I would be interested to hear from any experienced homebirth midwives how they would care for a woman who is a G10P9 if she chose to birth at home. She has had all normal, quick births so far. Would you use active management of third stage because she is a grand multip or would you still encourage a physiological third stage??
Leanne.
From: "Marilyn Kleidon" <[EMAIL PROTECTED]> Reply-To: ozmidwifery@acegraphics.com.au To: <ozmidwifery@acegraphics.com.au> Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT Date: Thu, 24 Feb 2005 16:55:56 -0800
Excellent point. I do think the 500mL definition for PPH is spurious. Having been educated by a homebirth midwifery school I have to say we were not concerned when the blood loss was less than 1000mL as most of our 3rd stages were physiological. Very occassionally we did use oxytocin for management of 3rd stage usually when the woman had a history of PPH greater than 1000mL or retained products etc.. However we were well versed in the Cochrane studies and aware of that evidence so we had a high degree of caution shall I say. We did carry 40 units of pitocin and also ergometrine both vials and tabs to births as well as herbal remedies. Syntometrine does not seem to be available in the USA at least not where I was. That being said from what i have seen here postnatally, active management really decreases the postpartum blood loss in most women. I am currently doing the extended midwifery service and visiting women in their home during the first 1 to 10 days and most seem to have almost finished bleeding by day 5, for most of the homebirth women I visited in the USA just from memory I would say they were almost finished by day 10. Both the American College of Nurse Midwives (ACNM) and the Midwives Alliance of North America (MANA) have been collecting stats for 5 to 10 years at least and must have good stats on this topic. I know it isn't Australian data but itmight be helpful.
marilyn ----- Original Message ----- From: Jenny Cameron To: ozmidwifery@acegraphics.com.au Sent: Wednesday, February 23, 2005 3:51 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Good point Michelle. If we used 1000ml as PPH definition the stats would not look so appealing for active mgmt. Also as someone stated women having a physiological 3 stage tend to lose more in the first few hours after birth than those having active mgmt. As far as I am aware no-one has researched total postpartum (say in the first week) blood loss. Hb or Hct estimation is the best way of determining blood loss post partum but you need to have a pre-partum Hb/Hct as well.
Jenny
Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717 ----- Original Message ----- From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Wednesday, February 23, 2005 10:34 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
I haven't heard of a study of this type beingb done. I find it interesting that the NSW policy (similar to many others) of PPH is over 500ml, and yet the WHO states that in healthy populations (ie not anaemic etc) up to 1000ml blood loss may be physiological. It is often said that blood loss at birth is underestimated.... I wonder how many women have blood loss of over 500ml and are fine due to the increased circulating blood volume in pregnancy.
Cheers Michelle
Fiona Rumble <[EMAIL PROTECTED]> wrote:
WITH REGARDS TO THE RESEARCH THAT SUBSTANTIATES THE CLAIMS THAT ACTIVE MANAGEMENT IS SAFER THAN PHYSIOLOGICAL MANGAEMENT OF THIRD STAGE,
DOES ANYONE KNOW IF THERE HAVE BEEN ANY STUDIES COMPARING PHYSIOLOGICAL WHOLE OF LABOUR AND BIRTH WITH ACTIVE MANAGEMENT OF THIRD STAGE FOLLOWING MANAGED LABOUR AND BIRTH???????? I AM SURE THE RESULTS WOULD BE VERY DIFFERENT. JUST A THOUGHT. CHEERS FIONA
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Leanne Wynne Midwife in charge of "Women's Business" Mildura Aboriginal Health Service Mob 0418 371862
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