A big impetus to
change the cord cutting routine at our unit was to revamp the birth
bundles.
We broke the bundles
down into separate items originally as a saving of work for CSSD in
sterilising unused stuff. So now having everything separately peel packed it
is very easy to just not include a pair if scissors when you grab the birth
stuff for the actual event.
We (in our own
practice) don't have Drs for births & the newer MW soon got used to
having to go & get scissors for any cutting they wanted to do. The
bundles just have a large kidney dish or bowl & 2 artery clamps in
them.
We have removed the
scissors from them entirely, episis haven't been done for years anyway
& as no one cuts tight cords anymore or feels for them around necks
the resus is done on the bed, initially anyway, then baby is only moved to
resus cot if really necessary.
It all seems to work
well, we often don't cut cords till placentas are out, Dads or partners do
it 99% of the time & catch 80% of the time so we are just the gate
keepers often anyway.
Really you need to
read the current research & it backs up all that you are suggesting,
perhaps print it off & present it at the next meeting, nothing like the
written word for initiating change.
Failing that, hide
the scissors!
-----
Original Message -----
Sent:
Tuesday, October 25, 2005 10:02 PM
Subject:
Re: [ozmidwifery] Re: Midwifery Educators
Ha ha - I remember doing the same
in my mid training tho we didn't have to do shaves. "I could give you an
enema if you would like one!" I would offer. Never had any
takers!!!! The power of consent!!!!
Maxine
-----
Original Message -----
Sent:
Tuesday, October 25, 2005 9:09 PM
Subject:
RE: [ozmidwifery] Re: Midwifery Educators
When I started my mid we were doing shaves and enemas. It
was my group of students that facillated change. Maybe because we were a
generally older lot. the women were informed they wold be shaved
and given an enema. If any objection or query of the procedure was made
they were quickly told that they could refuse. All did, and by the time
our 12 months were up there were no shaves or enemas taking place.
Midwives can effect change. As to cutting the cord quickly if baby needs
resus. I have resused 2 flat babies with cord intact, on the bed with
mum. Bub is getting 02 from mum, and mum is not nearly so stressed. Both
babies responded well.
Hi Barbara,
Do your parents have any say in the cord clamping? Perhaps they
need more information such as at their education sessions? We also do
active management, but Dad's are still able to cut the cord. Not many
of our Mum's do physiological third stage. However, we had a lotus
birth recently which went well.
I believe that although midwives do not have a lot of power in
hospitals, parents requests are often listened to. There is an
opportunity to harness this to bring about a cultural change, and if
parents continue to request certain practices they will break down the
resistance to change.
I have not given pethidine through an epidural before. We have
infusions though. They are Fentanyl/Marcain and we do obs 5 minutely
for 30 minutes, then full set of obs with pain score, sedation score,
dermatomes and motor function, then pulse, BP, resps and sedation
score hourly, with dermatomes and motor function 4 hourly. I
think it is good to keep your obs consistent to save confusion,
particularly with new or inexperienced staff.
Cheers,
Nicole.
Dear
Midwives,
I have just returned
from our small hospital midwives and doctors breakfast meeting.
This is to encourage communication.
We have 4 GP/Obs and 9 midwivies.
On discussion was a new
policy for epidural-top ups: both pethidine only and marcain/fenytal .
Policy is now insistent
on bp obs
5minutely for 30 minutes for both
top-ups.
Other hospitals have had
the pethidine only top-ups: prior giving top-up
bp, in 5 minutes and then in 15
minutes.
Does anyone have an
email address for me to contact?
Also does anyone have
policy or guidelines re allowing dads to cut cord?
This meeting has decided that no cord clamps
(plastic) will be put on set up so the forceps are used, Dad can do
a token cutting later (?how later) when cord clamp (plastic) is to
be put on.
I was hailed down when I
suggested that a well baby could be put onto mum and continue with
the cord clamp/ dad cutting cord when ready.
If the baby needed active
resuscitation then quick transfer to resus. trolley
would be normal procedure.
As you will have noticed
our GPs only do active 3rd stage, mothers have never
heard of physiological 3rd stage even though same
discussed at ante-natal classes.
Thanks from a
disappointed midwife,
Barbara
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