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Exactly!! To be licensed as an independent midwife
in Washington i had to be able to cannulate (I was stunned that this wasn't
expected here): it's emergency skills if you don't have them you shouldn't be
practicing independently, plus suturing plus other emergency skills: exactly how
can you manage a PPH completely without cannulation skills. Yes supporting the
mother and assessment of progress are definetly core skills but without these
other skills a midwife is surely flatfooted and dangerous at least out of
hospital. The epidural top up skills are just really who is going to do it
skills as opposed to these other emergency skills. As far as GBS positive:
we managed GBS positive women at home: they were given a detailed informed
consent and if they consented to IV antibiotics then their GP (or our GP
consultant) wrote the order and we administered the antibiotics IV at home
(yes we carried adrenaline/epinephrine in case of anaphylactic rx and we were
very thorough re hx of allergies), it did give us practice with cannulation
skills but also allowed women who would otherwise have to birth in hospital to
birth at home. Never had a complication due to the antibiotics. It was definetly
a community standard in Seattle not so though in Santa Cruz, California there we
followed the risk based protocol (no testing urine or 37 week lvs for
GBS) and so would have transferred to the hospital any women at risk via
the protocol. We took annual cannulation workshops as well as annual
neonatal resusc workshops.
marilyn
----- Original Message -----
Sent: Friday, May 20, 2005 9:25 PM
Subject: [ozmidwifery] IV &
epidural
In my opinion IV cannulation is a basic skill that all
midwives should have. How do you manage a PPH?? And yes you do
keep in practice by cannulating for IV antibiotics, etc - so when you need to
cannulate in an emergency you can!!
I know which of these skills (epidural top-up & IV
cannulation) I consider more valuable.
I work in a small rural hospital where we don't have doctors
on site all the time - it can be 1/2 hour from when you call them to when they
arrive. 1/2 hour waiting for an IV in an emergency would be
terrible. (And doctors do epidural top-ups here - not
midwives)
Maybe this is different from major hospitals - but it seems
odd to me that you have doctors available to cannulate, but not to do epidural
top-ups. Something is very warped in this thinking.
Jacky
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- Re: [ozmidwifery] IV & epidural Marilyn Kleidon
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