Re: [ozmidwifery] physiological third stage

[Mary Murphy]

Linda wrote:"Can some one tell me can there be a 
pulse in the umbilical cord if the separation of the placenta is 
complete.   Last night all the signs of separation ie. show, cord 
lengthening etc cord contiued to pulse.  My thoughts were that this doesnt 
happen."  
My experience has been that this is a reflex "loop" pulse from 
the baby's heartbeat down the cord.  the best place to find out is to feel 
the cord right down at the vagina.  My experience has been that the cord 
may be pulsing further up, but when separated, it has stopped near the 
vagins.  Not very scientific I am afraid, but a guideline.  
MM

Re: [ozmidwifery] fetal heart in labour

[Elissa and David]

The following are extracts from the MIDIRS Informed choice leaflet for 
professionals 2.Fetal heart rate monitoring in labour , and the NICE The use of 
electronic fetal monitoring: The use and interpretation of cardiotocography in 
intrapartum fetal surveillance-Guideline C .The full articles can be found at http://www.midirs.org/nelh/nelh.nsf/welcome?openform
and
http://www.nice.org.uk/cat.asp?c=20051
respectively .The question of listening during a 
contraction interests me , as none of the guidelines I've read recommend it but 
it seems to be common practice .Apart from  appearing uncomfortable and 
difficult , my understanding is that heart rate changes during the 
contraction are normal so can anyone tell me the reason for listening during a 
contraction?
  
Cheers,
David
  
Intermittent auscultation (IA) with 
a stethoscope (eg Pinard) or hand-held doppler device. 
Typically, the fetal heart rate is measured for one minute after a contraction 
every 15-30 minutes during the first stage of labour and after every maternal 
push during the second stage. As it is obtained in a non-permanent format, it 
requires the midwife to make contemporaneous records of the observations of the 
fetal heart rate in the woman's notes.
2.3. Appropriate monitoring in an uncomplicated pregnancy 

  
  
A 
For a woman who is healthy and has had an 
  otherwise uncomplicated pregnancy, intermittent auscultation should be 
  offered and recommended in labour to monitor fetal 
wellbeing.

  
  
A 
In the active stages of labour, intermittent auscultation 
  should occur after a contraction, for a minimum of 60 seconds, and at 
  least:

  Every 15 minutes in the first stage. 
  Every 5 minutes in the second stage. 
  Continuos EFM should be offered and recommended in pregnancies previously 
  monitored with intermittent auscultation 

  If there is evidence on auscultation of a baseline less than 110 or 
  greater than 160 bpm. 
  If there is evidence on auscultation of any decelerations. 
  If any intrapartum risk factors develop. 

  
  
B 
Current evidence does not support the use of the admission 
  cardiotocography (CTG) in low-risk pregnancy and it is therefore not 
  recommended. 

  - Original Message - 
  From: 
  Lesley 
  Kuliukas 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, December 02, 2003 12:10 
  AM
  Subject: [ozmidwifery] fetal heart in 
  labour
  
  Hi all
  I would really appreciate some opinions on 
  frequency of listening to the FH in labour, particularly the second stage. 
  I've always listened in every half hour in early labour, 15 minutely in 
  cracking labour and after every contraction (and through some of them) in the 
  second stage. I know of some midwives who do not feel this is necessary and so 
  I'd love to hear more opinions. What I wonder is if the FH is not being 
  listened in to how would you know whether to expedite the birth? Also if the 
  worst happened how would it stand up in court?
  Thanks
  Lesley

Re: [ozmidwifery] fetal heart in labour

[Denise Hynd]

With this question 
I would also ask you all to consider
when does intermittent auscultation become 
continuous auscultation (listening after every contraction?) and an intervention 
in normal progress of birth??Denise Hynd

  - Original Message - 
  From: 
  Lesley 
  Kuliukas 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, December 01, 2003 9:10 
  PM
  Subject: [ozmidwifery] fetal heart in 
  labour
  
  Hi all
  I would really appreciate some opinions on 
  frequency of listening to the FH in labour, particularly the second stage. 
  I've always listened in every half hour in early labour, 15 minutely in 
  cracking labour and after every contraction (and through some of them) in the 
  second stage. I know of some midwives who do not feel this is necessary and so 
  I'd love to hear more opinions. What I wonder is if the FH is not being 
  listened in to how would you know whether to expedite the birth? Also if the 
  worst happened how would it stand up in court?
  Thanks
  Lesley

Re: [ozmidwifery] New models of midwifery care

[Tom, Tania and Sam Smallwood]

Andrea,

It may interest you and others that we have only one birth centre in South
Australia that 'allows' women to have a VBAC, and it is NOT attached to one
of our large tertiary hospitals.  Waterbirth is also verbally denied at most
if not all birth centres, women and midwives need to orchestrate an
'accidental' waterbirth as far as I'm aware.

