We had a baby recently that became very unwell with GBS. I believe that the mother had PROM for quite some time. Had another case last year where a baby died. Both cases though associated with prolonged rupture of membranes. I have to say that now they are very jumpy with women with PROM. A woman the other day rang to say that she had just ruptured her membranes (term baby. She wanted to stay at home, but they insisted on her coming in for a 'check up'. Little did she know that the Syntocinon infusion and Abx were already charted. Lindsay
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Tuesday, 24 May 2005 11:38 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation Agree Marilyn. I have seen a baby develop GBS. He was a normal birth at term, good Apgars. No prolonged ROM. Became ill very quickly (within one hour of birth), profound apneas & brady's, collapsed & died with 24 hours of birth. A big contributing factor to his death was delay in starting him on AB's. The tricky thing with newborns is that they don't always become febrile in response to infection, even a severe one. More likely a drop in temp. This case was many years ago & a baby presenting like that now would be given AB's immediately until proven otherwise. GBS has an incidence of 1:1000 and good midwifery care will detect a sick or becoming sick infant. I wonder about the issue of antibiotic resistance, although this is less likely with Penicillin than the broad spectrums. WHO have big concerns about antibiotic resistance. 30% is a lot of women and babies. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 ----- Original Message ----- From: "Marilyn Kleidon" <[EMAIL PROTECTED]> To: <ozmidwifery@acegraphics.com.au> Sent: Tuesday, May 24, 2005 3:09 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation > What your describing is the risk based protocol vs the culture based one. > UNfortunately the recent evidence shows more babies were missed using the > risk based protocol that the culture based one. This is all covered on the > web sites posted. Whenever you practice prophylactic treatments you are > going to be treating some people unnecessarily it's the nature of the > beast!! We don't have the test(tests) to positively identify those mthers > who have a 100% chance of their babies becoming septic with GBS. And yes > it > does become a pathogen again we don't know all the triggers that make it > change from being normal flora. Of course women refuse the antibiotics and > I > personally have never known anyone who has had a baby become ill or die > from > GBS disease. And I have attended births at home and in hospital with women > who have refused the antibiotics(after testing positive) or who birthed > before the iv could be set up and we simply watched the baby closely > especially taking temp's 4/24 for 48 hours and regularly for the first > week. > However, if you read the web sites you must become aware that thinking you > can pick who will have a sick baby from health status of the mother can be > risky and erroneous. Though I have to say I would think babies in the > one-to-one continuity of care model would be much safer than those with > multiple providers and early discharge. > > marilyn > > ----- Original Message ----- > From: "Ken WArd" <[EMAIL PROTECTED]> > To: <ozmidwifery@acegraphics.com.au> > Sent: Monday, May 23, 2005 3:14 AM > Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation > > >> Do they really need iv ab's, or are we over treating as usual? The vast >> majority of these babies are fine. Maybe we should only be treating those >> women with prom, not those in active labour, especially those with intact >> membranes. Another reason for leaving membranes intact i.e. no arm's. >> as we all carry GBS can it be pathologic? >> >> -----Original Message----- >> From: [EMAIL PROTECTED] >> [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron >> Sent: Monday, 23 May 2005 10:34 AM >> To: ozmidwifery@acegraphics.com.au >> Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation >> >> >> I guess not if they need IV antibiotics. >> Jenny >> Jennifer Cameron FRCNA FACM >> PO Box 1465 >> Howard Springs NT 0835 >> >> 0419 528 717 >> ----- Original Message ----- >> From: "Sally Westbury" <[EMAIL PROTECTED]> >> To: <ozmidwifery@acegraphics.com.au> >> Sent: Sunday, May 22, 2005 3:30 PM >> Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation >> >> >> > 30% of women are not normal???? Gosh. >> > >> > -----Original Message----- >> > From: [EMAIL PROTECTED] >> > [mailto:[EMAIL PROTECTED] On Behalf Of Jenny >> > Cameron >> > Sent: Sunday, May 22, 2005 1:27 PM >> > To: ozmidwifery@acegraphics.com.au >> > Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation >> > >> > GBS is not normal. What is the cut-off point for midwifery care & scope >> > of >> > Px? >> > >> > Jennifer Cameron FRCNA FACM >> > PO Box 1465 >> > Howard Springs NT 0835 >> > >> > 0419 528 717 >> > ----- Original Message ----- >> > From: "Ken WArd" <[EMAIL PROTECTED]> >> > To: <ozmidwifery@acegraphics.com.au> >> > Sent: Saturday, May 21, 2005 5:06 PM >> > Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation >> > >> > >> >> Why involve an obs for GBS? As long as correct procedure is followed, >> >> there >> >> is little chance of transmission. We give oral abs if prom iv in >> > labour. >> >> We >> >> don't induce for 48hrs, rather just keep an eye on the woman's temp >> > and >> >> ctg >> >> at 18hrs and and 24hrs following. We have never had a problem. Our drs >> > rx >> >> the abs, antenatally when the woman is diagnosed at 37/40. A lot of >> > our >> >> women elect not to be swabbed, and again no probs. All babies are >> >> monitored >> >> temp etc for 24hrs and parents aware of what to watch for. Lets keep >> > drs >> >> away from normal women having nice pregnancies and babies >> >> >> >> -----Original Message----- >> >> From: [EMAIL PROTECTED] >> >> [mailto:[EMAIL PROTECTED] Behalf Of Jenny >> > Cameron >> >> Sent: Saturday, 21 May 2005 12:39 PM >> >> To: ozmidwifery@acegraphics.com.au >> >> Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation >> >> >> >> >> >> I take everyones point about it being useful and probably essential >> > for >> >> midwives in rural areas to be able to cannulate but don't forget the >> > core >> >> skills of midwifery practice during labour are support and assessment >> > of >> >> progress and the ability to recognise potential problems. I don't feel >> >> comfortable hearing that midwives are performing induction of labour >> >> cannulations etc. Or inserting bungs for IV antis for GBS for that >> > matter, >> >> If a woman is GBS pos then she should be referred and OBs involved. >> > Who >> >> orders the antis?? >> >> >> >> Jenny >> >> Jennifer Cameron FRCNA FACM >> >> PO Box 1465 >> >> Howard Springs NT 0835 >> >> >> >> 0419 528 717 >> >> ----- Original Message ----- >> >> From: "Miriam Hannay" <[EMAIL PROTECTED]> >> >> To: <ozmidwifery@acegraphics.com.au> >> >> Sent: Saturday, May 21, 2005 7:43 AM >> >> Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation >> >> >> >> >> >>> From a student's perspective any discussion on what >> >>> constitutes a core midwifery skill really interests >> >>> me. >> >>> >> >>> we have a template that needs to be completed and >> >>> signed off by supervising midwives regarding epidural >> >>> maintenance. we are supposed to witness a few and then >> >>> do the top ups ourselves and also remove the catheter >> >>> after the birth, document etc. This is obviously >> >>> regarded as an important midwifery skill by our >> >>> educators. However, I know of VERY few students who >> >>> have been given the opportunity to acquire cannulation >> >>> skills. In the tertiary hospital I am currently placed >> >>> in the RMOs do all the cannulation. Midwives can do it >> >>> but must do a course to become accredited. This course >> >>> is not available to students, and as far as i am >> >>> aware, you must have done a grad years in the hospital >> >>> to access the course. To me this seems ridiculous! I >> >>> have no intention of doing a GMP, instead intending to >> >>> apprentice in private practice before setting out my >> >>> own shingle. How on earth can I safely practice in the >> >>> private sector if i am not confident in establishing >> >>> iv access? to me this is a core midwifery skill that >> >>> while hopefully rarely utilised is of critical >> >>> importance when needed. It is a skill I would much >> >>> prefer to develop than doing maintenance and clean up >> >>> for our anaeshetists. >> >>> >> >>> Also, on the thread of epidurals and instrumental >> >>> births...in my limited experience what Marilyn >> >>> mentions is borne out. I have been involved in several >> >>> births with epidural blocks and have only seen >> >>> instrumental birth needed when coached pushing was >> >>> utlised. In those cases where the power of the uterus >> >>> was allowed to facilitate descent until we had head on >> >>> view no assistance was required. The power of these >> >>> women's bodies birthed their babies despite the block >> >>> and it was marvellous to watch. >> >>> >> >>> Miriam (2nd year Bachelor of Midwifery Flinders uni of >> >>> SA) >> >>> >> >>> >> >>> --- Marilyn Kleidon <[EMAIL PROTECTED]> wrote: >> >>>> LOvely, Alesa that is exactly how I had experienced >> >>>> epidurals being set up in the USA. However, I have >> >>>> been told here that these large syringes that >> >>>> require top ups are more innovative than the >> >>>> infusion (pcea) pumps : I can't see how, even though >> >>>> I can see (in some ways) that if this is the >> >>>> technology we are using then midwives should be ofay >> >>>> with it?? And yes I had never experienced the >> >>>> epidural as being anything but turned off in second >> >>>> stage in fact, at least until 2002 when i left it >> >>>> was common practice to allow passive descent so that >> >>>> active pushing did not commence until the head was >> >>>> on view. With this practice I saw very few >> >>>> instrumental births. Can anyone give me the >> >>>> justification for these syringe type epidurals >> >>>> requiring top ups over the infusion pumps? >> >>>> >> >>>> marilyn >> >>>> ----- Original Message ----- >> >>>> From: Alesa Koziol >> >>>> To: ozmidwifery >> >>>> Sent: Friday, May 20, 2005 6:17 AM >> >>>> Subject: [ozmidwifery] re epidural top ups >> >>>> >> >>>> >> >>>> Dear List >> >>>> Have read this thread with great interest. Not >> >>>> wishing to get into the debate regarding whose skill >> >>>> it is to perform this task I just wanted to share >> >>>> our experience. The move away from an epidural that >> >>>> required top ups in labour to infusion pumps came >> >>>> about when the midwives refused to perform the >> >>>> topups or push a bolus down the epidural line >> >>>> manually. We insisted on the anaesthetists doing >> >>>> this task as they were responsible for the integrity >> >>>> of the line and most certainly for its placement. >> >>>> Our anaesthetists got sick of returning again and >> >>>> again to do this and researched an alternative for >> >>>> themselves that we were happy to work with. In our >> >>>> setting a midwife will assist the anaesthetist with >> >>>> equipment required for epidural insertion, however >> >>>> she never ever pushes any fluids down the line >> >>>> manually. Priming the line is all done by the >> >>>> anaesthetist, he/she connects all lines, filter and >> >>>> tubing to a syringe and together they check the >> >>>> settings on the syringe driver and turn it on. Works >> >>>> for us, women have the analgesia they request, >> >>>> midwives turn the pump off when second stage is >> >>>> noted and many women push their infant actively- >> >>>> although there is still a high number of >> >>>> instrumental births >> >>>> Cheers >> >>>> Alesa >> >>>> >> >>>> Alesa Koziol >> >>>> Clinical Midwifery Educator >> >>>> Melbourne >> >>> >> >>> Find local movie times and trailers on Yahoo! Movies. >> >>> http://au.movies.yahoo.com >> >>> -- >> >>> This mailing list is sponsored by ACE Graphics. >> >>> Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. >> >>> >> >>> >> >>> -- >> >>> Internal Virus Database is out-of-date. >> >>> Checked by AVG Anti-Virus. >> >>> Version: 7.0.308 / Virus Database: 266.11.5 - Release Date: 4/05/2005 >> >>> >> >>> >> >> >> >> -- >> >> 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. >> >> >> >> >> >> -- >> >> No virus found in this incoming message. >> >> Checked by AVG Anti-Virus. >> >> Version: 7.0.322 / Virus Database: 266.11.14 - Release Date: >> > 20/05/2005 >> >> >> > >> > -- >> > 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. >> > >> > >> > -- >> > No virus found in this incoming message. >> > Checked by AVG Anti-Virus. >> > Version: 7.0.322 / Virus Database: 266.11.14 - Release Date: 20/05/2005 >> > >> > >> -- >> 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. > > > -- > No virus found in this incoming message. > Checked by AVG Anti-Virus. > Version: 7.0.322 / Virus Database: 266.11.14 - Release Date: 20/05/2005 > > -- This mailing list is sponsored by ACE Graphics. 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