Hi Marilyn. I totally understand where you are coming
from but just to play devil's advocate...... who is to care
for these women who have made educated choices to birth their
babies in a setting they believe to be safer than the
hospital? Someone has to do it (and it's not me at the moment
either!!!).
I know it's not ideal and at times, very scarry not to be
able to offer the full service but someone has to step up to the
mark and provide this service and not continue to be bullied by
this god forsaken government. Some of these women will birth
unattended and do. If I were to ever have any more children (cross
my legs as I write!!!), I'd have them at home. I'd like to
think I could find a midwife to support me and can understand the ones
who continue to birth unattended after exhausting all options to
find midwifery or should I say 'woman-centred' care. The hospital
setting is a frighting place for those who are 'birth educated'.
Just thinking out loud.
Kim.
-------Original
Message-------
Date: 04/30/05
22:55:50
Subject: Re:
[ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D
supps.
I hope I don't sound too rude but it
highlights exactly why I am not practicing independently at the moment.
Australian midwives do not have a mandate to be independent
practitioners; I simply cannot imagine not being able to order path
tests for the women I am caring for, not being able to order my own
emergency drugs etc.. We are dependent on GP/Obs to do this for us and
dependent on their records in case of transfer.... ahh!! sorry just had
a couple of wines!!
marilyn
----- Original Message -----
Sent: Friday, April 29, 2005 5:37
PM
Subject: RE: [ozmidwifery]
Antenatal Screening/Informed Choice Agreement. Vitamin D supps.
Hi
Gaye,
It is an
interesting question about antenatal
testing.
I ask all my
clients are booked into a hospital as a backup. They are booked through
antenatal clinics or GP/Obs or Obstetricians.
There is a problem with getting this booking in done properly. As a
midwife in WA I cannot order path tests, this is of course done by the
doctors and it is their responsibility to provide results to the local
hospital. I cannot book people into the hospital, this is the doctor’s responsibility also.
Some of the doctors are great and provide copies of blood tests to me so
that I can put them in my/clients antenatal records so that it is easy
for hospital transfer situations. Other doctors are not so cooperative
and will not provide them to me and make it difficult, even though the
woman has a right to have copies, for the woman to have a copy. In these
instances I trust what is passed on to me by the woman, hope the doctor
follows up on anything abnormal and ask the woman to remind the doctor
to provide copies for the hospitals records in case of transfer.
Sometime the doctors do this, sometimes they don’t. Sometimes the ‘offical’ result documents are in some doctors
surgery files only and not accessible in the middle of the night when a
transfer has happened.
Having said this I have had a
client that declined all blood tests, due to her own personal
belief systems. It is her right. I did speak with her about why these
test are done and clearly documented in my
antenatal notes the discussion and we both signed the notes.
Um… did that help clarify
anything???
Sally
Westbury
Hi
All, Just hoping some of
you wonderful Homebirth midwives out there can enlighten my ignorance
regarding what "routine" antenatal investigations you order for or
recommend to your clients, as part of your initial consultation. Is
there a standard guideline that you must adhere to?(Apart from the
"National Midwifery Guidelines for Consultation and Referral", that is).
Or is it only up to the individual practitioner and his/her client to
discuss and come to an agreement about what tests she will have and when
she must go to hospital?
My reason for asking is the vague responses to our enquiries we
recently encountered when a planned homebirth client presented to
hospital for delivery. There was no accompanying antenatal record so we
thought it feasible to ask basic questions of the client and her midwife
such as blood group, last Hb, etc because it was no longer a normal
situation. Is it probable these tests weren't done, because she was
hitherto a normal, healthy woman with the right to choose what invasive
procedures she had? Sorry to sound stupid but I'm used to the
Obstetrician/G.P. who orders every test the lab has ever done and then
some, you know - like the questionable Hep C and HIV without prior
counselling, but I won't go
there! I've done a couple of Web
searches re the evidence (and lack of), and cost-effectiveness of the
regular antenatal screen blood tests (I think I read it cost Medicare
some $48 million dollars back in 1997), but wanted to know what you guys
are practicing out there.
On
another tack, I just read this gem in an excerpt from a policy statement
by The American Academy of Paediatricians: "Vitamin D drops containing 200iu should be
given to all breastfed infants starting in the first two months of
life" Gartner LM et
al "Breastfeeding and the use of Human Milk" Pediatrics 2005 Feb; 115:
496-506. Alaskans born in the middle of
winter perhaps? I think our NICU give daily Pentavite from about Day 5,
but surely, if there is some sun exposure this routine administration
shouldn't be necessary? Do different skin colours absorb it from
sunlight at different rates, such as black skin slower, perhaps? Any
Lactation Consultants able to comment here
please? Cheers, Gaye
:)
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