From: "Christine Holliday" <[EMAIL PROTECTED]>
Reply-To: ozmidwifery@acegraphics.com.au
To: <ozmidwifery@acegraphics.com.au>
Subject: RE: [ozmidwifery] cord blood gases
Date: Wed, 18 Oct 2006 08:50:47 +0930
Do you have any figures for the well babies with abnormal cord gases as
this
evidence would not support routine cord gases on all babies but anecdotal
evidence such as this won't provide us with any support particularly when
it
could be the machine or operators.
Christine
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] Behalf Of michelle
gascoigne
Sent: 18 October 2006 05:45
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] cord blood gases
Melissa
As reported by others already I have seen MANY babes born who were in good
condition at birth with very poor gases. Do we tell parents that? "I know
your baby looks well but the blood gases that you 'consented?' to are
suggesting otherwise". If the baby is in really poor condition can we
console ourselves or the parents with the results of good cord blood gases?
We recently had a big issue in this country where organs from babies and
children who had sadly died were kept for medical research without consent.
Many parents were outraged! I donot believe that you can take samples from
a
cord (any more than organs)and not get permission with your reasons for
taking them, which in the end is purely to protect against litigation. My
experience of inaccuracies would certainly not help me to feel protected by
the results of any blood gases. Some of the reasons that I speculate for
inaccuracies are in collection methods speed of analysis accuracy of the
machine (we had one in theatre and one in labour ward and would get
diffferent results on same blood from each machine.) Then goodness only
knows what effect clinical practices in labour have on the results.
Simply in practice I saw nothing that gave me faith in them as a useful
tool
and I am unable to sell them to parents when we are collecting evidence to
protect us from future litigation.
I am keeping out of the way of football so going off on one now! If we care
for women to the very best of our ability, if we build a relationship with
them and the trust and respect us they are much less likely to sue. Our
efforts would be better placed here I think!
Ultimately a no fault compensation scheme for parents of children with
pregnancy/birth injuries would get away form us spending so much energy
defending ourselves.
I will post the references but have to type them up.
Shelly
----- Original Message -----
From: "Melissa Singer" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Monday, October 16, 2006 4:24 AM
Subject: Re: [ozmidwifery] cord blood gases
> 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.
>>>
>>>
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>>>
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>>
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