[ozmidwifery] not weighing placentas

[Helen and Graham]

Does anyone have research to support the 
discontinuation of weighing placentas as a routine practice?  I have worked 
in places that stopped doing it years ago and feel anecdotally that weighing 
placentas has no clinical benefit.  However, I don't know if it has 
been discontinued as a result of any particular research study...My current 
work place continues to carry out this practice and I would like to be able 
to give them research based evidence to support 
my suggestion to change their policy.
 
Thanks 
 
Helen

RE: [ozmidwifery] when to cut an episiotomy

[Jennifer Price]

Hi I am usually quite a silent participant but felt an urge to comment on 
this topic.  I have been a midwife for 15years and still am working in hospital settings with high risk women and women that choose to birth in a hospital.  The rate of episiotomy can be high in hospital settings but I 
have had to perform 8 in all this time and all for severe fetal distress and I 
feel that if all of my pregnant women that I cared for were low risk pregnancy 
and natural healthy labour then this would yield a different result.  Sometimes I keep a closer eye on previous history of 3rd & 4th degree tears 
who have done no perineal massage antenatally. hope this helps 
Jenni

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Fw: [ozmidwifery] when to cut an episiotomy

[brendamanning]

 
- Original Message - 
From: brendamanning 
To: [EMAIL PROTECTED] 

Sent: Monday, August 22, 2005 8:52 AM
Subject: Re: [ozmidwifery] when to cut an episiotomy

 Paivi<
 
This article was in a Melbourne newspaper 12 months 
ago, probably quite current stats. It can be seen in it's entirety 
on:
 www.theage.com.au
I have been working in Mid since 1979 & cut the 
required 5 episiotomies in my training, since then have cut 2 in the last 
20 years, both for fetal distress.
 
BM
To cut or not: debate on childbirth procedure

By Amanda DunnHealth 
ReporterAugust 13, 2004

A surgical cut to make room for the baby's head in a 
vaginal birth is too commonly performed in private Victorian hospitals, an 
obstetric expert has warned.
Obstetric epidemiologist James King also told The Age that, 
conversely, severe vaginal tears during childbirth are more prevalent in public 
hospitals, which may indicate the need for better supervision of inexperienced 
doctors. 
"Sometimes it (cutting) is absolutely necessary, but it's probably overused," 
he said.
His comments followed a report commissioned by the Department of Human 
Services, which found that between 1999 and 2002, an episiotomy - in which an 
incision is made through the perineum at the entrance to the vagina - was given 
to one in every three private patients, compared with one in five public 
patients. 
 Professor King, who led the review, said the 
difference between public and private rates may be because vaginal deliveries 
were more likely to be supervised by midwives in the public system, who 
supported lower episiotomy rates. 
 Euan Wallace, an obstetrician at Monash Medical 
Centre, said it was once the orthodox view that episiotomy was preferable to 
allowing a vaginal tear because it preserved pelvic floor muscles. But evidence 
since has challenged that view. 
 

  - Original Message - 
  From: 
  Päivi 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, August 21, 2005 6:31 
  PM
  Subject: [ozmidwifery] when to cut an 
  episiotomy
  
  A mom asked me when is episiotomy really needed. 
  She had asked from many professionals, and all just gave her the answer, that 
  "They will try to avoid episiotomy, but will cut just in case, if not sure". 
  In Finland the episiotomy rates are from 4% to 50%, and for 
  firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will 
  know best. (That is a medicalaized hospital midwife in most cases). I 
  already know, that you have a different opinion on  when it is needed, 
  but it would be interesting to know from you, who work as midwifes, how 
  often have you performed episiotomies? Does anyone know, what is the 
  national average in the Australian hospitals?
   
  Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Julia Vaughan]

Here is a quick story about my personal
experience.  When I was birthing my beautiful 4560 gram baby (now 16
months old) my midwife was concerned that my peri had stretched as far as it
was going to  (i.e. not far enough) and was about to perform an episiotomy. 
She was only able to make “a very slight nic” as the scissors were
blunt and I had one almighty contraction at just the right time!   Bub’s
head was out and she was then very quickly born with my peri basically intact
except for some slight grazing.  How lucky was I?  I am just so
thankful for this outcome.  So I tell everyone who is remotely interested
in birth that I was saved by a pair of blunt scissor and one contraction. 
Of course I KNEW (after giving birth to 2 other babies 4440 and 4320 grams
without episiotomy) that I did NOT NEED one of these things anyway!

 

Cheers,

 

Julia V. (Aspiring Midwife)

 

 

 

-Original Message-
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On
Behalf Of Nicole Carver
Sent: Sunday, 21 August 2005 7:56
 PM
To: [EMAIL PROTECTED]
Subject: RE: [ozmidwifery] when to
cut an episiotomy

 



I will only do an episiotomy if I am really concerned about getting
the baby out quickly. I have done one on a peri that was really tight, and
didn't stretch  up. I think I have done three in my career,





 

 

Nicole C.

 

RE: [ozmidwifery] when to cut an episiotomy

[Alan Rooney]

Hi 
paivi
I have 
never taken scissors to to a woman's peri. I believe that a tear is far better 
that cutting. An episiotomy will only open up the soft tissue. this is not 
usually the cause of any problem. However I suppose that there nay be some rare 
occasions that require an episiotomy but I am unable to think of one at this 
time.
 
Alan

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of 
  PäiviSent: Sunday, 21 August 2005 6:31 PMTo: 
  [EMAIL PROTECTED]Subject: [ozmidwifery] when to cut an 
  episiotomy
  A mom asked me when is episiotomy really needed. 
  She had asked from many professionals, and all just gave her the answer, that 
  "They will try to avoid episiotomy, but will cut just in case, if not sure". 
  In Finland the episiotomy rates are from 4% to 50%, and for 
  firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will 
  know best. (That is a medicalaized hospital midwife in most cases). I 
  already know, that you have a different opinion on  when it is needed, 
  but it would be interesting to know from you, who work as midwifes, how 
  often have you performed episiotomies? Does anyone know, what is the 
  national average in the Australian hospitals?
   
  Paivi

Re: [ozmidwifery] As if messing with humans isn't enough..

[Gloria Lemay]

This is the same nightmare scenario we have here in 
lovely Vancouver, BC Canada with our beluga and killer whales in captivity at 
the Vancouver Aquarium.  It would curl your hair.  The sea mammals are 
ultrasounded for "science" ---what does that do to their delicate sonar??  
If not for the fact that the sea mammals are large and in water, I'm sure there 
would be cesareans.  As it is, the babies are born spontaneously (at least 
vaginally although being contained in a small pool as opposed to an ocean has to 
cramp the mother's style) but then the fun begins.  The public is allowed 
to come into the viewing area and great throngs show up to see the cute baby and 
new mom trying to get together to breastfeed.  Needless to say, the breast 
feeding does not go well.  They used to gavage feed the baby whale but 
they always died of infection, so the scientists "discovered" that colostrum is 
essential to baby whale survival.  Now, the question arises, how to get 
that precious colostrum into the baby's gut while still selling tickets to the 
public  H. . . . they invented a whale breast pump.  So, 
the poor mother was lured into a "holding" pool, the water drained out of the 
pool once she was captive, and the pump attached to her mammaries.  The 
colostrum was  thus obtained and force fed to baby.  Baby died 
anywaythere's more to breastfeeding and colostrum than just the substance, 
obviously.  Peace, quiet, privacy and love seem to matter to whales, 
too.  I have it all on tape---videotaped the evening news every 
night.  All I could think was the words of Christ on the cross "Father, 
forgive them for they know not what they do."
Gloria Lemay

