Re: Strep B

[Jo Slamen]

Dear Alesa & List,
 
Thank you for the reassurance.  It's great to 
some more of the picture on this topic, and the various frames of 
reference.
 
I really do not want to have the IV during labour - 
for several reasons.  I am also conscious that all being well with the 
labour and birth, and because I have opted for the Family Birth Centre, I will 
be home possibly 36 hours max after the baby is born (which is great), but 
for this reason I'm not sure if the babe will have been observed for long enough 
to show signs of illness or infection.
 
Do you know the procedures for assessing the status 
of the infant regarding Strep B (I guess there's no simple diagnostic test to be 
administered?), and how soon after birth can this be confirmed?
 
Another thank you (I know I'm gushing - but am so 
appreciative of the support) to you all - the list has been 
absolutely fantastic in providing info and education on this for 
me.  Until I get to my homoeopath on Monday, I've switched to a Candida 
diet, and am swallowing acidophillus capsules as an early measure 
anyway...
 
Regards,
 
Jo Slamen
Melbourne
 
- Original Message - 

  From: 
  P & A 
  Koziol 
  To: ozmidwifery 
  Sent: Saturday, March 02, 2002 2:04 
  PM
  Subject: RE: Strep B
  
  Dear Jo
  I am always interested in what I see as the 
  hysteria that surrounds the Strep B debate. I work in a private hospital and 
  the women here are all under the care of their own Dr. The hospital itself 
  does not have a policy regrading treatment of strep B  as each Dr has 
  trained under a different system. They keep up to date and are aware of 
  current treatment options practised at the public hospitals in surrounding 
  suburbs. I trained in a public system which treated all women who were 
  positive with antibiotics in labour and was horrified the first time I 
  saw a Dr ignore this "rule". That was many 
  years ago.
  Some Dr's still treat known Strep B women in 
  labour this way, most do not. We watch the 
  infant closely and treat the infant, if an infant is affected they will 
  usually develop symptoms of illness within the first 24 hours. I have not seen 
  many babes who succumb to Strep B infections in the last 20 years  and of 
  these, many of the mothers have been of unknown status at birth as most of the 
  Dr's do not subject women to vag swabs in pregnancy.
  I am not trying to minimise the risks which Strep 
  B will bring to some infants, but I personally think that this risk is 
  overated for the majority of women and their 
  babes, and the option which we follow is a safe 
  alternative to intervening in pregnancy and labour
   
  Regards 
   
  Alesa
   
  Alesa 
  KoziolClinical Midwifery 
EducatorMelbourne

Re: Rural births

[PJ_WM_HERMEL]

Hi Marilyn,
 
In response to the air ambulance not taking multiparous 
women in labour
 
If it was an obstructed labour, the air ambulance would 
probably not be called instead we would call the Retrieval team.  The 
Retreival team would probably consist of obstetrician, neonatologist, 
anaethetist, midwife and they would deliver the women in our town and then 
mother and baby would be retreived back to Adelaide.  If it looked as if a 
multip women would deliver in town without a GP with obstetric privelages then 
again the retrieval team would be called - this happened only the other day 
& the woman ended up staying in town and they retreived a medical patient 
back to Adelaide 
 
The midwives on the RFDS do see it being a problem if a 
woman delivers mid flight.  It is often just the midwife and the pilot on 
each flight and the planes are very cramped.
Regards Wendy
 

RE: Strep B

[P & A Koziol]

Dear Jo
I am always interested in what I see as the 
hysteria that surrounds the Strep B debate. I work in a private hospital and the 
women here are all under the care of their own Dr. The hospital itself does not 
have a policy regrading treatment of strep B  as each Dr has trained under 
a different system. They keep up to date and are aware of current treatment 
options practised at the public hospitals in surrounding suburbs. I trained in a 
public system which treated all women who were positive with antibiotics in 
labour and was horrified the first time I saw a Dr ignore this "rule". 
That was many years ago.
Some Dr's still treat known Strep B women in labour 
this way, most do not. We watch the infant 
closely and treat the infant, if an infant is affected they will usually develop 
symptoms of illness within the first 24 hours. I have not seen many babes who 
succumb to Strep B infections in the last 20 years  and of these, many of 
the mothers have been of unknown status at birth as most of the Dr's do not 
subject women to vag swabs in pregnancy.
I am not trying to minimise the risks which Strep B 
will bring to some infants, but I personally think that this risk is overated 
for the majority of women and their babes, 
and the option which we follow is a safe 
alternative to intervening in pregnancy and labour
 
Regards 
 
Alesa
 
Alesa 
KoziolClinical Midwifery EducatorMelbourne

Re: Group B Strep Question - For Me This Time

[Jo Slamen]

Dear Lieve,

More great info - thank you so much for taking the time to write - I will be
in touch with my homoeopath on Monday and will be well prepared to discuss
all these aspects for diagnosis and treatment.

Thank you.

Jo Slamen

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Re: Is there moulding in a breech presentation?

[Kleimar]

Dear Melinda: I think (someone please correct me if I am wrong) that that is 
one of the primary concerns with breech birth: there is no moulding. To come 
out the diameter of the baby's skull that presents to move onder the pubic 
arch and out of the pelvic outlet has to match the diameter of the presenting 
part which in a breech would be the bisacromial diameter (hip to hip). If the 
baby is at term and has grown symmetrically, and is well flexed so that the 
smallest diameter of the baby's head presents to be born then all should go 
well.  This lack of moulding is evident on observation of the baby: the 
occiput area may even seem a little flat. Conversely the legs remain in a 
rather flexed position for a while after birth.  I have been present at only 
3 breech births: my second daughter's 24 years ago, and 2 in the last 2 
years. At my daughter's birth the OB used "forceps to ach" (written on her 
identity card) which he explained as necessary to prevent too sudden 
expansion of her cranial bones as she moved so quickly through my pelvis (she 
was only 6lb 8oz, HC 34.5 cm), in any case he used then to guide her out, she 
came out screaming. The first breech I observed was here in Washington in the 
OR and was an attempted standing breech with a primip. The baby's head did 
get stuck and would not deliver, the mom got back onto the "delivery" table 
and the OB delivered the head with forceps (no epis and no tear!), all within 
5 minutes although they were SUCH a long 5 minutes, baby's apgars were 3 then 
8 then 9. Quite scarry, obviously the baby needed resucc at birth but 
recovered well.  That baby was 6 lb 12 oz with a 14.5 inch head (37cm) and 
U/S had detected a large head, the labor had been a pretty typical primip 
labour long and slow with a 2-3 hour second stage. The third baby was an 
undiagnosed breech at home: mum's second baby, rapidly progressing labour (2 
hours active), arrived to mum on all fours making pushing noises and thick 
mec coming from her vagina. Actually relieved to find the presentation was 
breech. By the time  all was set up (10 minutes) she was pushing on de by 
birth stool and baby popped out in 3 to 4 pushes, Apgars  10/10 (no blue even 
on the toes), screaming and 9lb 2oz, don't have a record of the head 
circumference. This is probably more than you wanted, hope it helps. marilyn
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