Re: [ozmidwifery] Induction and third stage labour
Tanya
We only use syntocinon these days, ergometrine is
reserved for true PPH's - I think most places are the same in this -
syntometrine as a routine 3rd stage drug is not reccommended
anymore.
Sue
"The only thing necessary for the triumph of evil is for good men to do
nothing"Edmund Burke
- Original Message -
From:
Tanya Fleming
To: ozmidwifery@acegraphics.com.au
Sent: Wednesday, October 05, 2005 11:47
PM
Subject: Re: [ozmidwifery] Induction and
third stage labour
I totally understand what you are saying.
But what about the ergot component of the syntometrine that is given in 3rd
stage? I wonder what effect this has on babies? If ergot has the
quick action it does on causing a sustained uterine contraction...it obviously
enters the maternal circulation quickly and then one would expect that if the
cord is left pulsating (which can be a litle while) this would be crossing the
placenta as well?
tanya
- Original Message -
From:
Susan
Cudlipp
To: ozmidwifery@acegraphics.com.au
Sent: Tuesday, October 04, 2005 2:59
AM
Subject: Re: [ozmidwifery] Induction
and third stage labour
The reason given for hasty cord clamping AFTER
(not before) administering synto is not to prevent synto entering baby's
circulation, but to prevent over tranfusion due to the excessive contraction
thus produced 'pushing' too much blood into baby due to squeezing the
placenta. Synto infusions are given all the time for induction and I
have never heard of any concerns about it entering baby's circulation.
The synto bolus injectionis justified as a means to prevent PPH, the
baby's needs are not apparently considered important!
I realise that IPM'sonly give synto if
needed, and when cord has ceased pulsations, but the policies of most
hospitals for ACTIVE management of 3rd stage says: 1). give oxytocic with
anterior shoulder, 2). clamp and separate cord as soon as baby delivered,
3). commence controlled cord traction as soon as uterus felt to be
contracted.
I hasten to add that I do not agree with this,
but have had reason to research it quite a bit lately and have found, like
Karen, that the textbooks and policies are not crystal clear and many
are very much opposed to each other. Case in point being Obstetric
guidelines vs Midwifery guidelines both in circulation in the KEMH policy
manuals.
Sue
"The only thing necessary for the triumph of evil is for good men to do
nothing"Edmund Burke
- Original Message -
From:
Tanya Fleming
To: ozmidwifery@acegraphics.com.au
Sent: Wednesday, October 05, 2005
11:03 AM
Subject: Re: [ozmidwifery] Induction
and third stage labour
I am taken by surprised of this tooi
teach the very same as you Karen. I also believe that the cord
should be cut immediately before giving synto, to prevent passage of
syntocinon into baby's circulationif cord is still pulsating, one
would think this is possible as synto act quickly. I am interested
to hear everyone elses beleifs and practices too!
Cheers,
Tanya Fleming
- Original Message -
From:
karen shlegeris
To: ozmidwifery@acegraphics.com.au
Sent: Monday, October 03, 2005 6:21
PM
Subject: [ozmidwifery] Induction
and third stage labour
Dear
List,
Im a birth educator and
prenatal yoga teacher in Townsville. I hope these questions are
appropriate for this list and would appreciate information from
you:
Induction. Andreas
Preparing for Birth:Mothers book and the wall poster on cascade of
intervention states that induction increases the risks of further
intervention and ultimately caesarean, and thats what Ive always
taught in my Active Birth classes. However, when challenged for
statistics by a client in a recent workshop, I looked up Enkin, Kierse
etc. who stated that induction does not increase the risk of
caesareans, recommending that induction is recommended soon after a
women passes her EDD. Can anyone clear this up for
me?
Third stage
of labour. I was under the belief that if active management of
third stage was chosen, the cord had to be clamped and cut quickly to
avoid an over-transfusion of blood from the placenta into the
baby. However, an OB recently
told a client of mine that even if she had a Synto injection, the cord
could be left until it stopped pulsing. Ive checked Myles
Re: [ozmidwifery] Induction and third stage labour
As I understand the reasoning - the bigger than physiological contraction caused by the oxytocic bolus can 'squeeze' the placenta and cause blood to be forcibly transfused into the baby. I agree that it really doesn't make a lot of sense - the cord-clamping website posted by Jenny however, does make a lot of sense, and I only wish hospital procedures allowed some flexibility and common sense to occur! Especially in Rh-ve women and preterm infants as has been demonstrated to be of benefit. We had a very prem baby last week, 30 weeks, which as a small unit we are not equipped to deal with. He was OK and all went well but I was not game to suggest leaving the cord intact at the time, I would have been shot down in flames for sure! Sue As for jaundice, none of my 3 had any at all. All very different births, all breast fed without interruption. I have noted some increase when physiological 3rd stage practised, which begs the question - is it an abnormal event? "The only thing necessary for the triumph of evil is for good men to do nothing"Edmund Burke - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Thursday, October 06, 2005 7:25 AM Subject: Re: [ozmidwifery] Induction and third stage labour I have to admit I've never really understood the reasoning behind the baby supposedly receivinga bolus of blood if the cord is not clamped after synto. If the placenta is separating from the uterus how does that cause excessive blood to transfuse to the baby? Cheers Michelle Susan Cudlipp [EMAIL PROTECTED] wrote: The reason given for hasty cord clamping AFTER (not before) administering synto is not to prevent synto entering baby's circulation, but to prevent over tranfusion due to the excessive contraction thus produced 'pushing' too much blood into baby due to squeezing the placenta. Synto infusions are given all the time for induction and I have never heard of any concerns about it entering baby's circulation. The synto bolus injectionis justified as a means to prevent PPH, the baby's needs are not apparently considered important! I realise that IPM'sonly give synto if needed, and when cord has ceased pulsations, but the policies of most hospitals for ACTIVE management of 3rd stage says: 1). give oxytocic with anterior shoulder, 2). clamp and separate cord as soon as baby delivered, 3). commence controlled cord traction as soon as uterus felt to be contracted. I hasten to add that I do not agree with this, but have had reason to research it quite a bit lately and have found, like Karen, that the textbooks and policies are not crystal clear and many are very much opposed to each other. Case in point being Obstetric guidelines vs Midwifery guidelines both in circulation in the KEMH policy manuals. Sue "The only thing necessary for the triumph of evil is for good men to do nothing"Edmund Burke - Original Message - From: Tanya Fleming To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 11:03 AM Subject: Re: [ozmidwifery] Induction and third stage labour I am taken by surprised of this tooi teach the very same as you Karen. I also believe that the cord should be cut immediately before giving synto, to prevent passage of syntocinon into baby's circulationif cord is still pulsating, one would think this is possible as synto act quickly. I am interested to hear everyone elses beleifs and practices too! Cheers, Tanya Fleming - Original Message - From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Monday, October 03, 2005 6:21 PM Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me?
