Totally agree Sue. I was taught manual removal too and exactly the same re when to apply gentle but firm CCT. However, for a manual removal at home you do need maternal cooperation and did have one incidence in Seattle where we had to transfer for prolonged moderate/heavy blood loss that just would not settle and uterus that kept getting boggy. Para 3 with several years between each of the births, third birth being precipitous, placenta delivered easily (dirty duncan if you know what I mean) physiologically but bleeding would not subside and mum kept soaking a pad in an hour, could not stand a hand going past the introitus and was happy to go to the hospital. Estimated blood loss was 1600mL including theatre, a pin head size piece of membrane was all they could find. Mum declined transfusion and was home the next day tired but happy.
marilyn ----- Original Message ----- From: "Sue Cookson" <[EMAIL PROTECTED]> To: <ozmidwifery@acegraphics.com.au> Sent: Thursday, February 24, 2005 11:59 PM Subject: Re: [ozmidwifery] MORE ACTIVE MANGAEMENT > Hi, > I would definitely treat this woman like all others and assume > physiological 3rd stage is sufficient. > I have never actively managed a 3rd stage, and have given syntometrine 3 > times only after placentas were born - all in my early days of homebirth. > I always prefer to; > a) make sure women are well hydrated going into 2nd stage so they can > tolerate volume loss > b) if bleeding is serious go into "deliver placenta mode" > I always catch and therefore can measure blood loss at a glance > I engage the mother first and tell her she's bleeding and that I need > her to focus and deliver her placenta > I always give herbs as a first line of attack- shepherd's purse has > always been my first choice > I would rub up a ctxn, add an ice pack to her uterus if one available > Then with her assistance pushing I would apply cord traction and see if > the placenta would come > Repeat this maybe twice > Then contemplate manual removal if necessary (not had to yet...) > > I have managed 5 large haemorrhages (over 1.5 litres measured) in this > manner and have not had to transfer anyone yet.(I have a > haemoglobinometer with which I can measure Hbs on the spot over the next > few weeks if necessary..) > This management regime was taught to me by John Stevenson and always > seems to work.Up until very recently, I have always worked alone. > > Isn't it interesting all the different ways we'd handle this depending > on our personal experiences? > > By the way, late last year I witnessed the worst PPH I'd ever seen - > mainly because of the management in the hospital (it was a hospital > support not a homebirth), and with all the hands you could ever imagine > -I'd say too many - the woman was severley depleted. Drips in etc etc > but too much too late. A cord pulling midwife, and then no > acknowledgement of when she needed help (irrespective of my pleas) plus > she underestimated the blood loss by more than 100% (she thought 600ml, > and it was measured by weight (? accuracy) to be more like 1400ml) and > then the woman was taken to theatre - more time, more blood, why not a > manual removal then and there?? > > Aaaah. Expect no PPH but stay on your toes ...always my motto. > > Sue > > >----- Original Message ----- > >From: "leanne wynne" <[EMAIL PROTECTED]> > >To: <ozmidwifery@acegraphics.com.au> > >Sent: Thursday, February 24, 2005 2:43 PM > >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. > > > > > > > > -- > 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.