So much for offering women choice.

Tania


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[ozmidwifery] physiological third stage

[linda kamchevski]

Can some one tell me can there be a pulse in the 
umbilical cord if the separation of the placenta is complete.   Last 
night all the signs of separation ie. show, cord lengthening etc cord contiued 
to pulse.  My thoughts were that this doesnt happen.  twas a bit 
tricky.  lol.
 
linda.

Re: [ozmidwifery] New models of midwifery care

[Marilyn Kleidon]

Andrea:

What guidelines, protocols etc. will be implemented for these programs? From
your excitement I thought the NSWCMP was about to start being implemented,
if not why not? Will each Health Service Area have to come up with their own
guidelines? quite honestly I can't imagine IPM's working under any other
guidelines but the NSWCMP ones. Who knows? If the hospital  guidelines are
so good then maybe they could be posted and we could compare.

marilyn
- Original Message - 
From: "Andrea Robertson" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Monday, December 01, 2003 11:59 AM
Subject: Re: [ozmidwifery] New models of midwifery care


> Hi Mary,
>
>
>   " especially those who book into a Birth Centre because they want to
> avoid a medicalised birth and then discover along the way that  they could
> actually give birth at home quite safely." What happens is that along the
> way they discover some restrictive protocol that excludes them from the
> Birth Centre.  Our only BC in W.A. does not allow waterbirth and does not
> accept VBACs
>
> I didn't realise that your Birth Centre was so restrictive! I can't
imagine
> why they won't do waterbirths - this is a staple of Birth Centre
> care.  Sounds like the consumers in Perth need to take some action around
> this issue - why should they miss out in WA when women elsewhere can have
> this kind of birth in hospital birth centres with no problems?
>
> You certainly need to have your CMWA program - it is clearly the only real
> alternative to regular hospital care. I trust all your efforts to save and
> extend this great service willbe successful. Perhaps you can see why the
> extension of the Birth Centre care from hospitals like St George and RHW
to
> home based care is not such an issue for us - the policies that govern the
> Birth Centres in their units are already pretty flexible and inclusive.
>
> I well remember meeting the obstetricians in Perth  "en masse" at a
meeting
> I organised some years ago for Murray Enkina nd Marsden Wagner. My
> impression then was of a bunch of cowboys who cared not for women but very
> much their own power and status. Seems not much has changed!
>
> Andrea
>
>
>
>
> -
> Andrea Robertson
> Birth International * ACE Graphics * Associates in Childbirth Education
>
> e-mail: [EMAIL PROTECTED]
> web: www.birthinternational.com
>
>
> --
> This mailing list is sponsored by ACE Graphics.
> Visit  to subscribe or unsubscribe.
>


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Re: [ozmidwifery] CMP homebirth

[Marilyn Kleidon]

Sally: I know this is not what we were discussing, 
but from Andrea's excitement and announcement I erroneously (apparently) assumed 
this program was starting to be implemented. This is why, when this discussion 
first started I did ask what protocols were being discussed. To be honest I 
still don't know.
 
marilyn

  - Original Message - 
  From: 
  Sally Westbury 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, November 30, 2003 2:57 
  PM
  Subject: RE: [ozmidwifery] CMP 
  homebirth
  
  
  The NSWCMP is not 
  what we are discussing. NSWCMP is a model for statewide reform based on NMAP 
  which uses CMP (WA) as a model. We are discussing the implementation of 
  hospital based homebirth services in NSW. If ‘we’ were able to implement the 
  NSWCMMP as proposed by the Maternity Coalition it would be a whole world of 
  good! 
   