RE: [ozmidwifery] Induction and third stage labour
I think I would be tempted to say that mild jaundice is normal. I can't see primative man cutting the cord so quickly as we do and somehow he managed to survive and even proliferate. Where I work we do a lot of physiological third stages, late cord clamping and early breastfeeding and many babies have a bit of jaundice colour but it is not pathological. We do very few SBR blood tests. Probably helps that we don't have onsite pathology, it has to go to the tertiary hospital so it makes one think if one really needs to. Haven't had to use the phototherapy for ages. Cheers Judy --- Nicole Carver [EMAIL PROTECTED] wrote: There are some who believe the higher levels of antioxidants caused by jaundice may be protective of babies, and mild jaundice 'may' be normal. Nicole. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of lisa chalmers Sent: Wednesday, October 05, 2005 11:48 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Induction and third stage labour My experience of this, is that if the cords are not cut until they have finished pulsing, babies seem to develop jaundice for longer..(that the usual standards) . That makes complete sense to me, since they get more blood than babes that had cords clamped and cut quickley. I'm sure I read somewhere that babies are deprived of as much as 25% of their blood volume by cutting the cord. Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 9:33 AM Subject: Re: [ozmidwifery] Induction and third stage labour There are many reasons that influence whether a baby gets jaundiced or not Two of these are 1. prematurity ( of the liver as well as dates, some babies livers take ages to be efficient enough to clear the jaundice. 2. Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. The thing about synt is that it is often used to augment labour in a woman who has been labouring for hours or to induce labour in a woman who is not yet ready to go into labour and the result is a tired mother and baby who often dont come together well to feed without good assistance. This is often not forthcoming in the hurry to get things cleaned up, the move to the postnatal ward and paper work to be done. Ask your friend and she will probably not have seen jaundice in a woman who has had synt but had a quick labour. Most women who birth in hospitals have synt in some form or other for 3rd stage and the level of jaundice in some settings is very low. I would suggest it may be in direct relationship to the length of time until feeding is established. I think the whole reason synt is being used is the concern rather than blaming the synt for jaundice alone. Andrea Q On 06/10/2005, at 2:03 AM, Belinda wrote: I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.10/119 - Release Date: 4/10/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Do you Yahoo!? Messenger 7.0: Free worldwide PC to PC calls http://au.messenger.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Induction and third stage labour
Neither primative man nor any other contemporary mammal :). -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Judy Chapman Sent: Thursday, October 06, 2005 1:45 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Induction and third stage labour I think I would be tempted to say that mild jaundice is normal. I can't see primative man cutting the cord so quickly as we do and somehow he managed to survive and even proliferate. Where I work we do a lot of physiological third stages, late cord clamping and early breastfeeding and many babies have a bit of jaundice colour but it is not pathological. We do very few SBR blood tests. Probably helps that we don't have onsite pathology, it has to go to the tertiary hospital so it makes one think if one really needs to. Haven't had to use the phototherapy for ages. Cheers Judy --- Nicole Carver [EMAIL PROTECTED] wrote: There are some who believe the higher levels of antioxidants caused by jaundice may be protective of babies, and mild jaundice 'may' be normal. Nicole. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of lisa chalmers Sent: Wednesday, October 05, 2005 11:48 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Induction and third stage labour My experience of this, is that if the cords are not cut until they have finished pulsing, babies seem to develop jaundice for longer..(that the usual standards) . That makes complete sense to me, since they get more blood than babes that had cords clamped and cut quickley. I'm sure I read somewhere that babies are deprived of as much as 25% of their blood volume by cutting the cord. Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 9:33 AM Subject: Re: [ozmidwifery] Induction and third stage labour There are many reasons that influence whether a baby gets jaundiced or not Two of these are 1. prematurity ( of the liver as well as dates, some babies livers take ages to be efficient enough to clear the jaundice. 2. Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. The thing about synt is that it is often used to augment labour in a woman who has been labouring for hours or to induce labour in a woman who is not yet ready to go into labour and the result is a tired mother and baby who often dont come together well to feed without good assistance. This is often not forthcoming in the hurry to get things cleaned up, the move to the postnatal ward and paper work to be done. Ask your friend and she will probably not have seen jaundice in a woman who has had synt but had a quick labour. Most women who birth in hospitals have synt in some form or other for 3rd stage and the level of jaundice in some settings is very low. I would suggest it may be in direct relationship to the length of time until feeding is established. I think the whole reason synt is being used is the concern rather than blaming the synt for jaundice alone. Andrea Q On 06/10/2005, at 2:03 AM, Belinda wrote: I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.10/119 - Release Date: 4/10/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Do you Yahoo!? Messenger 7.0: Free worldwide PC to PC calls http://au.messenger.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
We are behind the times up here thenwe use it
at Atherton and Cairns Base also use it.
- Original Message -
From:
Susan
Cudlipp
To: ozmidwifery@acegraphics.com.au
Sent: Wednesday, October 05, 2005 11:57
PM
Subject: Re: [ozmidwifery] Induction and
third stage labour
Tanya
We only use syntocinon these days, ergometrine is
reserved for true PPH's - I think most places are the same in this -
syntometrine as a routine 3rd stage drug is not reccommended
anymore.
Sue
"The only thing necessary for the triumph of evil is for good men to do
nothing"Edmund Burke
- Original Message -
From:
Tanya Fleming
To: ozmidwifery@acegraphics.com.au
Sent: Wednesday, October 05, 2005 11:47
PM
Subject: Re: [ozmidwifery] Induction
and third stage labour
I totally understand what you are saying.
But what about the ergot component of the syntometrine that is given in 3rd
stage? I wonder what effect this has on babies? If ergot has the
quick action it does on causing a sustained uterine contraction...it
obviously enters the maternal circulation quickly and then one would expect
that if the cord is left pulsating (which can be a litle while) this would
be crossing the placenta as well?
tanya
- Original Message -
From:
Susan
Cudlipp
To: ozmidwifery@acegraphics.com.au
Sent: Tuesday, October 04, 2005 2:59
AM
Subject: Re: [ozmidwifery] Induction
and third stage labour
The reason given for hasty cord clamping
AFTER (not before) administering synto is not to prevent synto entering
baby's circulation, but to prevent over tranfusion due to the excessive
contraction thus produced 'pushing' too much blood into baby due to
squeezing the placenta. Synto infusions are given all the time for
induction and I have never heard of any concerns about it entering baby's
circulation. The synto bolus injectionis justified as a means
to prevent PPH, the baby's needs are not apparently considered
important!