  - Original Message - 
  From: 
  Andrea 
  Quanchi 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, August 21, 2005 2:59 
  PM
  Subject: Re: [ozmidwifery] As if messing 
  with humans isn't enough..
  It might be interesting for who ever wrote this to send a 
  letter to the orang u tan keeper at the zoo, When the Melbourne zoo gorilla 
  had a LUSCS a few years a go I ended up in quite a series of emails with the 
  gorilla keeper who was in fact keen to talk about what had happened and why 
  and to explore ways they could have handled it better next time. She in fact 
  very much led the dialogue asking questions about what she had observed and 
  what it might have meant. Asking the PR department at the zoo would be 
  equivilant to asking the PR department at a big hospital to describe why 
  things happen in labour ward. But ask the midwife and you'll get a very 
  different answer.Andrea QuanchiOn 20/08/2005, at 3:34 PM, 
  Carolyn Hastie wrote:
  FYI Carolyn Hastie  ICAN 
E-News 
  Line
  International 
Cesarean Awareness Network
  Volume 
31August 
17 , 2005Focus: 
Eve and Araca
  1. 
Essay: Eve and AracaEarly 
May in Utah usually brings a few warm days and this year was no exception. 
We enjoyed a day trip to the zoo during this warm respite. Hogle Zoo isn’t 
my favorite zoo, but the kids enjoy seeing the 
animals.Two weeks later – 
on Mother’s Day- Eve, a female Orangutan, had a cesarean to deliver her 
baby, Araca. When I first heard the news, I thought, “What else would you 
expect to happen? You have an animal on the endangered species list, 
pregnant. What zoo keeper is going to ‘risk’ that pregnancy and baby by 
sitting on her hands and not doing anything? And ‘anything’ is enough to 
slow an animal’s labor progress.” There were many articles in the following 
weeks about the baby’s arrival. Strangely enough, I wasn’t upset by any of 
them, until I happened to hear a radio ‘interview’ with one of the zoo 
staff. The zoo keeper described the baby’s day, being cared for by the 
staff, fed formula from a bottle and being held by staff in furry vests. The 
radio host joked with her about the care of the baby, asking how the staff 
avoided ‘getting messed on’. The zoo employee said, “We don’t diaper the 
baby, we want to do everything natural with this little orangutan.” 
Suddenly, I was so angry I couldn’t see straight. Here is Eve, whose birth 
was denied her by staff, who now rejects her own baby. Here is a baby, whose 
mother doesn’t recognize or claim her, being fed formula from humans, being 
held by humans in furry vests and being shown off between the hours of 10 
a.m. until 11 a.m. and again at 2 p.m. until 3 p.m. daily, and they have the 
nerve to claim they are doing everything natural because the baby doesn’t 
have a diaper on!I don’t 
know the details of Eve’s birth of her daughter. When called, the Zoo will 
not give out any details. When asked questions like, “How did staff know Eve 
was in labor? How long was she in labor? Was baby in distress at birth?”- no 
answer is given. You and I most likely will never get the answers to these 
questions or to the ultimate one they lead t

Re: [ozmidwifery] when to cut an episiotomy

[Gloria Lemay]

In more than 25 years and over 1200 births, I am 
ashamed to tell you I've cut 3.  One for an unyielding primip perineum 
which would not budge after hour of crowning.  Next birth, it stretched 
nicely and didn't need an epis.  Two, as a last ditch effort in a fatal 
shoulder dystocia--didn't help anything.  Third for a distressed babe with 
bad scalp colour, born with a non pulsing cord and am glad I did it because I 
think there was a real problem there that MAY have compromised the 
baby.
Gloria Lemay, Vancouver  BC

  - Original Message - 
  From: 
  Andrea 
  Quanchi 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, August 21, 2005 3:06 
  PM
  Subject: Re: [ozmidwifery] when to cut an 
  episiotomy
  I think many midwives can claim very good episiotomy rates. 
  Mine over twenty years in "0". My virginal scissors get taken to each birth 
  but have never been out of the packet except to be put in a new packet and re 
  sterilised. Who else would like to celebrate their lack of desire or interest 
  in cutting a woman's perineum.Andrea QuanchiOn 21/08/2005, at 
  6:57 PM, Janet Fraser wrote:
  I'm not one of the 
professionals in here, Paivi but hi anyway. : ) I've read in a few 
places about how episiotomy rates suddenly drop when studies into them 
begin. A hb MW I know does less than one a year so I figure that's a good 
guide.  Mostly in hospitals they're performed for no reason at all 
but the damage they do to women's bodies and psyches horrifies me. It's 
sanctioned genital mutilation. In birth planning meetings I run I suggest to 
women that they never put their bodies in a position that can be easily 
reached by someone with scissors. Our rates are very high in Australia. Well 
IMO, any rate of episiotomy is too high unless it's negligible.Just 
my 2c ; 
)Janet
- Original 
  Message -From: 
Päivi 
To: 
[EMAIL PROTECTED] 
Sent: 
  Sunday, August 21, 2005 6:31 PMSubject: 
  [ozmidwifery] when to cut an 
  episiotomyA 
  mom asked me when is episiotomy really needed. She had asked from many 
  professionals, and all just gave her the answer, that "They will try to 
  avoid episiotomy, but will cut just in case, if not sure". In Finland the 
  episiotomy rates are from 4% to 50%, and for firsttime moms from 
  9% to 88%!. It is usually beleived, that the midwife will know best. (That 
  is a medicalaized hospital midwife in most cases). I already know, 
  that you have a different opinion on  when it is needed, but it would 
  be interesting to know from you, who work as midwifes, how often have 
  you performed episiotomies? Does anyone know, what is the national average 
  in the Australian hospitals? Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Mary Murphy]

Because you asked:  I have cut 3 in 22 yrs
as a homebirth midwife.  1 for foetal distress, 1 for “buttonholing’
& the other I can’t remember.  It was all so long ago.  Working with
a group of 7 other midwives, I have never heard of them cutting episiotomies
either. MM

 











 Who else would like to
celebrate their lack of desire or interest in cutting a woman's perineum.

Re: [ozmidwifery] Kathleen Fahy article in Weekend Australian...

[Judy Chapman]

Thanks
Judy


--- Alphia Possamai-Inesedy <[EMAIL PROTECTED]> wrote:

> Here is a copy of it.
> 
> take care
> Alphia
> 
> August 20, 2005 Saturday Travel Edition
> 
> SECTION: REVIEW; Health; Pg. 29
> 
> LENGTH: 891 words
> 
> HEADLINE: Midwifery is safe,  and access a right
> 
> SOURCE: MATP
> 
> BYLINE: KATHLEEN  FAHY
> 
> BODY:
> ALICIA (not her real name) wanted to give birth in a private
> and safe 
> environment attended by a known midwife. She is young and
> healthy. This 
> makes her an ideal candidate for one-to-one midwifery care
> where a known 
> midwife provides all maternity care for Alicia and her family.
> Midwives are 
> qualified and licensed to provide antenatal, labour and
> post-birth care on 
> their own responsibility. Normal, healthy women who have
> straightforward 
> pregnancies do not need to be under the care of doctors.
> 
> But Alicia and her partner, Paul, couldn't find a midwife to
> provide her 
> care either at home or in a hospital.
> 
> Why not?
> 
> Because women who want to claim maternity care as a Medicare
> rebate must 
> use a doctor. Thanks to this monopoly, virtually all
> pregnancies are 
> managed by doctors, even though this is completely
> unnecessary. Another 
> reason that Alicia couldn't hire a midwife is that midwives
> have been 
> excluded from the network of taxpayer subsidies and safety
> nets provided by 
> the federal Government for doctors' professional indemnity
> cover. The issue 
> of Medicare rebates and indemnity insurance cover for midwives
> are matters 
> of professional competition.
> 
> It can be safely predicted that doctors will resist midwives
> being given 
> access to Medicare. Doctors will claim, or imply, that somehow
> midwives are 
> unsafe. As a midwifery researcher, however, I know that
> midwifery care is 
> safe, and I know doctors cannot produce research evidence from
> randomised 
> controlled trials to the contrary.
> 
> Why did Alice and Paul want a midwife as their maternity care
> provider? 
> According to them, it was because they wanted to feel in
> control of what 
> happened to Alicia and the baby. They disagreed with the
> medical model of 
> birth that thinks in terms of the bodies of women and babies.
> In the 
> medical metaphor, the womb, pelvis and baby are thought of as
> either inert 
> or mechanical. For doctors, the body is thought of as able to
> function 
> independently of the brains and emotions of women and babies;
> but Alicia 
> knows that this is not true.
> 
> Alicia and her partner understand that giving birth is a
> deeply private, 
> even a sexual function. That is why other primates birth in
> private. The 
> medicalised environment is full of strangers who come and go
> and touch the 
> woman. The birth environment that medicine creates is
> dominated by 
> stainless steel, artificial light, airconditioning, hard
> floors, surgical 
> lights and a hospital bed with a rubber-covered mattress.
> Machines are 
> frequently attached to the woman to constantly monitor the
> baby's heart. 
> This immediately suggests that maybe something is or will go
> wrong in a 
> perfectly normal process; thus fear is created. In this
> environment, the 
> woman needs to lie still so the machines that are attached to
> her work 
> well. Not surprisingly, the woman becomes uncomfortable, is
> fearful of 
> strangers and fearful for the baby, she is scared to make a
> noise and 
> scared to make trouble.
> 
> Women cope by using an epidural anaesthetic to block sensation
> below the 
> waist. The outcome of such labours is frequently complications
> for the 
> woman and the baby (BMJ 2000;321:137-141). Women who have
> surgical 
> interventions and who don't get to actually give birth have
> higher rates of 
> depression, guilt, regret, loss of self-esteem, feelings of
> violation, and 
> dissatisfaction with care -- sometimes to the point of
> outright hostility.
> 
> Midwives pay a lot of attention to creating the right
> environment for 
> birth. It is crucial to understand that birthing where the
> woman and 
> midwife know each other helps the women feel emotionally safe
> enough to be 
> uninhibited in labour. When women choose to birth unaided they
> usually 
> experience a great sense of their own strength and
> empowerment.
> 
> Labouring without feeling safe is like driving a car with one
> foot on the 
> pedal and one on the brake; thus fear leads to prolonged
> labour and 
> unnecessary medical interventions. Fear is damaging to labour
> because 
> adrenalin is produced and that disrupts the normal hormonal
> regulation of 
> the process.
> 
> Is midwifery care safe? Should the government allow access to
> Medicare for 
> midwifery managed birth?
> 
> Yes, absolutely!
> 
> All women are entitled to financial support to cover the costs
> of 
> childbirth and doctors shouldn't have a government-mandated
> monopoly. In 
> terms of safety, the research demonstrates that
> midwifery-managed care, for 
> w

