goggle search engine you will find lots of critiques on it. I attending the initial presentation of this trial. Although they did find actively managed labours had a lower pph outcome it was only with a pph thought to be over 500ml. When they changed the pph value to over 1000ml they actually found no difference in the rate. They questioned whether with women's health having improved along with diet and education maybe a re evaluation of pph on women's symptoms of large amounts of blood loss rather than our current system of estimating the loss of blood is more appropriate. (By that they didn't mean huge losses but maybe the 300 to 700ml estimation which varies a lot between practitioners. Also some women are not symptomatic after a 700ml loss so have they had a pph?) I'm not sure I've said this very well so maybe reading the trial for yourself will make it clearer. Lisa From: Emily To: ozmidwifery@acegraphics.com.au Sent: Friday, November 18, 2005 9:26 AM Subject: [ozmidwifery] PPH risks hi everyonedoes anyone know of any evidence on the volume of PPHs averted by active management? the big studies 'show' (whether flawed or not) that active management decreases the risk of PPH, but id like to know how much of this decrease is in the minor PPH range 500mL-1000mL which isnt likely to be symptomatic or adversely affect the woman anyway. another thing i find amazing is that physiological management 'isnt allowed' because of the increased risk of PPH, yet an emergency caesarean is associated with a 9 times increased risk of PPH !! and elective caesarean with a 4 times increased risk. an episiotomy is associated with a 5 times increased risk. yet these are never used as reasons why we shouldnt use such interventions. it is just accepted as part of the process. but any risk associated with leaving things alone is seen as unacceptable(reference http://www.show.scot.nhs.uk/sign/guidelines/sogap/sogap4.html)! :(emily Yahoo! FareChase - Search multiple travel sites in one click.
FW: [ozmidwifery] PPH
Title: Message Some quick research Article discussing definition of PPH as problematic http://www.emedicine.com/med/byname/postpartum-hemorrhage.htm Williams Obstetrics (2001) p.636. according to this medical text - Half of all women who give birth vaginally will loose 500mls or more if measured quantitatively (as opposed tosubjective measurement techniques). It is normal for a C/S to have a blood loss on average of 1000mls (although fluid replacement occurs no transfusion is used to replace lost RBC). Elective C/S with hysterectomy average blood loss is 1400ml and in an emergency situation 3-3.5L. If a women has a normal hypervolaemia in pregnancy (not seen in women with PIH etc) then there blood volume increases by 30-60% which is approximately 1-2 litres. Apparently this enables that woman to tolerate a blood loss at delivery that approaches the volume of blood she added during pregnancy. A mean post partum hematocrit decline ranged from 2.6 to 4.3 volume percent. A third of women had no decline or even showed an increase in hematocrit! Women undergoing C/S had a mean drop of 4.2 volume percent with 20% not having any decline at all. This text also identifies anything under 11 g/dl as anaemic. My interpretation - it seems as long aswomen are well and healthy then they are designed physiologically to withstand at least a litre blood loss. Unfortunately it is not easy in practice toaccurately or reliably identify a 500ml loss as compared to a litre loss. Research shows that clinicians tend tounderestimate blood loss 300mls and overestimate blood losses 300mls. Jackie Doolan -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Denise HyndSent: Saturday, March 19, 2005 8:34 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] PPH What about the relevance ofstored iron or ferritin levels?? Denise Hynd "Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled." Linda Hes - Original Message - From: Jenny Cameron To: ozmidwifery@acegraphics.com.au Sent: Saturday, March 19, 2005 2:18 PM Subject: Re: [ozmidwifery] PPH Hello Monica As far as I know WHO call 500ml a PPH. They acknowledge that 1000mls is probably manageable physiologically in a healthy woman but their policy statements are global and the 500 mls is to take into account the many anaemic women in the world. Brucker (2001) states that the average woman loses 500 mls in third stage. My own experience would agree with this. 1000 mls is a considerable amount to lose, even for a healthy woman. It is a matter of knowing the woman's Hb prior to birth and if she is healthy and of average height and weight with a good Hb; 12 or above, she probably can withstand up to a litre, certainly 800 mls without going into shock. O.K. she won't go into shock but a big fluid loss could mean she will be slow to establish a good breastmilk supply or she may take a while to recover postbirth. A few thoughts. Hope it is helpful. Brucker, M. 2001. Management of the third stage of labour: an evidence-based approach, Journal of Midwifery and Women's Health. Vol 46:6. Jenny Jennifer Cameron FRCNA FACMPO Box 1465Howard Springs NT 0835 0419 528 717 - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Saturday, March 19, 2005 3:01 PM Subject: Re: [ozmidwifery] PPH Hi Monica, In the WHO guide to care in childbirth it says is that up to 1000 ml blood lossmay be physiological in healthy populations. This WHO guide was published in 1997 I think, and I haven't yet seen a more recent edition. You can purchase it through Birth International (www.birthinternational.com.au ) Hope this helps. Cheers Michellemh [EMAIL PROTECTED] wrote: 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 to subscribe or unsubscribe. Find local movie times and trailers on Yahoo! Movies.
