Re: [ozmidwifery] question

[Susan Cudlipp]

Title: Message

Among my search last night was some comments on this thread from the ob/gyn list archives. One stated that "restitution is called a 'cardinal' mechanism - therefore it is vital to wait for it" (can't find the actual thread just now) How crazy it is that they ignore this in the hurry to 'get the baby out'  I get so discouraged by the lack of simple wisdom and respect for the natural process of labour. Barb, it is so true that we are unable to speak out when we see such terrible mis-management, those of us that do are indeed subjected to incredible bullying.  During my recent confrontation over some issues I was told " you are a good NURSE Sue, you care too much, that's the problem" !!! WE may avoid the bullying by not working in the area, but the women are still being bullied and babies still being damaged. Sue "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke ----- Original Message ----- From: B & G To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 17, 2005 7:06 PM Subject: RE: [ozmidwifery] question We have an OB who does not wait for restitution, instead is now training the Registrars before even looking at the way the head has come out to pull downward on the head, put their hand beside the head in the vagina and sweep the anterior arm forward. I have seen a run of 4 # humerus and/or clavicles. I have made efforts to address this at staff meetings because I have been documenting what I see and specifically stating 'not shoulder dystocia' in the notes. The result from this and for commenting on the second twin we lost from the same SOTB OB was that I have experienced the most incredible medical bullying/harassment. I now do not work in Birth Suite and thankfully the bullying has stopped. This is due to the Morris/Davies Royal commission and Forster review. I had my private say on bullying. However why can't I get other midwives to stand up for what they see and the damage that is done? Barb -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Tania Smallwood Sent: Thursday, 17 November 2005 3:41 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] question My goodness me –“not wait for restitution”, strikes me as someone trying to redefine the mechanism of normal birth to suit their own fears and prejudices - Wow!  So if in fact a baby needs to restitute to birth the shoulders comfortably and in the best position, and we’re going to cut that part of the birth out, are we not going to see a marked increase in the incidence of shoulder dystocia?   Might be one to look out for with these hasty practitioners.   I can only imagine how they would cope at the majority of water births I’ve been at, where the head is fully crowned, and it’s usually a matter of minutes, sometimes up to 5 or 6 before the body follows.  And then there’s that tricky little stop at the hips that those water babies tend to do too sigh, why is there so much fear and ignorance surrounding what has been happening for so many years?  Is it just an insane need to control everything, or am I just naïve in my belief that mother nature knows what she’s doing?    Tania     From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Susan Cudlipp Sent: Thursday, 17 November 2005 3:33 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] question   Good point Anne!   I did quite a thorough search last night and have printed off some good articles which I will pass on.  However I could not find the answer to why EXACTLY babies die in shoulder dystocia.  If it is asphyxia, then (obs point of view) this proves that the cord is not sustaining them. The ob said to me that if the cord WERE sustaining them there would be no urgency to deliver the body, also quoted from the ALSO course that the fetal Ph drops 0.04 (?)  per minute after delivery of head therefor we should not be waiting for restitution but delivering body ASAP.  (I didn't even go there!!) My feeling is that it is more to do with probable cord compression, (although I cannot picture why this should necessarily be so as the body and hence, presumably, the cord, would still be above the pelvic brim) and trauma to the neck usually caused by mis-management (panic) in trying to deliver the shoulders than asphyxia, but it is true that they become asphyxiated within a short time if truly stuck.  Any answers on that one? Thanks Sue   "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke ----- Original Message ----- From: Anne Clarke To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 17, 2005 5:54 AM Subject: Re: [ozmidwifery] question   Dear Susan,   You could say to them if this is so why do they rely so much on cord ph's ?  One would think when the baby was born and the pulsating cord was still not supplying the baby effectively the cord blood (venous and arterial) was null and void to provide an estimation of oxygenation for the babe.   Regards Anne Clarke Queensland ----- Original Message ----- From: Susan Cudlipp To: midwifery list Sent: Wednesday, November 16, 2005 9:30 PM Subject: [ozmidwifery] question   I have a question for you wise ozmidders. I was having a discussion today with one of our obstetricians regarding cord clamping, and the benefits to the baby of delaying this until pulsations cease.  When I mentioned the benefit of the baby recieving oxygenated blood via the pulsating cord which could assist it's transition to independent respiration particularly if it was compromised (etc etc)  the obs was of the view that the pulsations could NOT be providing oxygenated blood because the uterus would have contracted down and the placenta could no longer be getting oxygen from mother's circulation. Now I know that I have read reams on this and this is stated to be one of the benefits, but I could not answer that particular question physiologically and convincingly. The point was also raised that in shoulder dystocia, babies die of asphyxiation, which (obs opinion) would not happen if they were recieving oxygen via the cord.  I did print off George Morley's excellent papers for this Dr to read but would very much welcome anything that can show that the baby would still be receiving oxygenated blood post birth.   TIA Sue     "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke __________ NOD32 1.1289 (20051116) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.362 / Virus Database: 267.13.3/173 - Release Date: 16/11/2005 No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.362 / Virus Database: 267.13.3/173 - Release Date: 16/11/2005