RE: [ozmidwifery] when to cut an episiotomy

[Judy Chapman]

Also to consider, a sentence in "Episiotomy and the Second Stage
of Labor" edited by Sheila Kitzinger that has always stood out
for me as it makes so much sense. Whenever you put the scissors
in and cut you ALWAYS have second degree perineal trauma. If you
work to birth the baby with an intact peri then more than half
of the time you will have it. Why do we cause so much pain to
women unnecessarily?? 
In the last few years I have done a first degree nick for a
tight peri and another time for a tight hymenal ring but neither
needed sutures. Where I work we only have the cord scissors on
our tray. 
Cheers
Judy

--- Lieve Huybrechts <[EMAIL PROTECTED]> wrote:

>  
> 
> Hoi Païvi,
> 
>  
> 
> This was on  the list a while ago.
> 
>  
> 
> greetings
> 
> Lieve
> 
>  
> 
>  
> 
> Routine episiotomy shows no benefits, only harm
> Source: Journal of the American Medical Association 2005; 293:
> 2141-8
> 
> Comparing maternal outcomes with routine versus restrictive
> use of
> episiotomy in a systematic review of the literature. 
> 
> Routine episiotomy does not appear to provide the benefits
> traditionally
> credited to it, and, in some cases, is more damaging than a
> spontaneous
> tear, say researchers. 
> 
> Episiotomy was initially introduced on the assumption that a
> deliberate
> incision would heal more quickly and with fewer complications
> than a
> spontaneous tear, and that it would lead to less pelvic floor
> problems,
> such as fecal or urinary incontinence or impaired sexual
> function, later
> on. 
> 
> To determine whether this is actually the case, researchers
> led by
> Katherine Hartmann, from the University of North Carolina at
> Chapel Hill
> in the USA, conducted a systematic review of the best quality
> trials
> available comparing routine with restrictive use of the
> procedure. 
> 
> The 26 articles selected for detailed study were consistent in
> finding
> that routine episiotomy did not reduce the severity of
> laceration, pain,
> or pain medication use, compared with restricted surgery.
> There was also
> no evidence to support the longer-term outcomes ascribed to
> episiotomy,
> including prevention of fecal or urinary incontinence or
> reduced
> impaired sexual function. In fact, pain during intercourse was
> more
> common in women who underwent the procedure. 
> 
> Study co-author John Thorp Jr. summarized: "In most cases,
> episiotomy
> doesn't do any good, and it can harm women. Why would one want
> a
> surgical procedure that's worthless
> 
>  
>  
> Lieve Huybrechts
> vroedvrouw
> 0477/740853
> 
> -Oorspronkelijk bericht-
> Van: [EMAIL PROTECTED]
> [mailto:[EMAIL PROTECTED] Namens Päivi
> Verzonden: zondag 21 augustus 2005 10:31
> Aan: [EMAIL PROTECTED]
> Onderwerp: [ozmidwifery] when to cut an episiotomy
> 
> 
> A mom asked me when is episiotomy really needed. She had asked
> from many
> professionals, and all just gave her the answer, that "They
> will try to
> avoid episiotomy, but will cut just in case, if not sure". In
> Finland
> the episiotomy rates are from 4% to 50%, and for firsttime
> moms from 9%
> to 88%!. It is usually beleived, that the midwife will know
> best. (That
> is a medicalaized hospital midwife in most cases). I already
> know, that
> you have a different opinion on  when it is needed, but it
> would be
> interesting to know from you, who work as midwifes, how often
> have you
> performed episiotomies? Does anyone know, what is the national
> average
> in the Australian hospitals?
>  
> Paivi
> 
> 
> --
> No virus found in this incoming message.
> Checked by AVG Anti-Virus.
> Version: 7.0.338 / Virus Database: 267.10.13/78 - Release
> Date:
> 19/08/2005
> 
> 
> 
> -- 
> No virus found in this outgoing message.
> Checked by AVG Anti-Virus.
> Version: 7.0.338 / Virus Database: 267.10.13/78 - Release
> Date:
> 19/08/2005
>  
> 







 
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Re: [ozmidwifery] Kathleen Fahy article in Weekend Australian...

[Alphia Possamai-Inesedy]

Here is a copy of it.
take care
Alphia
August 20, 2005 Saturday Travel Edition

SECTION: REVIEW; Health; Pg.
29
LENGTH: 891 words
HEADLINE: Midwifery is safe, 
and access a right
SOURCE: MATP
BYLINE: KATHLEEN  FAHY
BODY:
ALICIA (not her real name) wanted to give birth in a private and
safe environment attended by a known midwife. She is young and
healthy. This makes her an ideal candidate for one-to-one
midwifery care where a known midwife provides all maternity care
for Alicia and her family. Midwives are qualified and licensed to provide
antenatal, labour and post-birth care on their own responsibility.
Normal, healthy women who have straightforward pregnancies do not need to
be under the care of doctors.
But Alicia and her partner, Paul, couldn't find a midwife to provide her
care either at home or in a hospital. 
Why not?
Because women who want to claim maternity care as a Medicare rebate must
use a doctor. Thanks to this monopoly, virtually all pregnancies are
managed by doctors, even though this is completely unnecessary. Another
reason that Alicia couldn't hire a midwife is that midwives have been
excluded from the network of taxpayer subsidies and safety nets provided
by the federal Government for doctors' professional indemnity cover. The
issue of Medicare rebates and indemnity insurance cover for midwives are
matters of professional competition.
It can be safely predicted that doctors will resist midwives being given
access to Medicare. Doctors will claim, or imply, that somehow
midwives are unsafe. As a midwifery researcher, however, I know
that midwifery care is safe, and I know doctors cannot
produce research evidence from randomised controlled trials to the
contrary.
Why did Alice and Paul want a midwife as their maternity care provider?
According to them, it was because they wanted to feel in control of what
happened to Alicia and the baby. They disagreed with the medical model of
birth that thinks in terms of the bodies of women and babies. In the
medical metaphor, the womb, pelvis and baby are thought of as either
inert or mechanical. For doctors, the body is thought of as able to
function independently of the brains and emotions of women and babies;
but Alicia knows that this is not true.
Alicia and her partner understand that giving birth is a deeply private,
even a sexual function. That is why other primates birth in private. The
medicalised environment is full of strangers who come and go and touch
the woman. The birth environment that medicine creates is dominated by
stainless steel, artificial light, airconditioning, hard floors, surgical
lights and a hospital bed with a rubber-covered mattress. Machines are
frequently attached to the woman to constantly monitor the baby's heart.
This immediately suggests that maybe something is or will go wrong in a
perfectly normal process; thus fear is created. In this environment, the
woman needs to lie still so the machines that are attached to her work
well. Not surprisingly, the woman becomes uncomfortable, is fearful of
strangers and fearful for the baby, she is scared to make a noise and
scared to make trouble.
Women cope by using an epidural anaesthetic to block sensation below the
waist. The outcome of such labours is frequently complications for the
woman and the baby (BMJ 2000;321:137-141). Women who have surgical
interventions and who don't get to actually give birth have higher rates
of depression, guilt, regret, loss of self-esteem, feelings of violation,
and dissatisfaction with care -- sometimes to the point of outright
hostility.
Midwives pay a lot of attention to creating the right environment for
birth. It is crucial to understand that birthing where the woman and
midwife know each other helps the women feel emotionally safe
enough to be uninhibited in labour. When women choose to birth unaided
they usually experience a great sense of their own strength and
empowerment.
Labouring without feeling safe is like driving a car with one foot
on the pedal and one on the brake; thus fear leads to prolonged labour
and unnecessary medical interventions. Fear is damaging to labour because
adrenalin is produced and that disrupts the normal hormonal regulation of
the process.
Is midwifery care safe? Should the government allow
access to Medicare for midwifery managed birth?
Yes, absolutely!
All women are entitled to financial support to cover the costs of
childbirth and doctors shouldn't have a government-mandated monopoly. In
terms of safety, the research demonstrates that midwifery-managed
care, for women who are healthy and have straightforward pregnancies,
there is no statistically significant difference in the outcomes for the
babies. Research shows, however, that midwifery-managed birth is
safer for women than birth under the direction of doctors (Cochrane,
2001, 2005).
The Australian Medical Association and the Royal Australian College of
Obstetricians and Gynaecologists both oppose independent occupational
status for midwives. Midwi

