RE: [ozmidwifery] risk
I downloaded it from http://bmj.bmjjournals.com/cgi/reprint/327/7417/745.pdf. It is great, thank you. Puts things into perspective. Vedrana From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Mary Murphy Sent: Monday, October 16, 2006 2:20 AM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] risk Visit BMJ2003;327:745-748(27September), doi:10.1136/bmj.327.7417.745 Strategies to help patients understand risks. J Paling. I have found his Palings Perspective Scale and P P Palette very useful in explaining the degree of risk to women re screening tests and possible outcomes of various actions. MM Off the top of my head and without philosophical musings, I read thousands of words in dozens of references (just try googling health risk management) and this was the only thing I saw about doing no harm to the patient. Most of it was all about being blamed for harm that might be done and how to minimize being taken to the cleaners. It was not contained in the body of the quoted article by paul bellarmy whose article is interesting. I forget which one it was in, but could probably find it again if needed. Thanks for the compliment. MM What strikes you as particularly interesting about that Mary? I'm very interested in your perspective as you are one of the wisest women I know. warmly, Carolyn
Re: [ozmidwifery] risk
Mary said, the reference The cardinal rule of risk communication is the same as that for emergency medicine: first do no harm. is interesting. What strikes you as particularly interesting about that Mary? I'm very interested in your perspective as you are one of the wisest women I know. warmly, Carolyn
RE: [ozmidwifery] risk
Off the top of my head and without philosophical musings, I read thousands of words in dozens of references (just try googling health risk management) and this was the only thing I saw about doing no harm to the patient. Most of it was all about being blamed for harm that might be done and how to minimize being taken to the cleaners. It was not contained in the body of the quoted article by paul bellarmy whose article is interesting. I forget which one it was in, but could probably find it again if needed. Thanks for the compliment. MM What strikes you as particularly interesting about that Mary? I'm very interested in your perspective as you are one of the wisest women I know. warmly, Carolyn
RE: [ozmidwifery] risk
Visit BMJ2003;327:745-748(27September), doi:10.1136/bmj.327.7417.745 Strategies to help patients understand risks. J Paling. I have found his Palings Perspective Scale and P P Palette very useful in explaining the degree of risk to women re screening tests and possible outcomes of various actions. MM Off the top of my head and without philosophical musings, I read thousands of words in dozens of references (just try googling health risk management) and this was the only thing I saw about doing no harm to the patient. Most of it was all about being blamed for harm that might be done and how to minimize being taken to the cleaners. It was not contained in the body of the quoted article by paul bellarmy whose article is interesting. I forget which one it was in, but could probably find it again if needed. Thanks for the compliment. MM What strikes you as particularly interesting about that Mary? I'm very interested in your perspective as you are one of the wisest women I know. warmly, Carolyn
Re: [ozmidwifery] risk management
Dear Rachel Again I have experience this also working in a midwifery led setting Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. - Linda Hes - Original Message - From: wump fish [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, November 01, 2005 11:34 AM Subject: Re: [ozmidwifery] risk management Denise I agree that adverse events analysis can be a very positive and useful way to learn and improve practice. But, I think we should also analyse those events that go well and learn and improve from them. Rachel From: Denise Hynd [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] risk management Date: Mon, 31 Oct 2005 16:03:36 +0800 Dear Rachel I suspect your experience is a reflection of the personalities and their power structure rather than adverse events analysis I only have a midwifery based experience of adverse events analysis and I felt it was an intersting structure which gave form and direction and which I feel we used as it was intended to address what can be done better to lessen the risk of a recurrence. Nothing is perfect when people are involved this is another way of looking at a situation which can as you have experienced can be abused!! Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. - Linda Hes - Original Message - From: wump fish [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, October 30, 2005 11:45 AM Subject: RE: [ozmidwifery] risk management I just think that the there are a number of problems generated by applying the current risk management strategies in health care to midwifery care. The strategies centred around adverse events analysis claim to be focussed on systems and not individuals. However, this is often not how they are perceived by those involved in the events. In the UK we had 'risk management meetings' every morning to discuss the events in the last 24hrs. Everyone was invited, but of course most midwives were busy caring for women and couldn't get to them. Instead management and the drs sat around and used the notes to discuss care (no names but everyone knew who was involved), the risk of litigation and improvements etc. This was very intimidating for the midwives and was referred to as 'the lynch mob' or the 'witch hunt'. These meetings often totally missed the point because they were focussed on what the participants thought was important - not the women. For example, one of the women I cared for postnatally had had an emergency c-section for fetal distress. The baby ended up with a cut on his face and the meeting discussed the cut. The mother did not give a stuff about the cut on her baby's face, but I spent many hours at her house due to the psychological effects of her experience during an unneccesary fetal blood sampling (flash backs, nightmares, anxiety attacks etc). They would analyse and discuss a poor forceps birth and how to improve the technique - but would not discuss and analyse how this OP baby could have been encouraged to rotate during labour so that the forceps did not need to be used in the first place. I became quite famous at these meeting for my opinionated and arsey contributions - it was almost fun throwing spanners (and research) in the works. Re-focusing risk managment onto optimal outcomes rather than adverse outcomes my be more appropriate and lead to improvements in women's birth experiences. There is a good chapter in Normal Childbirth: evidence and debate (ed Soo Downe) about risk, safety etc. If our aim was to improve outcomes - ie. women's satisfaction with their birth experiences, increasing the normal birth rate etc, we may find the system starts to change in our favour. Looking at why things go well rather than why they go wrong. Education could focus on facilitating physiological birth and improving the birth experience and very importantly - information giving. Obviously midwives still need education in dealing with emergencies, but preventing emergencies should be given equal weighting. Ok, end of my opinionated and arsey contribution ; ) Rachel From: Mary Murphy [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] The Advertiser today... Date: Sun, 30 Oct 2005 10:26:53 +0800 Rachel, working in homebirths makes me very interested in risk management and education. I would appreciate hearing what you have to say, so rave on. Mary M There is kudo is being competent in the management of abnormal and emergencies. Unfortunately, there is not the same emphasis placed
Re: [ozmidwifery] risk management
Dear Rachel I suspect your experience is a reflection of the personalities and their power structure rather than adverse events analysis I only have a midwifery based experience of adverse events analysis and I felt it was an intersting structure which gave form and direction and which I feel we used as it was intended to address what can be done better to lessen the risk of a recurrence. Nothing is perfect when people are involved this is another way of looking at a situation which can as you have experienced can be abused!! Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. - Linda Hes - Original Message - From: wump fish [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, October 30, 2005 11:45 AM Subject: RE: [ozmidwifery] risk management I just think that the there are a number of problems generated by applying the current risk management strategies in health care to midwifery care. The strategies centred around adverse events analysis claim to be focussed on systems and not individuals. However, this is often not how they are perceived by those involved in the events. In the UK we had 'risk management meetings' every morning to discuss the events in the last 24hrs. Everyone was invited, but of course most midwives were busy caring for women and couldn't get to them. Instead management and the drs sat around and used the notes to discuss care (no names but everyone knew who was involved), the risk of litigation and improvements etc. This was very intimidating for the midwives and was referred to as 'the lynch mob' or the 'witch hunt'. These meetings often totally missed the point because they were focussed on what the participants thought was important - not the women. For example, one of the women I cared for postnatally had had an emergency c-section for fetal distress. The baby ended up with a cut on his face and