I realise that IPM'sonly give synto if
needed, and when cord has ceased pulsations, but the policies of most
hospitals for ACTIVE management of 3rd stage says: 1). give oxytocic with
anterior shoulder, 2). clamp and separate cord as soon as baby delivered,
3). commence controlled cord traction as soon as uterus felt to be
contracted.
I hasten to add that I do not agree with
this, but have had reason to research it quite a bit lately and have
found, like Karen, that the textbooks and policies are not crystal
clear and many are very much opposed to each other. Case in point
being Obstetric guidelines vs Midwifery guidelines both in circulation in
the KEMH policy manuals.
Sue
"The only thing necessary for the triumph of evil is for good men to
do nothing"Edmund Burke
- Original Message -
From:
Tanya Fleming
To: ozmidwifery@acegraphics.com.au
Sent: Wednesday, October 05, 2005
11:03 AM
Subject: Re: [ozmidwifery]
Induction and third stage labour
I am taken by surprised of this tooi
teach the very same as you Karen. I also believe that the cord
should be cut immediately before giving synto, to prevent passage of
syntocinon into baby's circulationif cord is still pulsating, one
would think this is possible as synto act quickly. I am interested
to hear everyone elses beleifs and practices too!
Cheers,
Tanya Fleming
- Original Message -
From:
karen shlegeris
To: ozmidwifery@acegraphics.com.au
Sent: Monday, October 03, 2005
6:21 PM
Subject: [ozmidwifery] Induction
and third stage labour
Dear
List,
Im a birth educator and
prenatal yoga teacher in Townsville. I hope these questions are
appropriate for this list and would appreciate information from
you:
Induction.
Andreas Preparing for Birth:Mothers book and the wall poster on
cascade of intervention states that induction increases the risks of
further intervention and ultimately caesarean, and thats what Ive
always taught in my Active Birth classes. However, when
challenged for statistics by a client in a recent workshop, I looked
up Enkin, Kierse etc. who stated that induction does not increase
the risk of caesareans, recommending that induction is recommended
RE: [ozmidwifery] Induction and third stage labour
Ive seen it creeping back in to Metro hospitals here in W.A. MM We are behind the times up here thenwe use it at Atherton and Cairns Base also use it. We only use syntocinon these days, ergometrine is reserved for true PPH's - I think most places are the same in this - syntometrine as a routine 3rd stage drug is not reccommended anymore. Sue
RE: [ozmidwifery] Induction and third stage labour
Yes Megan I saw it and I was shouting at the TV get her off the bed or at least get her on hands and knees. But yo are right. It was TV. Alan -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Megan Larry Sent: Wednesday, 5 October 2005 12:07 To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Induction and third stage labour My hospital born baby, induction by gels, 8hr labour, synto to birth placenta had jaundice. My 3 water births at home, 1 same length and 2 shorter labours, no intervention, placenta attached around 3 hours after birth, no jaundice. Too many variables to suggest its one cause. Off topic, did anyone see the birth on All Saints last night? Seen worse, but could have got her off the bed or at least on her front. Nice to hear the male nurse (ex-midwife?) use a calming voice and somewhat supporting to her needs, still TV loves to make it so exciting. Megan -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of lisa chalmers Sent: Wednesday, 5 October 2005 11:18 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Induction and third stage labour My experience of this, is that if the cords are not cut until they have finished pulsing, babies seem to develop jaundice for longer..(that the usual standards) . That makes complete sense to me, since they get more blood than babes that had cords clamped and cut quickley. I'm sure I read somewhere that babies are deprived of as much as 25% of their blood volume by cutting the cord. Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 9:33 AM Subject: Re: [ozmidwifery] Induction and third stage labour There are many reasons that influence whether a baby gets jaundiced or not Two of these are 1. prematurity ( of the liver as well as dates, some babies livers take ages to be efficient enough to clear the jaundice. 2. Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. The thing about synt is that it is often used to augment labour in a woman who has been labouring for hours or to induce labour in a woman who is not yet ready to go into labour and the result is a tired mother and baby who often dont come together well to feed without good assistance. This is often not forthcoming in the hurry to get things cleaned up, the move to the postnatal ward and paper work to be done. Ask your friend and she will probably not have seen jaundice in a woman who has had synt but had a quick labour. Most women who birth in hospitals have synt in some form or other for 3rd stage and the level of jaundice in some settings is very low. I would suggest it may be in direct relationship to the length of time until feeding is established. I think the whole reason synt is being used is the concern rather than blaming the synt for jaundice alone. Andrea Q On 06/10/2005, at 2:03 AM, Belinda wrote: I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.10/119 - Release Date: 4/10/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
Here here Mary, I've also been doing physiological third stage for 22 years and have not seen any jaundice worth investigating. Cords are usually left for at least two hours, mostly longer... Placentas not held higher or lower ... no fuss. No synto and no 'milking ' of the cord. One significant jaundice was an ABO incompatibility... Sue Given that I have been doing physiological 3rd stage for 23 yrs, I feel I can add my bit to this theme. It has not been my observation that babies get more jaundiced if the cord is left unclamped. I rarely have a pathological jaundice and this is usually ABO and do not often have anything more than very mild physiological jaundice, mostly no jaundice at all. My long term interest in this are has led me to conclude that as well as the liver immaturity, the re-absorption of the bile in the mec. and the normal breakdown of excess foetal red blood cells, it may have to do with the ABO component and antibody formation in O pos mothers with A or B pos babies. Some are worse than others. A very interesting thread. Cheers. MM Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. __ NOD32 1.1240 (20051003) Information __ This message was checked by NOD32 antivirus system. http://www.nod32.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
I agree Sue, same, same. I have seen 1 severe jaundice in 25 years of H/Bs, breastmilk (she had it for both babies, lasted 6 months) . Otherwise nil. Brenda - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 6:18 PM Subject: Re: [ozmidwifery] Induction and third stage labour Here here Mary, I've also been doing physiological third stage for 22 years and have not seen any jaundice worth investigating. Cords are usually left for at least two hours, mostly longer... Placentas not held higher or lower ... no fuss. No synto and no 'milking ' of the cord. One significant jaundice was an ABO incompatibility... Sue Given that I have been doing physiological 3rd stage for 23 yrs, I feel I can add my bit to this theme. It has not been my observation that babies get more jaundiced if the cord is left unclamped. I rarely have a pathological jaundice and this is usually ABO and do not often have anything more than very mild physiological jaundice, mostly no jaundice at all. My long term interest in this are has led me to conclude that as well as the liver immaturity, the re-absorption of the bile in the mec. and the normal breakdown of excess foetal red blood cells, it may have to do with the ABO component and antibody formation in O pos mothers with A or B pos babies. Some are worse than others. A very interesting thread. Cheers. MM Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. __ NOD32 1.1240 (20051003) Information __ This message was checked by NOD32 antivirus system. http://www.nod32.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
Hi Jo, I totally agree with you. Sorry for not making it clearer. My 3 kids plus many women I have supported think its normal to NOT cut the cord. As a product of our experiences, I think yellowing of babes is misread as Jaundice or percieved as a problem.. Only my observation. :Lisa - Original Message - From: JoFromOz [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 6:20 PM Subject: Re: [ozmidwifery] Induction and third stage labour lisa chalmers wrote: Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. I thought 85% of babies had jaundice to some degree anyway? Surely it's normal *not* to cut the cord ASAP after birth? Jo -- 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 Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.10/119 - Release Date: 4/10/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