Re: [ozmidwifery] Kathleen Fahy article in Weekend Australian...

[Judy Chapman]

Tania,
Any chance of scanning and posting??
Cheers
Judy

--- Tania Smallwood <[EMAIL PROTECTED]> wrote:

> Unfortunately not available electronically, but titled
> "Midwifery is safe,
> and access a right" what a wonderful comment on women's rights
> and the sad
> state of affairs here in Australia where most midwives do not,
> and are not
> allowed to work truly as midwives, encompassing the full
> extent of our
> legislated practice guidelines.  She challenges Doctors to
> provide research
> evidence from randomized controlled trials to prove that
> midwifery care is
> not safe, and states that doctors shouldn't have a government
> mandated
> monopoly on provision of care for pregnant women.  She goes on
> to say that
> women should be free to choose their maternity care providers
> without
> financial penalty, and that as professional, midwives should
> have the right
> to provide maternity care to the full legal scope of their
> practice. 
> 
>  
> 
> Three cheers for Kathleen Fahy!
> 
>  
> 
> Tania
> 
> 




 
Do you Yahoo!? 
Messenger 7.0 beta: Free worldwide PC to PC calls
http://au.beta.messenger.yahoo.com
--
This mailing list is sponsored by ACE Graphics.
Visit  to subscribe or unsubscribe.

RE: [ozmidwifery] Liability ruling in Weekend Australian

[Tania Smallwood]

You said it all Sally_Anne

 

Tania

xx

 









From: owner-[EMAIL PROTECTED]
[mailto:owner-[EMAIL PROTECTED]]
On Behalf Of Sally-Anne Brown
Sent: Monday, 22 August 2005 5:19
AM
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery]
Liability ruling in Weekend Australian



 



Thanks for this link Tania, 





 





re the case - two thoughts





 





ONE - this is exactly why all midwives need to be aware that
they should have their own PI Insurance - because of the reality that vicarious
liability alone does not cover a midwife.  Sadly - many midwives still
make the assumption that the PI Insurance issue is to be put in the basket
for IPM's to deal with, in the belief it is only their issue (how sad our
colleagues are not supported anyway! ) - but the truth is PI is an issue
that affects all midwives ! 





 





good to see Bisits calling it as it is and not buying into
the primary care stuff as RANZCOG recently did (it would be delightful to be a
fly on the wall right now). Of course Mourik's claim that Ob's be responsible
for the work of midwives is the response we would expect when the issue not
been faced is the OB been responisble for
their own work..which leads into point two.





 





TWO - 





 







We all know obstetric beds are the highest number of
hospital beds used currently approx 250,000 per year.  And
despite the OB's  largely turning birthing into big
 'business' - with overservicing of well women and less time
available for the women who do need hrs of intensive obstetric care -
govts still provide the funds to keep it happenning,





 





Women do not actually receive the care they think they
will when they choose an obstetrician for their care in both the private and
public health sector. we know the OB's do not provide the care
for a woman experiencing labour and birth -  it
is the midwives who provide this care with the OB glorified for
catching the baby (if they actually make it in time -and only if the woman
has private health cover).  Whilst different OB's do have
different practices, in the public health arena a woman does not realise that
even in an obstetric emergency - caesarean section or emergency medical
care - the Obstetrician does not provide this.  - women do not
realise it is provided by the team of midwives and drs/ob's in
training (residents and registrars) while the obstetricians who may
have seen the women for one or two brief periods in pregnancy and birth (15-30
mins ?) are drumming up big business (scans and genetic tests), often
imposed on healthy well young women at whim - who again do not need to be overserviced
with costly and unnessary tests. and we all know only a small proportion of
women receiving this care actually need it - and the costs to women and the
system are exorbitant. 





 







Yet how do the govts address this ? - when the
insurance crisis hit the fed government bailed the OB's out to the
tune of $600 million and libs senator helen coonan secured coverage with
Llyods (London) ... the govt also provides access to
the high costs claim scheme (where if the Ob's PI insurance fee is more
than 7.5% of their income the govt pays the rest 80% AND will payout any
claim over $300,000 !) - not to mention the
coverage by medicare etc.





 





so why do govts continue to pay unnessary medicalised birth
costs and the 'patch up the damage funds' for other health costs resulting from
women recovering from traumatic birth experiences, postnatal depression etc ?
 why do they keep plugging up the holes and support a service that is
essentially unnessary and expensive medical sub standard care for the
majority of women (80% WHO) ?







 





Why do govts deny women the right to experience the safest
and most cost effective pregnancy and birth care ensuring the health
system 'dam' wall bursts while midwives do not have equity to
access medicare provider numbers or insurance ? ... yes abbott has stated
he is now finally considering
medicare for midwives but only if a woman has been serviced by the public
health budget of a medicare swiped visit to the GP for a referral first ! 





 





despite all the evidence, unnessa'scary costs are continuing
to be paid out big time - for sub-standard care of healthy well women
experiencing pregnancy and birth.  one does not need to look much
further than the individual and organisational donations at election time
and the politics of the obstetric alliance to work out why.





 





Sally-Anne 





 









- Original Message - 





From: Tania Smallwood






To: [EMAIL PROTECTED] 





Sent: Sunday, August 21,
2005 7:00 PM





Subject: [ozmidwifery]
Liability ruling in Weekend Australian





 



http://www.theaustralian.news.com.au/common/story_page/0,5744,16318814%255E23289,00.html

 

 


 
  
   
  
 


Liability ruling delivers
fuel to midwife debate
Adam Cresswell, health editor
August 20, 2005 

DOCTORS and midwives are at loggerheads
over their legal liab

Re: [ozmidwifery] when to cut an episiotomy

[Andrea Quanchi]

I think many midwives can claim very good episiotomy rates. Mine over twenty years in "0". My virginal scissors get taken to each birth but have never been out of the packet except to be put in a new packet and re sterilised.  Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum.

Andrea Quanchi

On 21/08/2005, at 6:57 PM, Janet Fraser wrote:

I'm not one of the professionals in here, Paivi but hi anyway. : ) I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide.  Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible.
Just my 2c ; )
Janet
- Original Message -
From: Päivi 
To: [EMAIL PROTECTED] 
Sent: Sunday, August 21, 2005 6:31 PM
Subject: [ozmidwifery] when to cut an episiotomy

A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomy rates are from 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases). I already know, that you have a different opinion on  when it is needed, but it would be interesting to know from you, who work as midwifes, how often have you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals?
 
