Cord gases will be normal if it is an acute recent event, they are abnormal if it has been a chronic ongoing event this is why they are useful in litigation cases where the woman/child family are claiming negligence during labour, the usual being there were signs of fetal distress and a LSCS should have been done earlier, cord gases that are normal prove this was not the case. Just to play devils advocate I can understand how people feel the need to defend themselves against being sued when so often there is no proof that they did anything wrong at the time (benefit of hindsight being a wonderful thing of course). It is better to be doing cord blood gases to protect against litigation than even more LSCSs. I know it is only a few people that sue unnecessarily but as usual the few spoil it for the many.
I would be interested to know what the rate of abnormal cord gases with a vigorous well baby were as sharing these stats are what will help decide sensible practices, we have to work towards being part of these decisions by using evidence and not just trying to go it on our own. Where I work the practice is to do cord gases at the births when a baby requires resus or there has been some problem in labour and any I have been involved in have been supportive of the care in labour. Christine -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of wump fish Sent: 16 October 2006 20:34 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] cord blood gases Hi Melissa I realise that from a 'scientific' perspective cord gases represent an accurate way of assessing fetal distress. But, I was on duty when a baby died due to shoulder dystocia - it's cord gases were normal. Kind of knocked my already weak faith in the technology. It was also policy in that hospital to do routine cord gases. Midwives would sometimes get poor cord gases with a vigorous baby??? I found that I was 'unable to obtain' cord gases unless there was an indication and/or the parents had consented (how can anyone prove otherwise?). I was concerned that if a baby came out healthy and I got documented 'proof' of compromise I was setting myself up for problems. Also, what do you tell the parents? You baby seems ok, but it's cord gases indicate otherwise? Kind of risk assessment in reverse. Quite interesting that cord gas analysis became routine overnight but waterbirth took years of battling to get up and running. I think cord gas analysis is an issue that needs debating - especially in relation to allocation of resources. Rachel >From: "Melissa Singer" <[EMAIL PROTECTED]> >Reply-To: ozmidwifery@acegraphics.com.au >To: <ozmidwifery@acegraphics.com.au> >Subject: Re: [ozmidwifery] cord blood gases >Date: Mon, 16 Oct 2006 11:24:56 +0800 > >Hi Shelley, >I recently attended a advanced fetal assessment course at our tertiary >hospital and all the pros for cord blood gases were presented. CTG's were >discussed with pros and cons such as 80% show some abnormality but 80% of >babies are not sick or acidotic. It was presented as one of certain >diagnostic tools for fetal acidosis and therefore useful for litigation. > >You mentioned the results are inaccurate. I'd be very interested in >hearing why they are inaccurate. We don't do them and I don't agree with >routinely doing them so any more information would be helpful. > >Thanks >Melissa >----- Original Message ----- From: "michelle gascoigne" ><[EMAIL PROTECTED]> >To: <ozmidwifery@acegraphics.com.au> >Sent: Saturday, October 14, 2006 10:39 PM >Subject: Re: [ozmidwifery] cord blood gases > > >>Naomi >>In England we have seen in increase in 'fear' of litigation. Obstetrics in >>this country has always taken a huge chunk of the litigation for most >>hospitals . We now have in our country CNST (clinical neglegence scheme >>for trusts). Trusts are what groups of health care organisations are >>called. CNST is an insurance that Trusts pay into so that litigation >>claims can be paid when won. The CNST set out standards for trusts and >>depending on how well you achieve the standards determines the insurance >>premiums, which you can imagine are huge figures. The trouble is that CNST >>requirements for the standards to be met are not always sensible or in the >>best interests of women. Some standards like (cord blood sampling for ph >>post birth) are simply taken to record results in the notes which may >>protect against litigation in the future. I have a million issues with >>this practice! We had a university supervised professional debate about >>this issue in the Trust where I worked when it first became an issue. The >>midwives against and the Obs. for. We won the debate but the CNST >>requirements meant that we could save the Trust loads of money if we did >>them so they were introduced. Some of us still refused to do them. I would >>only do them if it was explained in full to the mother and father and they >>agreed. I gave it to them warts and all (like the obs openly admit that it >>is just to defend them in cases of litigation.). I did not make the >>decision the parents did. Needless to say when you tell them how >>inaccurate the results are and that neither they nor the baby will benfit >>from the results. Many choose not to have it done. >>I will search out my references and post them seperately. Our debate was >>published in a midwifery mag here! >>Shelly >>Midwife >>----- Original Message ----- From: "Naomi Wilkin" >><[EMAIL PROTECTED]> >>To: <ozmidwifery@acegraphics.com.au> >>Sent: Friday, October 13, 2006 9:07 AM >>Subject: [ozmidwifery] cord blood gases >> >> >>>Hi all, >>>Just wondering how common it is for cord blood gases to be done in >>>maternity units. I work in a small metro. hospital with a very busy >>>maternity unit and our medical 'powers that be' are pushing for them to >>>be done at every birth. Something we, the midwives, are very, very >>>reluctant to do. >>>I was also wondering if anyone knows of any research that may help us to >>>prevent this from becoming a routine thing. >>> >>>Thanks >>>Naomi. >>> >>> >>>-- >>>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 Free Edition. >>>Version: 7.1.394 / Virus Database: 268.12.12/461 - Release Date: >>>02/10/2006 >>> >>> >> >> >>-- >>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. _________________________________________________________________ The new Windows Live Toolbar helps you guard against viruses http://toolbar.live.com/?mkt=en-gb -- This mailing list is sponsored by ACE Graphics. 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