  Love Sally 
  Westbury
   
  -Original 
  Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] On Behalf Of Marilyn KleidonSent: Monday, 1 December 2003 9:21 
  PMTo: 
  [EMAIL PROTECTED]Subject: Re: [ozmidwifery] CMP 
  homebirth
   
  
  This is the part of andrea's 
  website (under the features section) that i thought we were 
  discussing:
  
   
  
  Implementing 
  NSWCMP A program outline for the 
  implementation of caseload midwifery care in the public health 
  sector.
  
   
  
   
  
  if this is not so then, I 
  apologise and retract all previous 
  statements.
  
   
  
  marilyn
  
   
  
  - Original Message - 
  
  
  From: "Mary Murphy" 
  <[EMAIL PROTECTED]>
  
  To: <[EMAIL PROTECTED]>
  
  Sent: Sunday, November 30, 2003 
  5:53 AM
  
  Subject: [ozmidwifery] CMP 
  homebirth
  
   
  > Someone commented that the 
  CMP & Albany outcomes could not be compared.  I> agree, but 
  you should also know that the criteria for acceptance on the CMP> does 
  NOT exclude VBACs or some other higher risk women.   These women 
  and> those with complicated pregnancies do not get transferred out of 
  the> umbrella of the CMP.  The original plan for a homebirth is 
  changed to a> hospital birth with the CMP midwife continuing to give 
  antenatal care,> attending the labour and birth (as a birth companion) 
  and continuing to give> postnatal support while in hospital and care in 
  the home after discharge.> The main aim under these circumstances is 
  continuity of care and care> provider.  It is especially valuable 
  for those women who DO have problems.> These are the women who need to 
  have a trusted care providor.  Under our> present arrangement we 
  are employed by the Health Dept of W.A and insured> under the States 
  "Risk Cover".  All W.A. community groups are having their> funding 
  reviewed and this is an ongoing concern for us. Don't be deceived> that 
  the "Hospital based homebirth"  programs will have problem free> 
  administration and funding.  Doctors DO NOT approve of midwifery models 
  of> care, anywhere, hence the continual interference with the protocols 
  and> guidelines of Birth Centres and the closing of these centres all 
  over the> country, regardless of outcomes.  MM> > 
  > --> This mailing list is sponsored by ACE Graphics.> 
  Visit  to 
  subscribe or unsubscribe.> 

Re: [ozmidwifery] New models of midwifery care

[Marilyn Kleidon]

Denise: It is
[EMAIL PROTECTED]
 
marilyn

  - Original Message - 
  From: 
  Denise Hynd 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, November 30, 2003 11:45 
  PM
  Subject: Re: [ozmidwifery] New models of 
  midwifery care
  
  Marilynn 
  What is your email again??New computer 
  program yet again 
  Denise
  
- Original Message - 
From: 
Marilyn 
Kleidon 
To: [EMAIL PROTECTED] 

Sent: Monday, December 01, 2003 7:15 
AM
Subject: Re: [ozmidwifery] New models 
of midwifery care

Diedre:
Were you replying to me? Obviously the 
inclusion of vbac women as high risk is controversial, I specifically did 
not list risk factors because the debate can get very very long and somewhat 
emotional. Just for the record, I have supported many many women both at 
home and in hospital to vaginal births after c/s and personally do not 
consider this a high risk labour or pregnancy. I totally understand a woman 
not wanting to birth in a hospital after having prior c/s. However, I do 
think consumers have to try to be sensitive to the current insurance 
climate. I know that is hard especially if you feel confident you are 
prepared to take the risks if the unimaginable happens. But is not you who 
will be sued if it does(though you pay a horrible price), it is your care 
provider and she will be  sued by the authorities regardless of your 
intent. When I was in seattle  the practice I worked in went from 
attending vbac at home to attending in hospital in 2001. This was 
contentious at first, but the success rate was the same as before and the 
women still had their known midwife; we went with them and managed the birth 
in the hospital with early discharge. Yes it sucks but it can and does 
happen and is still midwifery care. Our clients were not strapped to 
monitors and they birthed in any position etc.. Our practice had hospital 
privileges. In the state of Washington all childbearing women and their 
children were govt funded for health insurance, so all women could choose 
homebirth: 2% did, midwives contracted with health insurance companies to be 
preferred providers and you had to have insurance (also 
provided/underwritten by that state)to be eligible.  Our transfer rate 
varied between 10 and 20%: higher if we were attending more 
primips.
 