Re: [ozmidwifery] PPH
What about the relevance ofstored iron or ferritin levels?? Denise Hynd "Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled." Linda Hes - Original Message - From: Jenny Cameron To: ozmidwifery@acegraphics.com.au Sent: Saturday, March 19, 2005 2:18 PM Subject: Re: [ozmidwifery] PPH Hello Monica As far as I know WHO call 500ml a PPH. They acknowledge that 1000mls is probably manageable physiologically in a healthy woman but their policy statements are global and the 500 mls is to take into account the many anaemic women in the world. Brucker (2001) states that the average woman loses 500 mls in third stage. My own experience would agree with this. 1000 mls is a considerable amount to lose, even for a healthy woman. It is a matter of knowing the woman's Hb prior to birth and if she is healthy and of average height and weight with a good Hb; 12 or above, she probably can withstand up to a litre, certainly 800 mls without going into shock. O.K. she won't go into shock but a big fluid loss could mean she will be slow to establish a good breastmilk supply or she may take a while to recover postbirth. A few thoughts. Hope it is helpful. Brucker, M. 2001. Management of the third stage of labour: an evidence-based approach, Journal of Midwifery and Women's Health. Vol 46:6. Jenny Jennifer Cameron FRCNA FACMPO Box 1465Howard Springs NT 0835 0419 528 717 - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Saturday, March 19, 2005 3:01 PM Subject: Re: [ozmidwifery] PPH Hi Monica, In the WHO guide to care in childbirth it says is that up to 1000 ml blood lossmay be physiological in healthy populations. This WHO guide was published in 1997 I think, and I haven't yet seen a more recent edition. You can purchase it through Birth International (www.birthinternational.com.au ) Hope this helps. Cheers Michellemh [EMAIL PROTECTED] wrote: 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 to subscribe or unsubscribe. Find local movie times and trailers on Yahoo! Movies.
Re: [ozmidwifery] PPH
Hi Monica, In the WHO guide to care in childbirth it says is that up to 1000 ml blood lossmay be physiological in healthy populations. This WHO guide was published in 1997 I think, and I haven't yet seen a more recent edition. You can purchase it through Birth International (www.birthinternational.com.au ) Hope this helps. Cheers Michellemh [EMAIL PROTECTED] wrote: 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 to subscribe or unsubscribe. Find local movie times and trailers on Yahoo! Movies.
Re: [ozmidwifery] PPH
Hello Monica As far as I know WHO call 500ml a PPH. They acknowledge that 1000mls is probably manageable physiologically in a healthy woman but their policy statements are global and the 500 mls is to take into account the many anaemic women in the world. Brucker (2001) states that the average woman loses 500 mls in third stage. My own experience would agree with this. 1000 mls is a considerable amount to lose, even for a healthy woman. It is a matter of knowing the woman's Hb prior to birth and if she is healthy and of average height and weight with a good Hb; 12 or above, she probably can withstand up to a litre, certainly 800 mls without going into shock. O.K. she won't go into shock but a big fluid loss could mean she will be slow to establish a good breastmilk supply or she may take a while to recover postbirth. A few thoughts. Hope it is helpful. Brucker, M. 2001. Management of the third stage of labour: an evidence-based approach, Journal of Midwifery and Women's Health. Vol 46:6. Jenny Jennifer Cameron FRCNA FACMPO Box 1465Howard Springs NT 0835 0419 528 717 - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Saturday, March 19, 2005 3:01 PM Subject: Re: [ozmidwifery] PPH Hi Monica, In the WHO guide to care in childbirth it says is that up to 1000 ml blood lossmay be physiological in healthy populations. This WHO guide was published in 1997 I think, and I haven't yet seen a more recent edition. You can purchase it through Birth International (www.birthinternational.com.au ) Hope this helps. Cheers Michellemh [EMAIL PROTECTED] wrote: 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 to subscribe or unsubscribe. Find local movie times and trailers on Yahoo! Movies.
[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.