the meeting discussed the cut. The mother did not give a stuff about the cut on her baby's face, but I spent many hours at her house due to the psychological effects of her experience during an unneccesary fetal blood sampling (flash backs, nightmares, anxiety attacks etc). They would analyse and discuss a poor forceps birth and how to improve the technique - but would not discuss and analyse how this OP baby could have been encouraged to rotate during labour so that the forceps did not need to be used in the first place. I became quite famous at these meeting for my opinionated and arsey contributions - it was almost fun throwing spanners (and research) in the works. Re-focusing risk managment onto optimal outcomes rather than adverse outcomes my be more appropriate and lead to improvements in women's birth experiences. There is a good chapter in Normal Childbirth: evidence and debate (ed Soo Downe) about risk, safety etc. If our aim was to improve outcomes - ie. women's satisfaction with their birth experiences, increasing the normal birth rate etc, we may find the system starts to change in our favour. Looking at why things go well rather than why they go wrong. Education could focus on facilitating physiological birth and improving the birth experience and very importantly - information giving. Obviously midwives still need education in dealing with emergencies, but preventing emergencies should be given equal weighting. Ok, end of my opinionated and arsey contribution ; ) Rachel From: Mary Murphy [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] The Advertiser today... Date: Sun, 30 Oct 2005 10:26:53 +0800 Rachel, working in homebirths makes me very interested in risk management and education. I would appreciate hearing what you have to say, so rave on. Mary M There is kudo is being competent in the management of abnormal and emergencies. Unfortunately, there is not the same emphasis placed on the skills involved in facilitating physiological birth and preventing those emergencies from occuring in the first place. Risk management strategies are also back-to-front and result concentrate on the symptoms ignoring the cause. Anyhow... I could rant on forever about risk management and education. So I will shut up for now. Rachel x -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ The new MSN Search Toolbar now includes Desktop search! http://toolbar.msn.co.uk/ -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.362 / Virus Database: 267.12.6/151 - Release Date: 28/10/2005 -- This mailing
RE: [ozmidwifery] risk management
Denise, I hope you don't think that we have a better system here in Perth. Our system is being discarded for exactly that which Rachel described. MM -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Denise Hynd Dear Rachel I suspect your experience is a reflection of the personalities and their power structure rather than adverse events analysis I only have a midwifery based experience of adverse events analysis and I felt it was an intersting structure which gave form and direction and which I feel we used as it was intended to address what can be done better to lessen the risk of a recurrence. scribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] risk management
Denise I agree that adverse events analysis can be a very positive and useful way to learn and improve practice. But, I think we should also analyse those events that go well and learn and improve from them. Rachel From: Denise Hynd [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] risk management Date: Mon, 31 Oct 2005 16:03:36 +0800 Dear Rachel I suspect your experience is a reflection of the personalities and their power structure rather than adverse events analysis I only have a midwifery based experience of adverse events analysis and I felt it was an intersting structure which gave form and direction and which I feel we used as it was intended to address what can be done better to lessen the risk of a recurrence. Nothing is perfect when people are involved this is another way of looking at a situation which can as you have experienced can be abused!! Denise Hynd Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled. - Linda Hes - Original Message - From: wump fish [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, October 30, 2005 11:45 AM Subject: RE: [ozmidwifery] risk management I just think that the there are a number of problems generated by applying the current risk management strategies in health care to midwifery care. The strategies centred around adverse events analysis claim to be focussed on systems and not individuals. However, this is often not how they are perceived by those involved in the events. In the UK we had 'risk management meetings' every morning to discuss the events in the last 24hrs. Everyone was invited, but of course most midwives were busy caring for women