And yes there were 2 serious attempted 
homebirth vbac's in the seattle area  from 1996 to 2000 that went 
horribly wrong, both involved midwives and clients (clients sought out the 
particular midwives who would push the limits) who had pushed the limits of 
good midwifery care. Everyone involved paid dearly. I did not work with 
either of these practices but I had a dear friend who did. 
 
Take a look at the guidelines etc. for 
midwifery care in the Netherlands, it is quite rigorous the definition of 
what is normal and it is my understanding that if the midwife says it is 
time to go to the hospital, there is no negotiation, you go. It has been 
said many times this is not Holland, clearly it isn't. Yes midwives in the 
Netherlands, Canada, NZ, and yes the USA (don't know about the UK) do have 
prescriptive privileges, the ability to order their own path tests, 
ultrasounds etc., in other word they are autonomous practitioners, to change 
this I think you need to lobby for legislative changes, these programs in 
NSW are working within current legalities. 
 
I do think it will be truly sad if these 
innovative programs are stopped before they get off the ground. Midwives who 
a confident and competent to attend births at home should not be restricted 
to opening their own business, it should be a choice for them too. They 
should not have to put their livelihoods at risk by practising without 
insurance. It is this insurance issue that has led midwives to creating 
these innovative programs. At least that is what i thought. Consumers should 
be able to have a homebirth on medicare either through a hospital midwifery 
service or an independent midwife duely accredited to receive a rebate. And 
if both of those are unacceptable to them, then they can pay independently 
for the care giver of their choice. And many more shoulds.
 
 Personally i don't think any healthcare 
practitioner working for a government health service should have to make 
healthcare decisions based on anything but best practice. Unfortunately we 
have accepted cost accounting into healthcare and many health decisions are 
based on cost not best practice/evidence based care. 
 
regards
marilyn

  - Original Message - 
  From: 
  Dierdre Bowman 
  To: [EMAIL PROTECTED] 
  
  Sent: Saturday, November 29, 2003 
  3:05 PM
  Subject: Re: [ozmid

RE: [ozmidwifery] fetal heart in labour

[hplerchbacher]

Dear Lesley, 

Checking in my little "Evidence based guidelines for midwifery led care
in labour" produced by NHS Sheffield Teaching Hospital, page 12 says all
about fetal heart rate monitoring: 
- every 15 minutes during first stage
- every 5 minutes in the second stage
Hope this helps

Ping Bullock

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Re: [ozmidwifery] New models of midwifery care

[Andrea Robertson]

Hi Mary,

 " especially those who book into a Birth Centre because they want to 
avoid a medicalised birth and then discover along the way that  they could 
actually give birth at home quite safely." What happens is that along the 
way they discover some restrictive protocol that excludes them from the 
Birth Centre.  Our only BC in W.A. does not allow waterbirth and does not 
accept VBACs

I didn't realise that your Birth Centre was so restrictive! I can't imagine 
why they won't do waterbirths - this is a staple of Birth Centre 
care.  Sounds like the consumers in Perth need to take some action around 
this issue - why should they miss out in WA when women elsewhere can have 
this kind of birth in hospital birth centres with no problems?

You certainly need to have your CMWA program - it is clearly the only real 
alternative to regular hospital care. I trust all your efforts to save and 
extend this great service willbe successful. Perhaps you can see why the 
extension of the Birth Centre care from hospitals like St George and RHW to 
home based care is not such an issue for us - the policies that govern the 
Birth Centres in their units are already pretty flexible and inclusive.

I well remember meeting the obstetricians in Perth  "en masse" at a meeting 
I organised some years ago for Murray Enkina nd Marsden Wagner. My 
impression then was of a bunch of cowboys who cared not for women but very 
much their own power and status. Seems not much has changed!

Andrea



-
Andrea Robertson
Birth International * ACE Graphics * Associates in Childbirth Education
e-mail: [EMAIL PROTECTED]
web: www.birthinternational.com
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Re: [ozmidwifery] New models of midwifery care

[Andrea Robertson]

Hi Jo,

Sorry if I confused you Both St George and the RHW Randwick are in the 
same Area Health Service. Both are considering setting up a home birth 
service. As there will no doubt be some geographical limits placed on the 
extent of the service, it will be wonderful if both can get their acts 
together as this will make this option available to more women.