I have to admit I've never really understood the reasoning behind the baby supposedly receivinga bolus of blood if the cord is not clamped after synto. If the placenta is separating from the uterus how does that cause excessive blood to transfuse to the baby? Cheers Michelle Susan Cudlipp [EMAIL PROTECTED] wrote: The reason given for hasty cord clamping AFTER (not before) administering synto is not to prevent synto entering baby's circulation, but to prevent over tranfusion due to the excessive contraction thus produced 'pushing' too much blood into baby due to squeezing the placenta. Synto infusions are given all the time for induction and I have never heard of any concerns about it entering baby's circulation. The synto bolus injectionis justified as a means to prevent PPH, the baby's needs are not apparently considered important! I realise that IPM'sonly give synto if needed, and when cord has ceased pulsations, but the policies of most hospitals for ACTIVE management of 3rd stage says: 1). give oxytocic with anterior shoulder, 2). clamp and separate cord as soon as baby delivered, 3). commence controlled cord traction as soon as uterus felt to be contracted. I hasten to add that I do not agree with this, but have had reason to research it quite a bit lately and have found, like Karen, that the textbooks and policies are not crystal clear and many are very much opposed to each other. Case in point being Obstetric guidelines vs Midwifery guidelines both in circulation in the KEMH policy manuals. Sue "The only thing necessary for the triumph of evil is for good men to do nothing"Edmund Burke - Original Message - From: Tanya Fleming To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 11:03 AM Subject: Re: [ozmidwifery] Induction and third stage labour I am taken by surprised of this tooi teach the very same as you Karen. I also believe that the cord should be cut immediately before giving synto, to prevent passage of syntocinon into baby's circulationif cord is still pulsating, one would think this is possible as synto act quickly. I am interested to hear everyone elses beleifs and practices too! Cheers, Tanya Fleming - Original Message - From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Monday, October 03, 2005 6:21 PM Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby. However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing. Ive checked Myles textbook for midwives but its not clear on this. I appreciate your support. Best wishes, Karen Shlegeris in Townsville No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.344 / Virus Database: 267.11.9/116 - Release Date: 30/09/2005 Do you Yahoo!? Yahoo! Photos: Now with unlimited storage
Re: [ozmidwifery] Induction and third stage labour
I am taken by surprised of this tooi teach the very same as you Karen. I also believe that the cord should be cut immediately before giving synto, to prevent passage of syntocinon into baby's circulationif cord is still pulsating, one would think this is possible as synto act quickly. I am interested to hear everyone elses beleifs and practices too! Cheers, Tanya Fleming - Original Message - From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Monday, October 03, 2005 6:21 PM Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby. However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing. Ive checked Myles textbook for midwives but its not clear on this. I appreciate your support. Best wishes, Karen Shlegeris in Townsville
Re: [ozmidwifery] Induction and third stage labour
The reason given for hasty cord clamping AFTER (not before) administering synto is not to prevent synto entering baby's circulation, but to prevent over tranfusion due to the excessive contraction thus produced 'pushing' too much blood into baby due to squeezing the placenta. Synto infusions are given all the time for induction and I have never heard of any concerns about it entering baby's circulation. The synto bolus injectionis justified as a means to prevent PPH, the baby's needs are not apparently considered important! I realise that IPM'sonly give synto if needed, and when cord has ceased pulsations, but the policies of most hospitals for ACTIVE management of 3rd stage says: 1). give oxytocic with anterior shoulder, 2). clamp and separate cord as soon as baby delivered, 3). commence controlled cord traction as soon as uterus felt to be contracted. I hasten to add that I do not agree with this, but have had reason to research it quite a bit lately and have found, like Karen, that the textbooks and policies are not crystal clear and many are very much opposed to each other. Case in point being Obstetric guidelines vs Midwifery guidelines both in circulation in the KEMH policy manuals. Sue "The only thing necessary for the triumph of evil is for good men to do nothing"Edmund Burke - Original Message - From: Tanya Fleming To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 11:03 AM Subject: Re: [ozmidwifery] Induction and third stage labour I am taken by surprised of this tooi teach the very same as you Karen. I also believe that the cord should be cut immediately before giving synto, to prevent passage of syntocinon into baby's circulationif cord is still pulsating, one would think this is possible as synto act quickly. I am interested to hear everyone elses beleifs and practices too! Cheers, Tanya Fleming - Original Message - From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Monday, October 03, 2005 6:21 PM Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby. However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing. Ive checked Myles textbook for midwives but its not clear on this. I appreciate your support. Best wishes, Karen Shlegeris in Townsville No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.344 / Virus Database: 267.11.9/116 - Release Date: 30/09/2005
Re: [ozmidwifery] Induction and third stage labour
CompareNepean'soptions of care medical or nothingand intervention rates and outcomes toSt George which you can on the NSW Birth stats website 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: jo To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 04, 2005 11:14 AM Subject: RE: [ozmidwifery] Induction and third stage labour Hi Karen, On top of what Karen has said. As soon as an induction is started the normal course of labour is changed. Often women end up with contractions on top of each other and have a hard time managing them, which then leads to pain relieving drugs, which can sometimes lead to c/section. Also, if the induction is fast and furious and the uterus in contracting like mad it sometimes causes fetal distress, which then leads to a c/section. Women that I am supporting in labour are more and more trying to push their inductions to the very last minute, not without a great amount of stress and fear mongering from some staff members about putting their babies at risk, one recently was told in so many words that if she didnt agree to her induction at 12 days over that she wouldnt be welcome to birth there really really scary stuff. I have since found out that 90 inductions a month are performed at Nepean Hospital thats 3 a day! What on earth is going on? This is ludicrous and I guess the only way it will change is if educated women stand up and say no. Ive even had clients who have been called by labour ward several times in a day to ask why they havent showed for their induction. How a women can relax and go into labour with all the external pressure of you must go into labour I dont know. Cheers jo From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Nicole CarverSent: Tuesday, 4 October 2005 11:56 AMTo: ozmidwifery@acegraphics.com.auSubject: RE: [ozmidwifery] Induction and third stage labour Hi Karen, This is my two bob's worth: 1. Once you start an induction, particularly once you have done an ARM, I believe that you are committed to having the baby within the next 24 hours preferably, (due to the risk of ascending infection in a hospital environment) so if labour does not establish, or fit the parameters the ob is happy with, you are going to have a c/s. Allowing a pregnancy to progress beyond 42 weeks, does have a much higher risk for the baby, as the placenta has a limited life span. How long an individual placenta will last is impossible to say, but perinatal mortality goes up past 42 weeks, and way up from 43 on (of course it helps to be sure of your dates!) 2. If you think of how much syntocinon some babies get when labour is induced, leaving the cord pulsating is not likely to give them any more synto than that, plus it will take a little while to enter mum's circulation (if given IM), and then babes. I was taught to clamp if the synto has been given, but someone at the ICM in Brisbane made the previous point about this, so I am a bit happier about it. I think the placenta probably separates better if it is allowed to drain, and the babe is meant to have that blood, otherwise they wouldn't be designed that way. Cheers, Nicole. -Original Message-[Nicole Carver]From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au]On Behalf Of karen shlegerisSent: Tuesday, October 04, 2005 11:22 AMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of
Re: [ozmidwifery] Induction and third stage labour
I totally understand what you are saying. But
what about the ergot component of the syntometrine that is given in 3rd
stage? I wonder what effect this has on babies? If ergot has the
quick action it does on causing a sustained uterine contraction...it obviously
enters the maternal circulation quickly and then one would expect that if the
cord is left pulsating (which can be a litle while) this would be crossing the
placenta as well?