and couldn't get to them. Instead management and the drs sat around and used the notes to discuss care (no names but everyone knew who was involved), the risk of litigation and improvements etc. This was very intimidating for the midwives and was referred to as 'the lynch mob' or the 'witch hunt'. These meetings often totally missed the point because they were focussed on what the participants thought was important - not the women. For example, one of the women I cared for postnatally had had an emergency c-section for fetal distress. The baby ended up with a cut on his face and the meeting discussed the cut. The mother did not give a stuff about the cut on her baby's face, but I spent many hours at her house due to the psychological effects of her experience during an unneccesary fetal blood sampling (flash backs, nightmares, anxiety attacks etc). They would analyse and discuss a poor forceps birth and how to improve the technique - but would not discuss and analyse how this OP baby could have been encouraged to rotate during labour so that the forceps did not need to be used in the first place. I became quite famous at these meeting for my opinionated and arsey contributions - it was almost fun throwing spanners (and research) in the works. Re-focusing risk managment onto optimal outcomes rather than adverse outcomes my be more appropriate and lead to improvements in women's birth experiences. There is a good chapter in Normal Childbirth: evidence and debate (ed Soo Downe) about risk, safety etc. If our aim was to improve outcomes - ie. women's satisfaction with their birth experiences, increasing the normal birth rate etc, we may find the system starts to change in our favour. Looking at why things go well rather than why they go wrong. Education could focus on facilitating physiological birth and improving the birth experience and very importantly - information giving. Obviously midwives still need education in dealing with emergencies, but preventing emergencies should be given equal weighting. Ok, end of my opinionated and arsey contribution ; ) Rachel From: Mary Murphy [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] The Advertiser today... Date: Sun, 30 Oct 2005 10:26:53 +0800 Rachel, working in homebirths makes me very interested in risk management and education. I would appreciate hearing what you have to say, so rave on. Mary M There is kudo is being competent in the management of abnormal and emergencies. Unfortunately, there is not the same emphasis placed on the skills involved in facilitating physiological birth and preventing those emergencies from occuring in the first place. Risk management strategies are also back-to-front and result concentrate on the symptoms ignoring the cause. Anyhow... I could rant on forever about risk management and education. So I will shut up for now. Rachel x -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe
RE: [ozmidwifery] risk management
I just think that the there are a number of problems generated by applying the current risk management strategies in health care to midwifery care. The strategies centred around adverse events analysis claim to be focussed on systems and not individuals. However, this is often not how they are perceived by those involved in the events. In the UK we had 'risk management meetings' every morning to discuss the events in the last 24hrs. Everyone was invited, but of course most midwives were busy caring for women and couldn't get to them. Instead management and the drs sat around and used the notes to discuss care (no names but everyone knew who was involved), the risk of litigation and improvements etc. This was very intimidating for the midwives and was referred to as 'the lynch mob' or the 'witch hunt'. These meetings often totally missed the point because they were focussed on what the participants thought was important - not the women. For example, one of the women I cared for postnatally had had an emergency c-section for fetal distress. The baby ended up with a cut on his face and the meeting discussed the cut. The mother did not give a stuff about the cut on her baby's face, but I spent many hours at her house due to the psychological effects of her experience during an unneccesary fetal blood sampling (flash backs, nightmares, anxiety attacks etc). They would analyse and discuss a poor forceps birth and how to improve the technique - but would not discuss and analyse how this OP baby could have been encouraged to rotate during labour so that the forceps did not need to be used in the first place. I became quite famous at these meeting for my opinionated and arsey contributions - it was almost fun throwing spanners (and research) in the works. Re-focusing risk managment onto optimal outcomes rather than adverse outcomes my be more appropriate and lead to improvements in women's birth experiences. There is a