I would still use physiological management but have synto and syntometrine on hand. I really think if you treat it as a problem before hand the you can precipitate the problem, that is the problem with much medical management they treat the potential problem before it is a problem and before you know it there is a problem!!! ----- Original Message ----- From: "leanne wynne" <[EMAIL PROTECTED]> To: <ozmidwifery@acegraphics.com.au> Sent: Friday, February 25, 2005 9:13 AM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
> Hi All, > 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 > > > > > > > > > >--------------------------------------------------------------------------- - > > Find local movie times and trailers on Yahoo! Movies. > > > Leanne Wynne > Midwife in charge of "Women's Business" > Mildura Aboriginal Health Service Mob 0418 371862 > > > -- > 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.