tanya
- Original Message -
From:
Susan
Cudlipp
To: ozmidwifery@acegraphics.com.au
Sent: Tuesday, October 04, 2005 2:59
AM
Subject: Re: [ozmidwifery] Induction and
third stage labour
The reason given for hasty cord clamping AFTER
(not before) administering synto is not to prevent synto entering baby's
circulation, but to prevent over tranfusion due to the excessive contraction
thus produced 'pushing' too much blood into baby due to squeezing the
placenta. Synto infusions are given all the time for induction and I
have never heard of any concerns about it entering baby's circulation.
The synto bolus injectionis justified as a means to prevent PPH, the
baby's needs are not apparently considered important!
I realise that IPM'sonly give synto if
needed, and when cord has ceased pulsations, but the policies of most
hospitals for ACTIVE management of 3rd stage says: 1). give oxytocic with
anterior shoulder, 2). clamp and separate cord as soon as baby delivered, 3).
commence controlled cord traction as soon as uterus felt to be
contracted.
I hasten to add that I do not agree with this,
but have had reason to research it quite a bit lately and have found, like
Karen, that the textbooks and policies are not crystal clear and many
are very much opposed to each other. Case in point being Obstetric
guidelines vs Midwifery guidelines both in circulation in the KEMH policy
manuals.
Sue
"The only thing necessary for the triumph of evil is for good men to do
nothing"Edmund Burke
- Original Message -
From:
Tanya Fleming
To: ozmidwifery@acegraphics.com.au
Sent: Wednesday, October 05, 2005 11:03
AM
Subject: Re: [ozmidwifery] Induction
and third stage labour
I am taken by surprised of this tooi teach
the very same as you Karen. I also believe that the cord should be cut
immediately before giving synto, to prevent passage of syntocinon into
baby's circulationif cord is still pulsating, one would think this is
possible as synto act quickly. I am interested to hear everyone elses
beleifs and practices too!
Cheers,
Tanya Fleming
- Original Message -
From:
karen shlegeris
To: ozmidwifery@acegraphics.com.au
Sent: Monday, October 03, 2005 6:21
PM
Subject: [ozmidwifery] Induction and
third stage labour
Dear
List,
Im a birth educator and
prenatal yoga teacher in Townsville. I hope these questions are
appropriate for this list and would appreciate information from
you:
Induction. Andreas
Preparing for Birth:Mothers book and the wall poster on cascade of
intervention states that induction increases the risks of further
intervention and ultimately caesarean, and thats what Ive always
taught in my Active Birth classes. However, when challenged for
statistics by a client in a recent workshop, I looked up Enkin, Kierse
etc. who stated that induction does not increase the risk of caesareans,
recommending that induction is recommended soon after a women passes her
EDD. Can anyone clear this up for me?
Third stage of
labour. I was under the belief that if active management of third
stage was chosen, the cord had to be clamped and cut quickly to avoid an
over-transfusion of blood from the placenta into the baby.
However, an OB recently told a client
of mine that even if she had a Synto injection, the cord could be left
until it stopped pulsing. Ive checked Myles textbook for midwives
but its not clear on this.
I appreciate your
support.
Best
wishes,
Karen Shlegeris in
Townsville
No virus found in this incoming message.Checked by AVG
Anti-Virus.Version: 7.0.344 / Virus Database: 267.11.9/116 - Release
Date: 30/09/2005
Re: [ozmidwifery] Induction and third stage labour
I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
I always firmly believed that too, I'm not soo sure now but I am open to being educated !! Brenda - Original Message - From: Belinda [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, October 06, 2005 2:03 AM Subject: Re: [ozmidwifery] Induction and third stage labour I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
There are many reasons that influence whether a baby gets jaundiced or not Two of these are 1. prematurity ( of the liver as well as dates, some babies livers take ages to be efficient enough to clear the jaundice. 2. Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. The thing about synt is that it is often used to augment labour in a woman who has been labouring for hours or to induce labour in a woman who is not yet ready to go into labour and the result is a tired mother and baby who often dont come together well to feed without good assistance. This is often not forthcoming in the hurry to get things cleaned up, the move to the postnatal ward and paper work to be done. Ask your friend and she will probably not have seen jaundice in a woman who has had synt but had a quick labour. Most women who birth in hospitals have synt in some form or other for 3rd stage and the level of jaundice in some settings is very low. I would suggest it may be in direct relationship to the length of time until feeding is established. I think the whole reason synt is being used is the concern rather than blaming the synt for jaundice alone. Andrea Q On 06/10/2005, at 2:03 AM, Belinda wrote: I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
My experience of this, is that if the cords are not cut until they have finished pulsing, babies seem to develop jaundice for longer..(that the usual standards) . That makes complete sense to me, since they get more blood than babes that had cords clamped and cut quickley. I'm sure I read somewhere that babies are deprived of as much as 25% of their blood volume by cutting the cord. Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 9:33 AM Subject: Re: [ozmidwifery] Induction and third stage labour There are many reasons that influence whether a baby gets jaundiced or not Two of these are 1. prematurity ( of the liver as well as dates, some babies livers take ages to be efficient enough to clear the jaundice. 2. Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. The thing about synt is that it is often used to augment labour in a woman who has been labouring for hours or to induce labour in a woman who is not yet ready to go into labour and the result is a tired mother and baby who often dont come together well to feed without good assistance. This is often not forthcoming in the hurry to get things cleaned up, the move to the postnatal ward and paper work to be done. Ask your friend and she will probably not have seen jaundice in a woman who has had synt but had a quick labour. Most women who birth in hospitals have synt in some form or other for 3rd stage and the level of jaundice in some settings is very low. I would suggest it may be in direct relationship to the length of time until feeding is established. I think the whole reason synt is being used is the concern rather than blaming the synt for jaundice alone. Andrea Q On 06/10/2005, at 2:03 AM, Belinda wrote: I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.10/119 - Release Date: 4/10/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Induction and third stage labour
Given that I have been doing physiological 3rd stage for 23 yrs, I feel I can add my bit to this theme. It has not been my observation that babies get more jaundiced if the cord is left unclamped. I rarely have a pathological jaundice and this is usually ABO and do not often have anything more than very mild physiological jaundice, mostly no jaundice at all. My long term interest in this are has led me to conclude that as well as the liver immaturity, the re-absorption of the bile in the mec. and the normal breakdown of excess foetal red blood cells, it may have to do with the ABO component and antibody formation in O pos mothers with A or B pos babies. Some are worse than others. A very interesting thread. Cheers. MM Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Induction and third stage labour