good chapter in Normal Childbirth: evidence and debate (ed Soo Downe) about risk, safety etc. If our aim was to improve outcomes - ie. women's satisfaction with their birth experiences, increasing the normal birth rate etc, we may find the system starts to change in our favour. Looking at why things go well rather than why they go wrong. Education could focus on facilitating physiological birth and improving the birth experience and very importantly - information giving. Obviously midwives still need education in dealing with emergencies, but preventing emergencies should be given equal weighting. Ok, end of my opinionated and arsey contribution ; ) Rachel From: Mary Murphy [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] The Advertiser today... Date: Sun, 30 Oct 2005 10:26:53 +0800 Rachel, working in homebirths makes me very interested in risk management and education. I would appreciate hearing what you have to say, so rave on. Mary M There is kudo is being competent in the management of abnormal and emergencies. Unfortunately, there is not the same emphasis placed on the skills involved in facilitating physiological birth and preventing those emergencies from occuring in the first place. Risk management strategies are also back-to-front and result concentrate on the symptoms ignoring the cause. Anyhow... I could rant on forever about risk management and education. So I will shut up for now. Rachel x -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ The new MSN Search Toolbar now includes Desktop search! http://toolbar.msn.co.uk/ -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Risk of uterine rupture + CARES
There are a couple more concerns Joh. Is your obstetrician being anticompetitive or even defamatory? Just worth thinking about. Warm regards, Robyn -Original Message- From: owner-ozmid[EMAIL PROTECTED] [mailto:owner-ozmid[EMAIL PROTECTED]] On Behalf Of Stringybarkers Sent: Monday, 11 July 2005 1:48 PM To: ozmid[EMAIL PROTECTED] Subject: Re: [ozmidwifery] Risk of uterine rupture + CARES Dear Joh, Who is this Ob working for? Is he keeping your best interests at heart? Is he breaking his Hippocratic Oath (if he still makes such a thing?) that states he has To keep the good of the patient as the highest priority? I think it's time to get another obstetrician, if you need one. Best of luck with your birth, David - David Vernon Editor Having a Great Birth in Australia and Men at Birth GPO Box 2314 CANBERRA CITY ACT 2601 AUSTRALIA Tel: 02 6230 2107 Em: [EMAIL PROTECTED] Web: http://www.acmi.org.au/greatbirth - On 11/07/2005, at 12:57 PM, Nathan and Joh wrote: I agree, after just being told by the obs that he would not see me if I continued with my independant midwife - to protect himself from potential litigation - I needed to read this and be reaffirmed that I am in control! Thanks Living in hope Joh - Original Message - From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 09, 2005 4:24 PM Subject: Re: [ozmidwifery] Risk of uterine rupture + CARES Hooray for Jo!!! You're such an inspiration to me! Janet Joyous Birth No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.323 / Virus Database: 267.8.11/44 - Release Date: 8/07/2005
RE: [ozmidwifery] Risk of uterine rupture + CARES
That sort of comment can be taken to politicians and the media if desired: that a professional would use blackmail and/or defamatory comments to sway your choice. It adds to Jenny Gambles comments about OB’s defaming midwives and midwifery and the shit you would get in if you said it about their profession! You could even write to the college of OBs to complain although there would be little they would/could do nut the state and federal health ministers would not be able to ignore it. Not what you want to do when you’re pregnant but if you do act it might stop it from happening to someone else. Cheers Jo -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Robyn Thompson Sent: Wednesday, July 13, 2005 3:30 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Risk of uterine rupture + CARES There are a couple more concerns Joh. Is your obstetrician being anticompetitive or even defamatory? Just worth thinking about. Warm regards, Robyn -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Stringybarkers Sent: Monday, 11 July 2005 1:48 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Risk of uterine rupture + CARES Dear Joh, Who is this Ob working for? Is he keeping your best interests at heart? Is he breaking his Hippocratic Oath (if he still makes such a thing?) that states he has To keep the good of the patient as the highest priority? I think it's time to get another obstetrician, if you need one. Best of luck with your birth, David - David Vernon Editor Having a Great Birth in Australia and Men at Birth GPO Box 2314 CANBERRA CITY ACT 2601 AUSTRALIA Tel: 02 6230 2107 Em: [EMAIL PROTECTED] Web: http://www.acmi.org.au/greatbirth - On 11/07/2005, at 12:57 PM, Nathan and Joh wrote: I agree, after just being told by the obs that he would not see me if I continued with my independant midwife - to protect himself from potential litigation - I needed to read this and be reaffirmed that I am in control! Thanks Living in hope Joh - Original Message - From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 09, 2005 4:24 PM Subject: Re: [ozmidwifery] Risk of uterine rupture + CARES Hooray for Jo!!! You're such an inspiration to me! Janet Joyous Birth No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.323 / Virus Database: 267.8.11/44 - Release Date: 8/07/2005 -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.323 / Virus Database: 267.8.11/45 - Release Date: 7/9/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.323 / Virus Database: 267.8.11/45 - Release Date: 7/9/2005
Re: [ozmidwifery] Risk of uterine rupture + CARES
I agree, after just being told by the obs that he would not see me if I continued with my independant midwife - to protect himself from potential litigation - I needed to read this and be reaffirmed that I am in control! Thanks Living in hope Joh - Original Message - From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 09, 2005 4:24 PM Subject: Re: [ozmidwifery] Risk of uterine rupture + CARES Hooray for Jo!!! You're such an inspiration to me! Janet Joyous Birth No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.323 / Virus Database: 267.8.11/44 - Release Date: 8/07/2005
Re: [ozmidwifery] Risk of uterine rupture + CARES
Dear Joh, Who is this Ob working for? Is he keeping your best interests at heart? Is he breaking his Hippocratic Oath (if he still makes such a thing?) that states he has To keep the good of the patient as the highest priority? I think it's time to get another obstetrician, if you need one. Best of luck with your birth, David x-tad-bigger- David Vernon Editor /x-tad-biggerx-tad-biggerHaving a Great Birth in Australia /x-tad-biggerx-tad-biggerand /x-tad-biggerx-tad-biggerMen at Birth/x-tad-biggerx-tad-bigger GPO Box 2314 CANBERRA CITY ACT 2601 AUSTRALIA Tel: 02 6230 2107 Em: [EMAIL PROTECTED] Web: http://www.acmi.org.au/greatbirth - /x-tad-bigger On 11/07/2005, at 12:57 PM, Nathan and Joh wrote: x-tad-smallerI agree, after just being told by the obs that he would not see me if I continued with my independant midwife - to protect himself from potential litigation - I needed to read this and be reaffirmed that I am in control! Thanks/x-tad-smallerx-tad-smallerLiving in hope/x-tad-smallerx-tad-smallerJoh/x-tad-smaller- Original Message - From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 09, 2005 4:24 PM Subject: Re: [ozmidwifery] Risk of uterine rupture + CARES x-tad-smallerHooray for Jo!!! You're such an inspiration to me!/x-tad-smallerx-tad-smallerJanet/x-tad-smallerx-tad-smallerJoyous Birth/x-tad-smallerNo virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.323 / Virus Database: 267.8.11/44 - Release Date: 8/07/2005
Re: [ozmidwifery] Risk of uterine rupture + CARES
Hooray for Jo!!! You're such an inspiration to me! Janet Joyous Birth
RE: [ozmidwifery] Risk of uterine rupture + CARES
I agree Jo, We have a VBAc model here that provides known midwife care especially to women that have had a traumatic experience with their past birth. We also have a team model available (5 midwives... not all women are fussed about 1 particular carer). One ob doesn't refer many VBAC women to us, but all the ward midwives are comfortable supportive of VBAC. As a result we have excellent outcomes (don't have the stats to hand) because each individual woman gets the midwife support SHE needs to achieve the birth she wants.From: "Dean Jo" [EMAIL PROTECTED]Reply-To: ozmidwifery@acegraphics.com.auTo: ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] Risk of uterine rupture + CARESDate: Sat, 9 Jul 2005 14:42:28 +0930CARES SA web site is HYPERLINK"http://www.cares-sa.org.au/"www.cares-sa.org.auThe thing that we all have to keep in mind is that the research doneinto vbac is all done within the medical model with no known careproviders, inductions, augmentations and epidurals included and yetstill the actual rates of rupture is an ESTIMATED 0.2%Estimatedbecause the actual events are so rare, as quoted in the actual research.What women need to take into considerations the things that make VBACmore risky not being educated about why she had the first section; whatinformation and support she has for this pregnancy and birth; whatconstraints they are wanting to impose on her; what risks they arewilling to impose on her (like the above listed); and also she needs toseriously consider the long term serious risks of repeat cs. Womenneed to know that by having someone who is experienced with supportingvbac and who do not impose their own fears upon her, and if she allowsherself to