CHeers

Andrea

At 10:26 PM 1/12/2003, Jo Bourne wrote:
Andrea, I am a little confused, you seem to have switched from talking 
about a homebirth service run from RHW to one run from St.George, or am I 
getting my wires crossed?

cheers
Jo


-
Andrea Robertson
Birth International * ACE Graphics * Associates in Childbirth Education
e-mail: [EMAIL PROTECTED]
web: www.birthinternational.com
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[ozmidwifery] fetal heart in labour

[Lesley Kuliukas]

Hi all
I would really appreciate some opinions on 
frequency of listening to the FH in labour, particularly the second stage. I've 
always listened in every half hour in early labour, 15 minutely in cracking 
labour and after every contraction (and through some of them) in the second 
stage. I know of some midwives who do not feel this is necessary and so I'd love 
to hear more opinions. What I wonder is if the FH is not being listened in to 
how would you know whether to expedite the birth? Also if the worst happened how 
would it stand up in court?
Thanks
Lesley

Re: [ozmidwifery] New models of midwifery care

[Denise Hynd]

Dear Andrea
I concur with yoiur statement
The fact
that home birth rates are rising steadily in Britain comes down to the
commitment fo the system to home birth as an option andn its availability
as a free service to every woman wo wants it.

It is not the case here in Australia and so questions need to be asked when
a mass evidence based campaign (NMAP) requests govt to fund Community based
midwifery-consumer  led homebirth options but we get offered govt funding of
a hospital based service?

What are the implications for future women and midwives options in this
country??

I can tell from personal expereince CMP as the only real funded (1-on-1)
midwifery option in this state does not get all low risk (whatever they are)
easy women with easy life situations!!
Now do they all want a homebirth mostly they want their own midwife to stay
with them!!

I would like to hear more information, particualry facts and the views of
local IPMs about the proposal
Nor do I think there should be only one model but the first model can
influence or stymie other options particualrly with our histrory where
midwifery models have been closed egardless of the outcomes and support of
consumers & midwives whilst the jugganaut of intervention rolls on despite
the costs and the enquiries!

So please tell us more if you can or get local MIPPs to comment??

Also I absolutely worship the idea of leaving the place of birth to the
needs of the labouring woman and baby
Denise Hynd

- Original Message -
From: "Andrea Robertson" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Monday, December 01, 2003 5:41 AM
Subject: [ozmidwifery] New models of midwifery care


> Hello everyone,
>
> It is very good to see such a useful debate on the proposed home birth
> services that are in the wind.  I think everyone has had something very
> useful to offer to the discussion and here are my thoughts on some of
those
> responses.
>
> The reason that I raised the way home birth works in the UK is firstly
> because I have had a lot of exposure to its variations across the UK and
> therefore feel we can learn a lot from the way it works there. The fact
> that home birth rates are rising steadily in Britain comes down to the
> commitment fo the system to home birth as an option andn its availability
> as a free service to every woman wo wants it. Yes, some women don't get to
> choose their midwife but at the end of the day, research has shown that
for
> the majority of women, it is not just the person (midwife) who matters to
> women but the quality of the care. As long as the midwife is caring, and
> the woman's needs are met, most women are happy - they realise that
> midwives too have lives and may not be able to be the beck and call of
> women 24/7. If a colleague arrives instead of the expected midwife, as
long
> as the care remains the same women will accept this.
>
> The remarkable outcomes achieved by the Albany midwives (43% home birth
> rate) is with a population of women who would not even be considered for a
> home birth by most services because of existing risk factors. This
services
> does not set out to offer "home births" as such, but woman centred care.
> The decision about where to give birth is made during the labour, and
> because of the flexibility of the midwives and the service, many woman are
> able to elect to stay put and have an "unplanned" homebirth.
>
> In constrast, the CMWA is working with a select group of women, who are
> very unlikely to have the social risks that the Albany team work with
> (homeless, poor, drug users, teenagers, non-English speaking etc). It
could
> be argued that in such a select group, who start out wanting a homebirth,
> that a 75% home birth (or even higher) would be expected. A lower rate
than
> this would be a cause for concern.
>
> I agree that we should use our own home grown service in WA as a model of
> care for other community based programs. It is exemplary and an ideal
model
> to follow. But it is not the only model, and there must be other choices
> available for women, especially those who book into a Birth Centre because
> they want to avoid a medicalised birth and then discover along the way
that
> they could actually give birth at home quite safely. A hosptial based
> service that offers either birth centre or home births could make this a
> reality for many women.
>
> I also quoted the UK experience because many people are using it as an
> argument to stymie the proposed program at St George, quoting anecdotal
> evidence rather than hard facts to strengthen their opposition. Many
> assumptions are being made, without investigating the facts, and unfounded
> fears are being used as a basis for doubting the commitment and philosophy
> of those striving to initiate much needed change within the system.
>
> The bottom line is that the SESAHS has still not signed off on the
proposed
> service and unless there is overwhelming support (and pressure) from the
> community (including the