I absolutely agree on the early feeding theory Andrea. Years ago Noble Park (?) Pvt Hosp (who I think either don't exist or don't do mid anymore) did a study (in 1990/1 maybe) on how initiating early breast feeding (with EBM or colostrum if no suckling happening) maintaining reg feeding over subsequent days effected jaundice in the new born. They presented the stats at a wshop at the HB conf 1992 in Sydney. The results were staggering. They reduced the number of infants with high SBRs /or those requiring Phototh by 56% simply by feeding EBM early often. Irrelevant about the early or late C/C issue. It makes such sense really. Including the prematurity Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. factors. Brenda the how - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 11:33 AM Subject: Re: [ozmidwifery] Induction and third stage labour There are many reasons that influence whether a baby gets jaundiced or not Two of these are 1. prematurity ( of the liver as well as dates, some babies livers take ages to be efficient enough to clear the jaundice. 2. Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. The thing about synt is that it is often used to augment labour in a woman who has been labouring for hours or to induce labour in a woman who is not yet ready to go into labour and the result is a tired mother and baby who often dont come together well to feed without good assistance. This is often not forthcoming in the hurry to get things cleaned up, the move to the postnatal ward and paper work to be done. Ask your friend and she will probably not have seen jaundice in a woman who has had synt but had a quick labour. Most women who birth in hospitals have synt in some form or other for 3rd stage and the level of jaundice in some settings is very low. I would suggest it may be in direct relationship to the length of time until feeding is established. I think the whole reason synt is being used is the concern rather than blaming the synt for jaundice alone. Andrea Q On 06/10/2005, at 2:03 AM, Belinda wrote: I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Induction and third stage labour
There are some who believe the higher levels of antioxidants caused by jaundice may be protective of babies, and mild jaundice 'may' be normal. Nicole. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of lisa chalmers Sent: Wednesday, October 05, 2005 11:48 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Induction and third stage labour My experience of this, is that if the cords are not cut until they have finished pulsing, babies seem to develop jaundice for longer..(that the usual standards) . That makes complete sense to me, since they get more blood than babes that had cords clamped and cut quickley. I'm sure I read somewhere that babies are deprived of as much as 25% of their blood volume by cutting the cord. Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 9:33 AM Subject: Re: [ozmidwifery] Induction and third stage labour There are many reasons that influence whether a baby gets jaundiced or not Two of these are 1. prematurity ( of the liver as well as dates, some babies livers take ages to be efficient enough to clear the jaundice. 2. Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. The thing about synt is that it is often used to augment labour in a woman who has been labouring for hours or to induce labour in a woman who is not yet ready to go into labour and the result is a tired mother and baby who often dont come together well to feed without good assistance. This is often not forthcoming in the hurry to get things cleaned up, the move to the postnatal ward and paper work to be done. Ask your friend and she will probably not have seen jaundice in a woman who has had synt but had a quick labour. Most women who birth in hospitals have synt in some form or other for 3rd stage and the level of jaundice in some settings is very low. I would suggest it may be in direct relationship to the length of time until feeding is established. I think the whole reason synt is being used is the concern rather than blaming the synt for jaundice alone. Andrea Q On 06/10/2005, at 2:03 AM, Belinda wrote: I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.10/119 - Release Date: 4/10/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Induction and third stage labour
My hospital born baby, induction by gels, 8hr labour, synto to birth placenta had jaundice. My 3 water births at home, 1 same length and 2 shorter labours, no intervention, placenta attached around 3 hours after birth, no jaundice. Too many variables to suggest its one cause. Off topic, did anyone see the birth on All Saints last night? Seen worse, but could have got her off the bed or at least on her front. Nice to hear the male nurse (ex-midwife?) use a calming voice and somewhat supporting to her needs, still TV loves to make it so exciting. Megan -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of lisa chalmers Sent: Wednesday, 5 October 2005 11:18 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Induction and third stage labour My experience of this, is that if the cords are not cut until they have finished pulsing, babies seem to develop jaundice for longer..(that the usual standards) . That makes complete sense to me, since they get more blood than babes that had cords clamped and cut quickley. I'm sure I read somewhere that babies are deprived of as much as 25% of their blood volume by cutting the cord. Nearly everyone I know that did not cut the cord, had babies that developed Jaundice. Nothing serious just yellowing. - Original Message - From: Andrea Quanchi [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, October 05, 2005 9:33 AM Subject: Re: [ozmidwifery] Induction and third stage labour There are many reasons that influence whether a baby gets jaundiced or not Two of these are 1. prematurity ( of the liver as well as dates, some babies livers take ages to be efficient enough to clear the jaundice. 2. Not passing mec soon after birth. The longer the mec stays inside the more bilirubin is reabsorbed increasing the workload of the immature system. This is usually influenced by how quickly the baby is able to feed. The thing about synt is that it is often used to augment labour in a woman who has been labouring for hours or to induce labour in a woman who is not yet ready to go into labour and the result is a tired mother and baby who often dont come together well to feed without good assistance. This is often not forthcoming in the hurry to get things cleaned up, the move to the postnatal ward and paper work to be done. Ask your friend and she will probably not have seen jaundice in a woman who has had synt but had a quick labour. Most women who birth in hospitals have synt in some form or other for 3rd stage and the level of jaundice in some settings is very low. I would suggest it may be in direct relationship to the length of time until feeding is established. I think the whole reason synt is being used is the concern rather than blaming the synt for jaundice alone. Andrea Q On 06/10/2005, at 2:03 AM, Belinda wrote: I have a friend who has been a ipm for many years and she believes that babies are more likely to get jaundiced when the mother has had synto, it makes sense of they get that extra unneccessary boost of blood. Belinda -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.10/119 - Release Date: 4/10/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Induction and third stage labour