Paivi

Re: [ozmidwifery] As if messing with humans isn't enough..

[Andrea Quanchi]

It might be interesting for who ever wrote this to send a letter to the orang u tan keeper at the zoo, When the Melbourne zoo gorilla had a LUSCS a few years a go I ended up in quite a series of emails with the gorilla keeper who was in fact keen to talk about what had happened and why and to explore ways they could have handled it better next time. She in fact very much led the dialogue asking questions about what she had observed and what it might have meant. Asking the PR department at the zoo would be equivilant to asking the PR department at a big hospital to describe why things happen in labour ward. But ask the midwife and you'll get a very different answer.

Andrea Quanchi


On 20/08/2005, at 3:34 PM, Carolyn Hastie wrote:

FYI
 
Carolyn Hastie 

 
ICAN E-News LineInternational Cesarean Awareness NetworkVolume 31
August 17 , 2005

Focus: Eve and Araca1. Essay: Eve and Araca

Early May in Utah usually brings a few warm days and this year was no exception. We enjoyed a day trip to the zoo during this warm respite. Hogle Zoo isn’t my favorite zoo, but the kids enjoy seeing the animals.

Two weeks later – on Mother’s Day- Eve, a female Orangutan, had a cesarean to deliver her baby, Araca. When I first heard the news, I thought, “What else would you expect to happen? You have an animal on the endangered species list, pregnant. What zoo keeper is going to ‘risk’ that pregnancy and baby by sitting on her hands and not doing anything? And ‘anything’ is enough to slow an animal’s labor progress.” There were many articles in the following weeks about the baby’s arrival. Strangely enough, I wasn’t upset by any of them, until I happened to hear a radio ‘interview’ with one of the zoo staff. The zoo keeper described the baby’s day, being cared for by the staff, fed formula from a bottle and being held by staff in furry vests. The radio host joked with her about the care of the baby, asking how the staff avoided ‘getting messed on’. The zoo employee said, “We don’t diaper the baby, we want to do everything natural with this little orangutan.” Suddenly, I was so angry I couldn’t see straight. Here is Eve, whose birth was denied her by staff, who now rejects her own baby. Here is a baby, whose mother doesn’t recognize or claim her, being fed formula from humans, being held by humans in furry vests and being shown off between the hours of 10 a.m. until 11 a.m. and again at 2 p.m. until 3 p.m. daily, and they have the nerve to claim they are doing everything natural because the baby doesn’t have a diaper on!

I don’t know the details of Eve’s birth of her daughter. When called, the Zoo will not give out any details. When asked questions like, “How did staff know Eve was in labor? How long was she in labor? Was baby in distress at birth?”- no answer is given. You and I most likely will never get the answers to these questions or to the ultimate one they lead to, “Was the cesarean really necessary?”

In the end, it might matter if we knew and it might not. What I do know is that there is a mother who does not know her baby and a baby who does not know her mother. They did not get to bond after a natural birth. The baby never breast feed. The baby has not learned to cuddle with her mother and, in turn, may not mother her own babies naturally. Generations have been affected by this cesarean, in a species that does not have generations to give to the nervous human.

~  Pamela Udy, ICAN VP

A quick note: Hogle Zoo itself admits the cesarean is the reason Eve does not recognize her baby. Here is a blurb from their website:
Baby Orangutan

The baby, born Mother’s Day weekend by cesarean section, is slowly being introduced to her mom. Because of the cesarean birth, Eve does not yet recognize the baby as hers. The staff is doing slow introductions, in an off exhibit area, to help mother and daughter bond.

http://hoglezoo.org/about/events/

http://www.hoglezoo.org/whats.new/

Re: [ozmidwifery] Liability ruling in Weekend Australian

[Sally-Anne Brown]

Thanks for this link Tania, 
 
re the case - two thoughts
 
ONE - this is exactly why all midwives need to be 
aware that they should have their own PI Insurance - because of the reality that 
vicarious liability alone does not cover a midwife.  Sadly - many midwives 
still make the assumption that the PI Insurance issue is to be put in the 
basket for IPM's to deal with, in the belief it is only their issue (how sad our 
colleagues are not supported anyway! ) - but the truth is PI is an issue 
that affects all midwives ! 
 
good to see Bisits calling it as it is and not 
buying into the primary care stuff as RANZCOG recently did (it would be 
delightful to be a fly on the wall right now). Of course Mourik's claim that 
Ob's be responsible for the work of midwives is the response we would expect 
when the issue not been faced is the OB been responisble for their own 
work..which leads into point two.
 
TWO - 
 

We all know obstetric beds are the highest 
number of hospital beds used currently approx 250,000 per year.  
And despite the OB's  largely 
turning birthing into big  'business' - with overservicing of well 
women and less time available for the women who do need hrs of 
intensive obstetric care - govts still provide the funds to keep it 
happenning,
 
Women do not actually receive the care they 
think they will when they choose an obstetrician for their care in both the 
private and public health sector. we know the OB's do not 
provide the care for a woman experiencing 
labour and birth -  it is the midwives who provide this care 
with the OB glorified for catching the baby (if they actually make it in 
time -and only if the woman has private health cover).  Whilst 
different OB's do have different practices, in the public health arena a woman 
does not realise that even in an obstetric 
emergency - caesarean section or emergency medical care - the Obstetrician 
does not provide this.  - women do 
not realise it is provided by the team of midwives and drs/ob's 
in training (residents and registrars) while the obstetricians who may 
have seen the women for one or two brief periods in pregnancy and birth (15-30 
mins ?) are drumming up big business (scans and genetic tests), often 
imposed on healthy well young women at whim - who 
again do not need to be overserviced with costly and unnessary tests. and we all 
know only a small proportion of women receiving this care actually need it - and 
the costs to women and the system are exorbitant. 
 

Yet how do the govts address this ? - when the 
insurance crisis hit the fed government bailed the OB's out to the 
tune of $600 million and libs senator helen coonan secured coverage with 
Llyods (London) ... the govt also provides access to 
the high costs claim scheme (where if the Ob's PI insurance fee is more 
than 7.5% of their income the govt pays the rest 80% AND will payout any 
claim over $300,000 !) - not to mention the 
coverage by medicare etc.
 
so why do govts continue to pay unnessary 
medicalised birth costs and the 'patch up the damage funds' for other health 
costs resulting from women recovering from traumatic birth experiences, 
postnatal depression etc ?  why do they keep plugging up the holes and 
support a service that is essentially unnessary and expensive 
medical sub standard care for the majority of women (80% 
WHO) ?
 
Why do govts deny women the right to experience the 
safest and most cost effective pregnancy and birth care ensuring the health 
system 'dam' wall bursts while midwives do not have equity to 
access medicare provider numbers or insurance ? ... yes abbott has stated he is now finally considering 
medicare for midwives but only if a woman has been serviced by the public health 
budget of a medicare swiped visit to the GP for a referral first ! 
 
despite all the evidence, unnessa'scary costs are 
continuing to be paid out big time - for sub-standard care of healthy well 
women experiencing pregnancy and birth.  one does not need to look 
much further than the individual and organisational donations at election 
time and the politics of the obstetric alliance to work out why.
 
Sally-Anne 
 

  - Original Message - 
  From: 
  Tania 
  Smallwood 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, August 21, 2005 7:00 
  PM
  Subject: [ozmidwifery] Liability ruling 
  in Weekend Australian
  
  
  http://www.theaustralian.news.com.au/common/story_page/0,5744,16318814%255E23289,00.html
   
   
  


  
 
  Liability ruling delivers 
  fuel to midwife debateAdam Cresswell, health editorAugust 20, 2005 
  
  DOCTORS and midwives are at 
  loggerheads over their legal liabilities from new-style birthing units after a 
  hospital sued an obstetrician to recover a share of the $7.5million it was 
  ordered to pay for a birth mishap involving a 
  midwife.Obstetricians say the 
  case vindicates their fears they will be held responsible for the work of 
  midwives, who are pushing for expanded ro

RE: [ozmidwifery] when to cut an episiotomy

[Sally Westbury]

I have never cut an episiotomy since I have
been registered as a midwife. I did as a student midwife in 1988. 

 

Sally Westbury

Homebirth Midwife

"Learn from
mothers and babies; every one of them has a unique story to tell. Look for
wisdom in the humblest places - that's usually where you'll find it."