[ozmidwifery] PPH interesting. (long)
An old method still useful in modern times FYI: MM From Medscape Ob/Gyn Women's Health MedGenMed Ob/Gyn Women's Health Uterovaginal Packing With Rolled Gauze in Postpartum Hemorrhage Case Report Posted 02/13/2004 Rashmi Bagga, MD; Vanita Jain MD; Seema Chopra, MD; Jasvinder Kalra, MD; Sarala Gopalan, PhD, FRCOG Abstract: Management options for postpartum hemorrhage (PPH) include oxytocics, prostaglandins, genital tract exploration, ligation or angiographic embolization of uterine/internal iliac arteries, and hysterectomy. After excluding uterine rupture, genital tract lacerations, and retained placental tissue, efforts are directed toward contracting the uterus by bimanual compression and oxytocics. If these are not successful, one must resort to surgical techniques. At this stage, an alternative option to remember is uterovaginal packing. Easy and quick to perform, it may be used to control bleeding by tamponade effect and stabilize the patient until a surgical procedure is arranged. Uterovaginal packing may sometimes obviate the need for surgery altogether. Two cases, a primary and a secondary PPH, managed recently with uterovaginal packing are reported. Despite concerns about concealed hemorrhage or the development of infection with this intervention, none of these problems were encountered, and uterine packing was successful even in the case of secondary PPH with documented infection. Case 1: A 25-year-old primipara attended this hospital with PPH after vaginal delivery of a 2-kg boy at another hospital 2 hours prior to presentation. The placenta had been delivered by controlled cord traction. She was pale (hemoglobin 5.2 g/dL) and had tachycardia and hypotension (blood pressure 80/60; pulse 140/min). The uterus was 16 weeks size, not well retracted, and the patient was bleeding continuously. Examination under anesthesia revealed partial uterine inversion. After manual reposition, the uterus remained atonic, and bleeding continued despite administration of bimanual compression, oxytocin, ergometrine, and prostaglandins. Tight uterovaginal packing was done with packing forceps using 6 units of povidone-iodine-soaked rolled gauze (knotted end to end). The rolled gauze was fashioned from a rolled bandage 10 cm wide and 4 meters long, which was folded lengthwise 4 times. Bleeding stopped and the patient became hemodynamically stable. She received 5 units of blood transfusion and broad-spectrum antibiotics. Oxytocin infusion was continued for 12 hours. The pack was removed uneventfully 36 hours later. Cultures sent from the uterine cavity at the time of packing grew Escherichia coli with sensitivity to cefotaxime and amikacin, which she had been receiving. She remained afebrile and was discharged 7 days later. Case 2: A 27-year-old, para 2, attended this hospital 40 days after elective cesarean with secondary PPH. During cesarean (at another hospital), the placenta was found adherent and was removed only partially. She had been readmitted to that same hospital with PPH and fever 10 days before presentation to us. There she had received blood transfusion (4 units), oxytocics, and antibiotics. Because her condition did not improve, she was referred to our institution. On admission, she was pale (hemoglobin 7.3 g/dL) and febrile (39°C), but hemodynamically stable (blood pressure 110/80; pulse 110/min). Her abdomen was soft, and the incision had healed. The uterus was subinvoluted (16 weeks size), the cervix was 2 cm dilated, and placental tissue was extruding from it. Significant vaginal bleeding was present. Broad-spectrum antibiotics were started. The uterus was evacuated under anesthesia, and about 100 g of placental tissue was removed. Despite administration of oxytocics and prostaglandins, bleeding continued. Tight uterovaginal packing using 3 units of povidone-iodine-soaked rolled gauze successfully controlled the bleeding. Four units of blood were transfused during and after the procedure. The pack was removed uneventfully 44 hours later. Placental culture grew anaerobic bacteria. She became afebrile after 5 days and was discharged after 10 days.
[ozmidwifery] PPH
From Midwifery Today E-News: At the beginning of my practice as a midwife, we had a homebirth client who was expecting her fourth baby. She had hemorrhaged badly after each of her prior hospital births. I called [midwife/herbalist] Lisa Goldstein and asked her, expecting a negative answer, if there was anything we could suggest so this woman would not bleed at her homebirth. Lisa's one-word answer: "Alfalfa." Alfalfa's roots go extremely deep into the soil; it contains every vitamin and mineral known to man; and it is a good source of vitamin K, a natural blood clotter. The mom began to take alfalfa religiously and had completely normalscant evenbleeding postpartum (she had a wonderful homebirth!). Since then I have learned quite a bit more about avoiding postpartum heavy blood loss. During the past 11 years, it has been extremely rare for a client of mine to bleed seriously. Most of my clients choose to try the following suggestions, and nearly all have had minimal, normal bleeding. I keep medications on hand but throw them out and replace them, unused. Here is the crux of what we do: Check the mom's hemoglobin at 28 weeks and again at 36 weeks; use natural means to help her avoid anemia. Recommend an excellent multiple vitamin from NF formulas (available through birth supply firms), Spectrum 2C, at the full 8-per-day dose, throughout pregnancy. The number of capsules seems large, but the beneficial minerals, etc., are bulky. (many prenatals simply don't supply much in their one-a-day form). Require that women take alfalfa, 812 tablets per day, any brand. For other reasons, especially the formation of the baby's brain, I recommend taking fish oils (4 capsules per day) or vegetarian DHA capsules. It is a lot of pills, but think of it as the nutrients your food is missing. I suggest taking half of them in the morning and half in the evening. Bagging one month's worth in small ziplocks makes it easier. Keep them where you will remember to take them (e.g., where you brush your teeth). I have been able to compare my methods with those of other caregivers because I also worked in a birth center and assisted other midwives whose clients have not had the benefit of these protective components. I have seen some serious bleeding in women who don't use these methods. Even then, it is usually stopped with herbs. My favorite is 30 drops (three droppersful) of Lady's Mantle tincture, which stops bleeding "right now"! The Web site, www.gentlebirth.org/archives/, gives other midwives' suggestions. I assume you will eat healthy food and take a good brisk walk (3045 minutes) each day. It would be great if you found someone with a calmer approach to placenta birthing! Julie Martin, CPM, NHCM