birth as naturally as possible the better her chances are.The research that is out there highlights that rupture rates areextremely low, but rupture is a serious situation just like the risk ofcs are rare but serious.The research also needs to be addressed from the point of view that itdoes NOT take into consideration midwifery expertise and continuouscare.There is little to no research from midwifery with vbac and whatthere is says that womens chances of success are as high as 90%.So ifthe conservative medical model can still have rates of rupture as low as0.2% with all the crap that they still do to vbacs and the success ratesfor vbac is still 70%then imagine how good it is with midwifery care!Even a doula with vbac experience (if it is personal experience evenbetter) can affect positive vbac outcomes.Women need to get educated or just go ahead with what doctor says.Iknow what type of person I am and it is not to just hand over my body,my baby and my potential mortality to someone who is only making choicesthat suit them ie no REAL medical reason.Potential litigation andlaziness are not reasons to encourage women to go under the knife onceagain.The long term serious risks of repeat cs are only just comingout now and we should be taking them very seriously.Jo--No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.323 / Virus Database: 267.8.11/44 - Release Date: 7/8/2005--No virus found in this outgoing message.Checked by AVG Anti-Virus.Version: 7.0.323 / Virus Database: 267.8.11/44 - Release Date: 7/8/2005 -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
RE: [ozmidwifery] Risk of uterine rupture
The likelihood of uterine rupture with attempted VBAC is 0.5%. (0.2% uterine rupture, 1.1% asymptomatic dehiscence from case control studies). The risk of hysterectomy and perinatal death from uterine rupture are 0.05% and 0.07% respectively in hospitals equipped to provide rapid laparotomy. (Australian VBAC study) Major uterine rupture, before or during labour, after a classical Caesarean section is 5%. http://www.birthrites.org/ From the birthrites website. Love Sally Westbury
RE: [ozmidwifery] Risk of uterine rupture
Hi Barb, This is why caesarean section is not to be taken lightly in the first place. I have heard this figure quoted too (others will probably know more than me). What they don't seem to tell women, is that rupture can happen during pregnancy too. I have never seen one rupture. I have heard doctors say when they have done a repeat c/s that the 'scar was about to give way, it's a good thing we did a c/s'. What they don't seem to discuss is that there are complications of c/s too, associated with the anaesthetic, or immobility, or surgical error such as nicking the bladder or babe. I suggest a look at theCARES website. It is very informative. http://homepages.picknowl.com.au/caressa/ Regards, Nicole -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Barb Glare Chris BrightSent: Saturday, July 09, 2005 8:46 AMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] Risk of uterine rupture Hi, I know this has been talked about to death - but I didn't need the info then, so I just didn't take it in. but a friend told me she would be having an elective C/S because the risk of rupture was 1 in 200. Is that right? Barb Barb GlareMum of Zac, 12, Dan, 10, Cassie 7 and Guan 2www.mothersdirect.com.au
Re: [ozmidwifery] Risk of uterine rupture
G'day Barb, 1:200 is the equivalent of 0.5%. According to Henci Goer in “Obstetric Myths and Research Realities” the uterine rupture rate for a prior caesarean is 0.3% (1995, 42). In addition, a study by Lyndon-Rochelle, Holt, Easterling and Martin in the New England Journal of Medicine Risk of Uterine Rupture During Labor (sic) Among Women with a Prior Caesarean Delivery (2001, v345:3-8) gives a uterine rupture rate of 0.77% for non-induced labour and 2.45% for prostaglandin-induced labour in a study covering 20,095 women. Interestingly, these figures are vastly below those quoted by ex-Queensland AMA Presdent Dr David Molloy who claims that the risk is between 5 and 20 percent (quoted in The Australian - 4 Feb 2005). I have written to Dr Molloy three times and he has been unable to provide me with any scientific references supporting his claim. Has your friend weighed up the other risks from having a caesarean so that her decision is fully-informed, or simply the risks of rupture? With best wishes, David x-tad-bigger- David Vernon Editor /x-tad-biggerx-tad-biggerHaving a Great Birth in Australia /x-tad-biggerx-tad-biggerand /x-tad-biggerx-tad-biggerMen at Birth/x-tad-biggerx-tad-bigger GPO Box 2314 CANBERRA CITY ACT 2601 AUSTRALIA Tel: 02 6230 2107 Em: [EMAIL PROTECTED] Web: http://www.acmi.org.au/greatbirth - /x-tad-bigger On 09/07/2005, at 8:45 AM, Barb Glare Chris Bright wrote: x-tad-smallerHi,/x-tad-smaller x-tad-smallerI know this has been talked about to death - but I didn't need the info then, so I just didn't take it in. but a friend told me she would be having an elective C/S because the risk of rupture was 1 in 200. Is that right?/x-tad-smaller x-tad-smallerBarb/x-tad-smallerx-tad-smallerBarb Glare/x-tad-smallerx-tad-smallerMum of Zac, 12, Dan, 10, Cassie 7 and Guan 2/x-tad-smallerx-tad-smallerwww.mothersdirect.com.au/x-tad-smaller