— Lois Wilson

 

RE: [ozmidwifery] when to cut an episiotomy

[Nicole Carver]

Hi 
Paivi,
Not as 
many births as some of my colleagues. However, I have been to a Dennis Walsh 
workshop called something like Evidence Based Care in Normal Labour. He stated 
that the ONLY evidence based reason for episiotomy is in severe fetal distress. 
They are sometimes required for manoevres to get a baby out with severe shoulder 
dystocia, but in most cases not.
Certainly, I have had a couple of tears personally, and I didn't find 
them a problem. However, the thought of someone taking scissors to my perineum 
fills me with terror!
Kind 
regards,
Nicole.

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of 
  PäiviSent: Sunday, August 21, 2005 9:53 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to 
  cut an episiotomy
  Hi Nicole,
   
  That is so awasome, how many births have you done 
  in your career?  I read about a midwife, who had performed 6 episiotomies 
  in 650 births. Two of these were when she was taught how to make them as a 
  student.
   
  Paivi
  
- Original Message - 
From: 
Nicole Carver 
To: ozmidwifery@acegraphics.com.au 

Sent: Sunday, August 21, 2005 12:55 
PM
Subject: RE: [ozmidwifery] when to cut 
an episiotomy

I 
will only do an episiotomy if I am really concerned about getting the baby 
out quickly. I have done one on a peri that was really tight, and didn't 
stretch  up. I think I have done three in my 
career,
Nicole C.

  -Original Message-From: [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Janet 
  FraserSent: Sunday, August 21, 2005 6:57 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when 
  to cut an episiotomy
  I'm not one of the 
  professionals in here, Paivi but hi anyway. : ) I've read in a few 
  places about how episiotomy rates suddenly drop when studies into them 
  begin. A hb MW I know does less than one a year so I figure that's a good 
  guide.  Mostly in hospitals they're performed for no reason at 
  all but the damage they do to women's bodies and psyches horrifies me. 
  It's sanctioned genital mutilation. In birth planning meetings I run I 
  suggest to women that they never put their bodies in a position that can 
  be easily reached by someone with scissors. Our rates are very high in 
  Australia. Well IMO, any rate of episiotomy is too high unless it's 
  negligible.
  Just my 2c ; 
  )
  Janet
  
- Original Message - 
From: 
Päivi 
To: ozmidwifery@acegraphics.com.au 

Sent: Sunday, August 21, 2005 6:31 
PM
Subject: [ozmidwifery] when to cut 
an episiotomy

A mom asked me when is episiotomy really 
needed. She had asked from many professionals, and all just gave her the 
answer, that "They will try to avoid episiotomy, but will cut just in 
case, if not sure". In Finland the episiotomy rates are from 
4% to 50%, and for firsttime moms from 9% to 88%!. It is usually 
beleived, that the midwife will know best. (That is a medicalaized 
hospital midwife in most cases). I already know, that you have a 
different opinion on  when it is needed, but it would be 
interesting to know from you, who work as midwifes, how often have 
you performed episiotomies? Does anyone know, what is the national 
average in the Australian hospitals?
 
Paivi

Re: [ozmidwifery] when to cut an episiotomy

[Päivi]

Hi Nicole,
 
That is so awasome, how many births have you done 
in your career?  I read about a midwife, who had performed 6 episiotomies 
in 650 births. Two of these were when she was taught how to make them as a 
student.
 
Paivi

  - Original Message - 
  From: 
  Nicole 
  Carver 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Sunday, August 21, 2005 12:55 
  PM
  Subject: RE: [ozmidwifery] when to cut an 
  episiotomy
  
  I 
  will only do an episiotomy if I am really concerned about getting the baby out 
  quickly. I have done one on a peri that was really tight, and didn't 
  stretch  up. I think I have done three in my career,
  Nicole C.
  
-Original Message-From: [EMAIL PROTECTED] 
[mailto:[EMAIL PROTECTED]On Behalf Of Janet 
FraserSent: Sunday, August 21, 2005 6:57 PMTo: 
ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to 
cut an episiotomy
I'm not one of the 
professionals in here, Paivi but hi anyway. : ) I've read in a few 
places about how episiotomy rates suddenly drop when studies into them 
begin. A hb MW I know does less than one a year so I figure that's a good 
guide.  Mostly in hospitals they're performed for no reason at all 
but the damage they do to women's bodies and psyches horrifies me. It's 
sanctioned genital mutilation. In birth planning meetings I run I suggest to 
women that they never put their bodies in a position that can be easily 
reached by someone with scissors. Our rates are very high in Australia. Well 
IMO, any rate of episiotomy is too high unless it's negligible.
Just my 2c ; 
)
Janet

  - Original Message - 
  From: 
  Päivi 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Sunday, August 21, 2005 6:31 
  PM
  Subject: [ozmidwifery] when to cut an 
  episiotomy
  
  A mom asked me when is episiotomy really 
  needed. She had asked from many professionals, and all just gave her the 
  answer, that "They will try to avoid episiotomy, but will cut just in 
  case, if not sure". In Finland the episiotomy rates are from 4% 
  to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, 
  that the midwife will know best. (That is a medicalaized hospital midwife 
  in most cases). I already know, that you have a different opinion 
  on  when it is needed, but it would be interesting to know from you, 
  who work as midwifes, how often have you performed episiotomies? Does 
  anyone know, what is the national average in the Australian 
  hospitals?
   
  Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Nicole Carver]

I will 
only do an episiotomy if I am really concerned about getting the baby out 
quickly. I have done one on a peri that was really tight, and didn't 
stretch  up. I think I have done three in my career,
Nicole 
C.

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Janet 
  FraserSent: Sunday, August 21, 2005 6:57 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to 
  cut an episiotomy
  I'm not one of the 
  professionals in here, Paivi but hi anyway. : ) I've read in a few places 
  about how episiotomy rates suddenly drop when studies into them begin. A hb MW 
  I know does less than one a year so I figure that's a good 
  guide.  Mostly in hospitals they're performed for no reason at all 
  but the damage they do to women's bodies and psyches horrifies me. It's 
  sanctioned genital mutilation. In birth planning meetings I run I suggest to 
  women that they never put their bodies in a position that can be easily 
  reached by someone with scissors. Our rates are very high in Australia. Well 
  IMO, any rate of episiotomy is too high unless it's negligible.
  Just my 2c ; )
  Janet
  
- Original Message - 
From: 
Päivi 
To: ozmidwifery@acegraphics.com.au 

Sent: Sunday, August 21, 2005 6:31 
PM
Subject: [ozmidwifery] when to cut an 
episiotomy

A mom asked me when is episiotomy really 
needed. She had asked from many professionals, and all just gave her the 
answer, that "They will try to avoid episiotomy, but will cut just in case, 
if not sure". In Finland the episiotomy rates are from 4% to 50%, 
and for firsttime moms from 9% to 88%!. It is usually beleived, that the 
midwife will know best. (That is a medicalaized hospital midwife in most 
cases). I already know, that you have a different opinion on  when 
it is needed, but it would be interesting to know from you, who work as 
midwifes, how often have you performed episiotomies? Does anyone know, 
what is the national average in the Australian hospitals?
 
Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Lieve Huybrechts]

Title: Bericht




 
Hoi 
Païvi,
 
This was on  the 
list a while ago.
 
greetings
Lieve
 
 
Routine episiotomy shows no 
benefits, only harmSource: Journal 
of the American Medical Association 2005; 293: 2141-8
Comparing maternal 
outcomes with routine versus restrictive use of episiotomy in a systematic 
review of the literature. 

Routine episiotomy 
does not appear to provide the benefits traditionally credited to it, and, in 
some cases, is more damaging than a spontaneous tear, say researchers. 

Episiotomy was 
initially introduced on the assumption that a deliberate incision would heal 
more quickly and with fewer complications than a spontaneous tear, and that it 
would lead to less pelvic floor problems, such as fecal or urinary incontinence 
or impaired sexual function, later on. 
To determine 
whether this is actually the case, researchers led by Katherine Hartmann, from 
the University of North Carolina at Chapel Hill in the 
USA, conducted a systematic review of 
the best quality trials available comparing routine with restrictive use of the 
procedure. 
The 26 articles 
selected for detailed study were consistent in finding that routine episiotomy 
did not reduce the severity of laceration, pain, or pain medication use, 
compared with restricted surgery. There was also no evidence to support the 
longer-term outcomes ascribed to episiotomy, including prevention of fecal or 
urinary incontinence or reduced impaired sexual function. In fact, pain during 
intercourse was more common in women who underwent the procedure. 