Hi Karen, This is my two bob's worth: 1. Once you start an induction, particularly once you have done an ARM, I believe that you are committed to having the baby within the next 24 hours preferably, (due to the risk of ascending infection in a hospital environment) so if labour does not establish, or fit the parameters the ob is happy with, you are going to have a c/s. Allowing a pregnancy to progress beyond 42 weeks, does have a much higher risk for the baby, as the placenta has a limited life span. How long an individual placenta will last is impossible to say, but perinatal mortality goes up past 42 weeks, and way up from 43 on (of course it helps to be sure of your dates!) 2. If you think of how much syntocinon some babies get when labour is induced, leaving the cord pulsating is not likely to give them any more synto than that, plus it will take a little while to enter mum's circulation (if given IM), and then babes. I was taught to clamp if the synto has been given, but someone at the ICM in Brisbane made the previous point about this, so I am a bit happier about it. I think the placenta probably separates better if it is allowed to drain, and the babe is meant to have that blood, otherwise they wouldn't be designed that way. Cheers, Nicole. -Original Message-[Nicole Carver]From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of karen shlegerisSent: Tuesday, October 04, 2005 11:22 AMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby. However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing. Ive checked Myles textbook for midwives but its not clear on this. I appreciate your support. Best wishes, Karen Shlegeris in Townsville
Re: [ozmidwifery] Induction and third stage labour
EDD is just that, an estimated date of delivery. Term is 38 to 42 weeks and there is reasonable evidence to offer induction once a woman is 10 days past her EDD, provided it is accurate. Babies are born in better condition and there is less mec stained liquor. However it is a personal choice and second daily CTG is usually offered if the woman does not want induction. If women are induced it does increase the risk of C/S for the reasons Nicole outlined and certainly if the cervix is unfavorable. A useful web-site is www.cordclamping.com Cheers Jenny Jennifer Cameron FRCNA FACMPresident NT branch ACMIPO Box 1465Howard Springs NT 083508 8983 19260419 528 717 - Original Message - From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 04, 2005 10:51 AM Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby. However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing. Ive checked Myles textbook for midwives but its not clear on this. I appreciate your support. Best wishes, Karen Shlegeris in Townsville Internal Virus Database is out-of-date.Checked by AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.10.7/70 - Release Date: 11/08/2005
RE: [ozmidwifery] Induction and third stage labour
Hi Karen, On top of what Karen has said. As soon as an induction is started the normal course of labour is changed. Often women end up with contractions on top of each other and have a hard time managing them, which then leads to pain relieving drugs, which can sometimes lead to c/section. Also, if the induction is fast and furious and the uterus in contracting like mad it sometimes causes fetal distress, which then leads to a c/section. Women that I am supporting in labour are more and more trying to push their inductions to the very last minute, not without a great amount of stress and fear mongering from some staff members about putting their babies at risk, one recently was told in so many words that if she didnt agree to her induction at 12 days over that she wouldnt be welcome to birth there really really scary stuff. I have since found out that 90 inductions a month are performed at Nepean Hospital thats 3 a day! What on earth is going on? This is ludicrous and I guess the only way it will change is if educated women stand up and say no. Ive even had clients who have been called by labour ward several times in a day to ask why they havent showed for their induction. How a women can relax and go into labour with all the external pressure of you must go into labour I dont know. Cheers jo From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Nicole Carver Sent: Tuesday, 4 October 2005 11:56 AM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Induction and third stage labour Hi Karen, This is my two bob's worth: 1. Once you start an induction, particularly once you have done an ARM, I believe that you are committed to having the baby within the next 24 hours preferably, (due to the risk of ascending infection in a hospital environment) so if labour does not establish, or fit the parameters the ob is happy with, you are going to have a c/s. Allowing a pregnancy to progress beyond 42 weeks, does have a much higher risk for the baby, as the placenta has a limited life span. How long an individual placenta will last is impossible to say, but perinatal mortality goes up past 42 weeks, and way up from 43 on (of course it helps to be sure of your dates!) 2. If you think of how much syntocinon some babies get when labour is induced, leaving the cord pulsating is not likely to give them any more synto than that, plus it will take a little while to enter mum's circulation (if given IM), and then babes. I was taught to clamp if the synto has been given, but someone at the ICM in Brisbane made the previous point about this, so I am a bit happier about it. I think the placenta probably separates better if it is allowed to drain, and the babe is meant to have that blood, otherwise they wouldn't be designed that way. Cheers, Nicole. -Original Message- [Nicole Carver] From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au]On Behalf Of karen shlegeris Sent: Tuesday, October 04, 2005 11:22 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby. However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing. Ive checked Myles textbook for midwives but its not clear on this. I appreciate your support. Best wishes, Karen Shlegeris in Townsville
Re: [ozmidwifery] Induction and third stage labour
Here is one study. Induction of labour leads to caesarean sections, instrumental delivery and shoulder dystocia Maternal and neonatal outcomes after induction of labour without an identified indication.Am J Obstet Gynecol. 2000 Oct;183(4):986-94.Dublin S, Lydon-Rochelle M, Kaplan RC, Watts DH, Critchlow CWDepartment of Epidemiology, University of Washington. OBJECTIVE: This study was undertaken to examine associations between induction of labour and maternal and neonatal outcomes among women without an identified indication for induction. Study Design: This was a population-based cohort study of 2886 women with induced labour and 9648 women with spontaneous labour who were delivered at 37 to 41 weeks' gestation, all without identified medical and obstetric indications for induction. RESULTS: Among nulliparous women 19% of women with induced labour versus 10% of those with spontaneous labour underwent caesarean delivery (adjusted relative risk, 1.77 ; 95% confidence interval, 1.50-2.08). No association was seen in multiparous women (relative risk, 1.07; 95% confidence interval, 0.81-1.39). Among all women induction was associated with modest increases in instrumental delivery (19% vs 15%; relative risk, 1.20; 95% confidence interval, 1.09-1.32) and shoulder dystocia (3.0% vs 1.7%; relative risk, 1.32; 95% confidence interval, 1.02-1.69). CONCLUSION: Among women who lacked an identified indication for induction of labour, induction was associated with increased likelihood of caesarean delivery for nulliparous but not multiparous women and with modest increases in the risk of instrumental delivery and shoulder dystocia for all women. Regards Fiona Rumble - Original Message - From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 04, 2005 11:21 AM Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby. However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing. Ive checked Myles textbook for midwives but its not clear on this. I appreciate your support. Best wishes, Karen Shlegeris in Townsville