RE: [ozmidwifery] Risk of uterine rupture
Doctors will tell you anything to get you to do what they want. Even if the risk is 1:200, isn't that pretty low anyway? Why even consider it. I agree, the risk is 0.5% -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of StringybarkersSent: Saturday, 9 July 2005 10:57 AMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] Risk of uterine ruptureG'day Barb,1:200 is the equivalent of 0.5%. According to Henci Goer in “Obstetric Myths and Research Realities” the uterine rupture rate for a prior caesarean is 0.3% (1995, 42). In addition, a study by Lyndon-Rochelle, Holt, Easterling and Martin in the New England Journal of Medicine "Risk of Uterine Rupture During Labor (sic) Among Women with a Prior Caesarean Delivery" (2001, v345:3-8) gives a uterine rupture rate of 0.77% for non-induced labour and 2.45% for prostaglandin-induced labour in a study covering 20,095 women.Interestingly, these figures are vastly below those quoted by ex-Queensland AMA Presdent Dr David Molloy who claims that the risk is between 5 and 20 percent (quoted in The Australian - 4 Feb 2005). I have written to Dr Molloy three times and he has been unable to provide me with any scientific references supporting his claim.Has your friend weighed up the other risks from having a caesarean so that her decision is fully-informed, or simply the risks of rupture?With best wishes,David-David VernonEditorHaving a Great Birth in Australia and Men at BirthGPO Box 2314CANBERRA CITY ACT 2601AUSTRALIATel: 02 6230 2107Em: [EMAIL PROTECTED]Web: http://www.acmi.org.au/greatbirth-On 09/07/2005, at 8:45 AM, Barb Glare Chris Bright wrote: Hi, I know this has been talked about to death - but I didn't need the info then, so I just didn't take it in. but a friend told me she would be having an elective C/S because the risk of rupture was 1 in 200. Is that right? Barb Barb Glare Mum of Zac, 12, Dan, 10, Cassie 7 and Guan 2 www.mothersdirect.com.au
RE: [ozmidwifery] Risk of uterine rupture + CARES
CARES SA web site is www.cares-sa.org.au The thing that we all have to keep in mind is that the research done into vbac is all done within the medical model with no known care providers, inductions, augmentations and epidurals included and yet still the actual rates of rupture is an ESTIMATED 0.2% Estimated because the actual events are so rare, as quoted in the actual research. What women need to take into considerations the things that make VBAC more risky…not being educated about why she had the first section; what information and support she has for this pregnancy and birth; what constraints they are wanting to impose on her; what risks they are willing to impose on her (like the above listed); and also she needs to seriously consider the long term serious risks of repeat cs. Women need to know that by having someone who is experienced with supporting vbac and who do not impose their own fears upon her, and if she allows herself to birth as naturally as possible the better her chances are. The research that is out there highlights that rupture rates are extremely low, but rupture is a serious situation…just like the risk of cs are rare but serious. The research also needs to be addressed from the point of view that it does NOT take into consideration midwifery expertise and continuous care. There is little to no research from midwifery with vbac and what there is says that women’s chances of success are as high as 90%. So if the conservative medical model can still have rates of rupture as low as 0.2% with all the crap that they still do to vbacs and the success rates for vbac is still 70% then imagine how good it is with midwifery care! Even a doula with vbac experience (if it is personal experience even better) can affect positive vbac outcomes. Women need to get educated or just go ahead with what doctor says. I know what type of person I am and it is not to just hand over my body, my baby and my potential mortality to someone who is only making choices that suit them – ie no REAL medical reason. Potential litigation and laziness are not reasons to encourage women to go under the knife once again. The long term serious risks of repeat cs are only just coming out now and we should be taking them very seriously. Jo -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.323 / Virus Database: 267.8.11/44 - Release Date: 7/8/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.323 / Virus Database: 267.8.11/44 - Release Date: 7/8/2005