Study co-author 
John Thorp Jr. summarized: "In most cases, episiotomy doesn't do any good, and 
it can harm women. Why would one want a surgical procedure that's 
worthless
 
 
Lieve Huybrechts
vroedvrouw
0477/740853

  
  -Oorspronkelijk bericht-Van: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] Namens 
  PäiviVerzonden: zondag 21 augustus 2005 10:31Aan: 
  ozmidwifery@acegraphics.com.auOnderwerp: [ozmidwifery] when to cut 
  an episiotomy
  A mom asked me when is episiotomy really needed. 
  She had asked from many professionals, and all just gave her the answer, that 
  "They will try to avoid episiotomy, but will cut just in case, if not sure". 
  In Finland the episiotomy rates are from 4% to 50%, and for 
  firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will 
  know best. (That is a medicalaized hospital midwife in most cases). I 
  already know, that you have a different opinion on  when it is needed, 
  but it would be interesting to know from you, who work as midwifes, how 
  often have you performed episiotomies? Does anyone know, what is the 
  national average in the Australian hospitals?
   
  Paivi
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  Date: 19/08/2005


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Re: [ozmidwifery] Human Milk Bank

[Pinky McKay]

I have forwarded this to Margaret Callaghan ( in 
the article)- she is a fabulous LC - a past pres of ALCA a few 
years ago.
 
Haven't heard anything recently re milk bank 
proposal. I think Marg is in NZ at present so we may not hear for a 
while.
 
Pinky 

  - Original Message - 
  From: 
  Janet 
  Fraser 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Sunday, August 21, 2005 6:08 
  PM
  Subject: Re: [ozmidwifery] Human Milk 
  Bank
  
  Hmmm. Well I haven't heard 
  anything about it and I'm in contact with many lactavists who'd love this. I 
  shall do some investigating! Anyone know the LC in the article?
  J
  
- Original Message - 
From: 
Helen and Graham 
To: ozmidwifery 
Sent: Sunday, August 21, 2005 6:02 
PM
Subject: [ozmidwifery] Human Milk 
Bank

This was on the list earlier this 
year.
 
Helen Cahill
 
http://www.theage.com.au/articles/2004/08/12/1092102573402.html
 

  Australia's first milk bankAugust 12, 
  2004 - 1:06PMAustralia's first milk bank is to start offering 
  breast milk to newmothers in Victoria from the beginning of next 
  year.Melbourne-based lactation consultant Margaret Callaghan plans 
  to openthe private service which will pasteurise milk donations and 
  offer themto mothers who cannot produce enough for their own 
  babies.The proposal has raised questions about how the new service 
  would beregulated.Ms Callaghan said the private company 
  setting up the Victorian milk bankplanned to set up in NSW next and 
  then to establish clinics nationwide.She said new mothers who 
  wanted to donate would be screened for diseaseand would then express 
  the milk at home."It wouldn't be like a cow shed," she 
  said.The milk would be pasteurised and given to premature babies 
  whosemothers for some reason could not provide enough 
  milk.Premature babies would be targeted initially as they were the 
  mostlikely to suffer necrotising enterocolitis (NEC), or bowel 
  blockages,after being fed formula, she said.Mothers milk also 
  aided neurological development and reduced the risksof infections, Ms 
  Callaghan said.Hospitals used to provide excess milk from new 
  mothers to babies whoneeded it until the rise of the spectre of AIDS 
  in the 80s.Ms Callaghan said that as the average age of mothers 
  increased, so hadthe demand for breast milk."I have people 
  ringing me saying 'Where can I get some human milkfrom'," she 
  said.The president of paediatrics and child health of the Royal 
  AustralasianCollege of Physicians, Professor Don Roberton today said 
  any move tomake breast milk more available was positive as long as the 
  milk wasproperly screened for disease.Professor Roberton said 
  human milk had advantages over formula,especially for premature 
  babies."But we also have to be very aware of any potential risks 
  that mightoccur with human milk," he said.Breast milk would 
  need to be carefully screened in the same way donatedblood was, he 
  said.Breast milk banks operate in the UK, the USA and parts of 
  Europe but theprospect of them opening in Australia has raised the 
  question of who isresponsible for their regulation.A 
  Therapeutic Goods Administration spokesman said a breast milk 
  bankwould be a state rather than a federal responsibility.A 
  spokesman for the Victorian Department of Human Services said a 
  breastmilk bank would come under the State food act.The 
  operators would have to show their product was "free of infectionand 
  fit for human consumption" and convince the government that they 
  hadstrict screening processes in place, he said.- 
  AAP
  
  

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[ozmidwifery] Kathleen Fahy article in Weekend Australian...

[Tania Smallwood]

Unfortunately not available electronically, but titled “Midwifery
is safe, and access a right” what a wonderful comment on women’s
rights and the sad state of affairs here in Australia where most midwives do
not, and are not allowed to work truly as midwives, encompassing the full
extent of our legislated practice guidelines.  She challenges Doctors to
provide research evidence from randomized controlled trials to prove that
midwifery care is not safe, and states that doctors shouldn’t have a
government mandated monopoly on provision of care for pregnant women.  She
goes on to say that women should be free to choose their maternity care
providers without financial penalty, and that as professional, midwives should
have the right to provide maternity care to the full legal scope of their
practice. 

 

Three cheers for Kathleen Fahy!

 

Tania

[ozmidwifery] Liability ruling in Weekend Australian

[Tania Smallwood]

http://www.theaustralian.news.com.au/common/story_page/0,5744,16318814%255E23289,00.html

 

 


 
  
   
  
 


Liability ruling delivers
fuel to midwife debate
Adam Cresswell, health editor
August 20, 2005 

DOCTORS and midwives are at
loggerheads over their legal liabilities from new-style birthing units after a
hospital sued an obstetrician to recover a share of the $7.5million it was
ordered to pay for a birth mishap involving a midwife.

Obstetricians say
the case vindicates their fears they will be held responsible for the work of
midwives, who are pushing for expanded roles and recently started a second
midwife-led birthing unit in NSW at Belmont near
Newcastle. 

But midwives
such as Robyn Rudner, who works at the Ryde midwifery group practice in Sydney, the state's first
public midwife-led birthing centre, said doctors' fears were overblown. 

She said while
the Ryde and Belmont units had good safety records, midwives would remain
legally responsible for any mistakes they made. 

"We are
fully responsible for women under our care as midwives, and when we transfer
women to a hospital we remain responsible (for their own actions)," she
said. 


 
  
  
   
  
  
  
  
 
 
  
  
   
  
  
  
  
   
  
  
  
  
  
  
   
  
 
 
  
  
   
  
 
 
  
  
   
  
 


The legal case,
adjourned this week in the NSW Supreme Court, was mounted by the Greater
Southern Area Health Service in NSW. 

The doctor
being sued was an on-call obstetrician when the baby was born in September
1995. While the delivery was handled by a midwife in the obstetrician's
absence, the health service claims the doctor failed to adequately supervise
the case. It was ordered to pay the mother $7.5million in April 2003, and is
now seeking a contribution from the obstetrician. 

Pieter Mourik,
a retired obstetrician from Albury, NSW, claimed the case bore out fears
doctors would continue to carry the responsibility for mishaps in a midwife's
delivery. 

Dr Mourik said
the case was "dynamite" and it was "unheard of" for a
hospital to sue a doctor for a procedure carried out by another health worker. 

However, Andrew Bisits, director of
obstetrics at John Hunter Hospital,
who has helped develop the Belmont
unit, said while "the whole atmosphere around pregnancy and childbirth ...
has degenerated into this very negative and fearful experience", units
such as Ryde and Belmont were "an antidote" to such fears. 