Re: [ozmidwifery] Induction and third stage labour
Two more Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term.Obstet Gynecol. 2000 Jun;95(6 Pt 1):917-22.Maslow AS, Sweeny ALDepartment of Clinical Outcomes and Quality Improvement, Franciscan Health System, Tacoma, Washington, USA. OBJECTIVE: To determine the effects of elective induction on the risk of cesarean delivery in a cohort of women with low-risk term pregnancies and to evaluate the costs of elective induction services within our hospital system. METHODS: Records of 1135 eligible women with low-risk, singleton, vertex pregnancies at 38-41 weeks' gestation who were eligible for vaginal delivery were analyzed retrospectively after elective induction (n = 263) or spontaneous labor (n = 872). Outcome measures included cesarean delivery and direct costs. Variables evaluated were parity, maternal age, estimated gestational age, birth weight, prior cesarean delivery, epidural anesthetic use, and provider category. Analysis was by univariable and multivariable regression modeling. RESULTS: Elective induction placed nulliparas at a twofold higher risk for cesarean delivery (odds ratio 2.4, 95% confidence interval 1.2, 4.9) after adjustment for birth weight, maternal age, and gestational age. We found a significantly increased risk of cesarean delivery with increased birth weight for nulliparas (2-66.7%). Increasing maternal age increased the risk of cesarean delivery in all parity groups (P.05), but particularly among nulliparas (3-26.3%) (P .001). Electively induced labors that ended in vaginal delivery cost $273 more and required an average of 4 hours more in the hospital before delivery than did noninduced vaginal deliveries (P .001). CONCLUSION: Elective induction significantly increased the risk of cesarean delivery for nulliparas, and increased in-hospital predelivery time and costs. PMID: 10831992 Women having their first babies are twice as likely to get sections when labor is induced Induction of labor and the relationship to cesarean delivery: A review of 7001 consecutive inductions.Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):628-33.Yeast JD, Jones A, Poskin M Saint Luke's Perinatal Center, Saint Luke's Hospital of Kansas City, Kansas City, Missouri 64111, USA. OBJECTIVE: The goal of this project was to study the increasing risk of induction of labor in a community hospital and to determine whether it had an adverse effect on the rate of cesarean delivery. Study Design: From January 1, 1990, through July 31, 1997, 18,055 consecutive singleton pregnancies in women who were candidates for labor were reviewed via a comprehensive perinatal database. The risk of and indication for induction were reviewed. Cesarean delivery rates were calculated for nulliparous and multiparous patients by indication for induction and were compared with rates for patients who had spontaneous labor. Overall trends in cesarean delivery were reviewed for the duration of the study period. RESULTS: The annual induction rate significantly rose from 32% to 43% at the conclusion of the study period. Labor was induced in nearly 40% of nulliparous patients. Postdate pregnancy was the most common indication for induction, although few patients were at or beyond 42 weeks' gestation. The cesarean delivery rate remained at or below 20% for the years of the study. No increase was noted in spite of the increasing risk of induction. However, for nulliparous patients who had elective induction of labor, the risk of cesarean delivery was twice that of nulliparous patients who had spontaneous labor. CONCLUSION: The use of induction methods has significantly increased in this community hospital. More than 40% of patients are now candidates for induction. The cesarean delivery rate remains low in this facility in spite of a marked increase in risk of operative delivery for nulliparous patients who undergo induction Comment in: Am J Obstet Gynecol 1999 Nov;181(5 Pt 1):1273-4PMID: 10076139, UI: 99176971 Regards Fiona Rumble - Original Message - From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 04, 2005 11:21 AM Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a
Re: [ozmidwifery] Induction and third stage labour
and another. Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol. 1999 Oct;94(4):600-7.Seyb ST, Berka RJ, Socol ML, Dooley SLDepartment of Obstetrics and Gynecology, Northwestern University Medical School, Northwestern Memorial Hospital, Chicago, Illinois, USA. OBJECTIVE: To quantify the risk of cesarean delivery associated with elective induction of labor in nulliparous women at term. METHODS: We performed a cohort study on a major urban obstetric service that serves predominantly private obstetric practices. All term, nulliparous women with vertex, singleton gestations who labored during an 8-month period (n = 1561) were divided into three groups: spontaneous labor, elective induction, and medical induction. The risk of cesarean delivery in the induction groups was determined using stepwise logistic regression to control for potential confounding factors. RESULTS: Women experiencing spontaneous labor had a 7.8% cesarean delivery rate, whereas women undergoing elective labor induction had a 17.5% cesarean delivery rate (adjusted odds ratio [OR] 1.89; 95% confidence interval [CI] 1.12, 3.18) and women undergoing medically indicated labor induction had a 17.7% cesarean delivery rate (OR 1.69; 95% CI 1.13, 2.54). Other variables that remained significant risk factors for cesarean delivery in the model included: epidural placement at less than 4 cm dilatation (OR 4.66; 95% CI 2.25, 9.66), epidural placement after 4 cm dilatation (OR 2.18; 95% CI 1.06, 4.48), chorioamnionitis (OR 4.61; 95% CI 2.89, 7.35), birth weight greater than 4000 g (OR 2.59; 95% CI 1.69, 3.97), maternal body mass index greater than 26 kg/m2 (OR 2.36; 95% CI 1.61, 3.47), Asian race (OR 2.35; 95% CI 1.04, 5.34), and magnesium sulfate use (OR 2.18; 95% CI 1.04, 4.55). CONCLUSION: Elective induction of labor is associated with a significantly increased risk of cesarean delivery in nulliparous women. Avoiding labor induction in settings of unproved benefit may aid efforts to reduce the primary cesarean delivery rate. Regards Fiona Rumble - Original Message - From: karen shlegeris To: ozmidwifery@acegraphics.com.au Sent: Tuesday, October 04, 2005 11:21 AM Subject: [ozmidwifery] Induction and third stage labour Dear List, Im a birth educator and prenatal yoga teacher in Townsville. I hope these questions are appropriate for this list and would appreciate information from you: Induction. Andreas Preparing for Birth:Mothers book and the wall poster on cascade of intervention states that induction increases the risks of further intervention and ultimately caesarean, and thats what Ive always taught in my Active Birth classes. However, when challenged for statistics by a client in a recent workshop, I looked up Enkin, Kierse etc. who stated that induction does not increase the risk of caesareans, recommending that induction is recommended soon after a women passes her EDD. Can anyone clear this up for me? Third stage of labour. I was under the belief that if active management of third stage was chosen, the cord had to be clamped and cut quickly to avoid an over-transfusion of blood from the placenta into the baby. However, an OB recently told a client of mine that even if she had a Synto injection, the cord could be left until it stopped pulsing. Ive checked Myles textbook for midwives but its not clear on this. I appreciate your support. Best wishes, Karen Shlegeris in Townsville