 

Re: [ozmidwifery] when to cut an episiotomy

[Janet Fraser]

I'm not one of the 
professionals in here, Paivi but hi anyway. : ) I've read in a few places 
about how episiotomy rates suddenly drop when studies into them begin. A hb MW I 
know does less than one a year so I figure that's a good 
guide.  Mostly in hospitals they're performed for no reason at all but 
the damage they do to women's bodies and psyches horrifies me. It's sanctioned 
genital mutilation. In birth planning meetings I run I suggest to women that 
they never put their bodies in a position that can be easily reached by someone 
with scissors. Our rates are very high in Australia. Well IMO, any rate of 
episiotomy is too high unless it's negligible.
Just my 2c ; )
Janet

  - Original Message - 
  From: 
  Päivi 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Sunday, August 21, 2005 6:31 
  PM
  Subject: [ozmidwifery] when to cut an 
  episiotomy
  
  A mom asked me when is episiotomy really needed. 
  She had asked from many professionals, and all just gave her the answer, that 
  "They will try to avoid episiotomy, but will cut just in case, if not sure". 
  In Finland the episiotomy rates are from 4% to 50%, and for 
  firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will 
  know best. (That is a medicalaized hospital midwife in most cases). I 
  already know, that you have a different opinion on  when it is needed, 
  but it would be interesting to know from you, who work as midwifes, how 
  often have you performed episiotomies? Does anyone know, what is the 
  national average in the Australian hospitals?
   
  Paivi

[ozmidwifery] when to cut an episiotomy

[Päivi]

A mom asked me when is episiotomy really needed. 
She had asked from many professionals, and all just gave her the answer, that 
"They will try to avoid episiotomy, but will cut just in case, if not sure". In 
Finland the episiotomy rates are from 4% to 50%, and for firsttime 
moms from 9% to 88%!. It is usually beleived, that the midwife will know best. 
(That is a medicalaized hospital midwife in most cases). I already know, 
that you have a different opinion on  when it is needed, but it would be 
interesting to know from you, who work as midwifes, how often have you 
performed episiotomies? Does anyone know, what is the national average in the 
Australian hospitals?
 
Paivi

Re: [ozmidwifery] Human Milk Bank

[Janet Fraser]

Hmmm. Well I haven't heard 
anything about it and I'm in contact with many lactavists who'd love this. I 
shall do some investigating! Anyone know the LC in the article?
J

  - Original Message - 
  From: 
  Helen and Graham 
  To: ozmidwifery 
  Sent: Sunday, August 21, 2005 6:02 
  PM
  Subject: [ozmidwifery] Human Milk 
  Bank
  
  This was on the list earlier this 
  year.
   
  Helen Cahill
   
  http://www.theage.com.au/articles/2004/08/12/1092102573402.html
   
  
Australia's first milk bankAugust 12, 2004 
- 1:06PMAustralia's first milk bank is to start offering breast milk 
to newmothers in Victoria from the beginning of next 
year.Melbourne-based lactation consultant Margaret Callaghan plans 
to openthe private service which will pasteurise milk donations and 
offer themto mothers who cannot produce enough for their own 
babies.The proposal has raised questions about how the new service 
would beregulated.Ms Callaghan said the private company setting 
up the Victorian milk bankplanned to set up in NSW next and then to 
establish clinics nationwide.She said new mothers who wanted to 
donate would be screened for diseaseand would then express the milk at 
home."It wouldn't be like a cow shed," she said.The milk 
would be pasteurised and given to premature babies whosemothers for some 
reason could not provide enough milk.Premature babies would be 
targeted initially as they were the mostlikely to suffer necrotising 
enterocolitis (NEC), or bowel blockages,after being fed formula, she 
said.Mothers milk also aided neurological development and reduced 
the risksof infections, Ms Callaghan said.Hospitals used to 
provide excess milk from new mothers to babies whoneeded it until the 
rise of the spectre of AIDS in the 80s.Ms Callaghan said that as the 
average age of mothers increased, so hadthe demand for breast 
milk."I have people ringing me saying 'Where can I get some human 
milkfrom'," she said.The president of paediatrics and child 
health of the Royal AustralasianCollege of Physicians, Professor Don 
Roberton today said any move tomake breast milk more available was 
positive as long as the milk wasproperly screened for 
disease.Professor Roberton said human milk had advantages over 
formula,especially for premature babies."But we also have to be 
very aware of any potential risks that mightoccur with human milk," he 
said.Breast milk would need to be carefully screened in the same way 
donatedblood was, he said.Breast milk banks operate in the UK, 
the USA and parts of Europe but theprospect of them opening in Australia 
has raised the question of who isresponsible for their 
regulation.A Therapeutic Goods Administration spokesman said a 
breast milk bankwould be a state rather than a federal 
responsibility.A spokesman for the Victorian Department of Human 
Services said a breastmilk bank would come under the State food 
act.The operators would have to show their product was "free of 
infectionand fit for human consumption" and convince the government that 
they hadstrict screening processes in place, he said.- 
AAP



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[ozmidwifery] Human Milk Bank

[Helen and Graham]

This was on the list earlier this 
year.
 
Helen Cahill
 
http://www.theage.com.au/articles/2004/08/12/1092102573402.html
 

  Australia's first milk bankAugust 12, 2004 - 
  1:06PMAustralia's first milk bank is to start offering breast milk to 
  newmothers in Victoria from the beginning of next 
  year.Melbourne-based lactation consultant Margaret Callaghan plans to 
  openthe private service which will pasteurise milk donations and offer 
  themto mothers who cannot produce enough for their own babies.The 
  proposal has raised questions about how the new service would 
  beregulated.Ms Callaghan said the private company setting up the 
  Victorian milk bankplanned to set up in NSW next and then to establish 
  clinics nationwide.She said new mothers who wanted to donate would be 
  screened for diseaseand would then express the milk at home."It 
  wouldn't be like a cow shed," she said.The milk would be pasteurised 
  and given to premature babies whosemothers for some reason could not 
  provide enough milk.Premature babies would be targeted initially as 
  they were the mostlikely to suffer necrotising enterocolitis (NEC), or 
  bowel blockages,after being fed formula, she said.Mothers milk 
  also aided neurological development and reduced the risksof infections, Ms 
  Callaghan said.Hospitals used to provide excess milk from new mothers 
  to babies whoneeded it until the rise of the spectre of AIDS in the 
  80s.Ms Callaghan said that as the average age of mothers increased, so 
  hadthe demand for breast milk."I have people ringing me saying 
  'Where can I get some human milkfrom'," she said.The president of 
  paediatrics and child health of the Royal AustralasianCollege of 
  Physicians, Professor Don Roberton today said any move tomake breast milk 
  more available was positive as long as the milk wasproperly screened for 
  disease.Professor Roberton said human milk had advantages over 
  formula,especially for premature babies."But we also have to be 
  very aware of any potential risks that mightoccur with human milk," he 
  said.Breast milk would need to be carefully screened in the same way 
  donatedblood was, he said.Breast milk banks operate in the UK, the 
  USA and parts of Europe but theprospect of them opening in Australia has 
  raised the question of who isresponsible for their regulation.A 
  Therapeutic Goods Administration spokesman said a breast milk bankwould be 
  a state rather than a federal responsibility.A spokesman for the 
  Victorian Department of Human Services said a breastmilk bank would come 
  under the State food act.The operators would have to show their 
  product was "free of infectionand fit for human consumption" and convince 
  the government that they hadstrict screening processes in place, he 
  said.- AAP
  
  

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Information __This message was checked by NOD32 antivirus 
system.http://www.nod32.com

[ozmidwifery] Breastfeeding The Natural State

[Barbara Glare & Chris Bright]

Hi,
 
Not long to go until the Australian Breastfeeding 
Association's International Conference.  Already we have more than 500 
registrants, but there's roon for plenty more.
 
We also have some space available for trade 
displays.  The prices are extremely reasonable  The sponsorship 
prospectus can be downloaded from www.cdesign.com.au/aba2005.The 3 day Conference program includes many well 
known and world renownedspeakers - Dr James McKenna, Dr Brian Palmer, Prof 
Peter Hartmann, Sue Coxand Prof Heather Jeffery, Nancy MoorbacherDay 1 - 
Natural State - focuses on how babies and breasts are meant to be,their 
unique anatomical and physiological qualities, and the role we play 
inensuring they get together for their mutual benefit.Day 2 - Stormy 
Weather - has the scientification of breastfeeding made itmore difficult 
than what it is? Have we created conflict between instinctand expert?Day 
3 -Cultural Perspectives - explores how cultural variations 
influencebreastfeeding knowledge and practice.The provisional 
program has now been uploaded on the website and can beaccessed at www.cdesign.com.au/aba2005.