[ozmidwifery] oxygen in labour

[Mary Murphy]

 

  
  
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20031125-39 Maternal oxygen administration 
  for fetal distress (Cochrane Review). (Date of most recent 
  substantive amendment: 25 June 2003) 
   - In: The 
  Cochrane Library. Chichester: Wiley , issue 4, 
  2003 Fawole B; Hofmeyr GJ 
   - (2003)
  
 
Background: Maternal oxygen administration has 
  been used in an attempt to lessen fetal distress by increasing 
  the available oxygen from the mother. This has been used for 
  suspected fetal distress during labour, and prophylactically 
  during the second stage of labour on the assumption that the 
  second stage is a time of high risk for fetal distress. 
  Objectives: The objective of this review was to assess the 
  effects of maternal oxygenation for fetal distress during 
  labour and to assess the effects of prophylactic oxygen 
  therapy during the second stage of labour on perinatal 
  outcome. Search Strategy: We searched the Cochrane Pregnancy 
  and Childbirth Group trials register (March 2003) and the 
  Cochrane Central Register of Controlled Trials (The Cochrane 
  Library, Issue 3, 2002). Selection Criteria: Randomised trials 
  comparing maternal oxygen administration for fetal distress 
  during labour and prophylactic oxygen administration during 
  the second stage of labour with a control group (dummy or no 
  oxygen therapy). Data collection and analysis: Both reviewers 
  assessed eligibility and trial quality. Data were extracted, 
  checked and entered into RevMan software. For dichotomous 
  data, relative risks (RR) and 95% confidence intervals (CI) 
  were calculated. For continuous data, weighted mean 
  differences and 95% CI were calculated. Main Results: 
  No trials addressing maternal oxygen therapy for fetal 
  distress were located. Two trials which addressed prophylactic 
  oxygen administration during labour were included. Abnormal 
  cord blood pH values (less than 7.2) were recorded 
  significantly more frequently in the oxygenation group than 
  the control group (relative risk 3.51, 95% confidence interval 
  1.34 to 9.19). There were no other statistically significant 
  differences between the groups. There were conflicting 
  conclusions on the effect of the duration of oxygen 
  administration on umbilical artery pH values between the two 
  trials. Reviewers' conclusions: Implications 
  for practice There is not enough evidence to support the use 
  of prophylactic oxygen therapy for women in labour, nor to 
  evaluate its effectiveness for fetal distress. Implications 
  for research: In view of the widespread use of oxygen 
  administration during labour and the possibility that it may 
  be ineffective or harmful, there is an urgent need for 
  randomised trials to assess its effects. (Author) 
  
  


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  Similiar 
Terms: Fetal 
distress, Labour, 
Labour 
stage, second, Labour 
complications, Oxygen 
inhalation therapy / therapeutic use, Pregnancy.
  

[ozmidwifery] more about breech.

[Mary Murphy]

  
  
20031126-16# Breech deliveries and 
  cesarean section - Journal 
  of Perinatal Medicine , vol 31, no 5, 2003, pp 415-419 Papp 
  Z - (2003)
  
 
Breech presentation is the most common 
  malpresentation, with about 3-4% of singleton fetuses presenting breech at 
  delivery. Management of breech presentation has been a contentious issue 
  with a lowering threshold for cesarean section in recent years. Perinatal 
  mortality and morbidity are estimated to be three times that of comparable 
  infants with vertex presentation. Breech presentation is commonly 
  associated with certain adverse maternal and fetal factors which 
  inherently give rise to increased perinatal morbidity and mortality. At 
  present, most obstetricians favor cesarean delivery for uncomplicated 
  pre-term breech. Controlled prospective studies have shown that the 
  outcome of breech fetuses weighing more than 1500 g was not dependent on 
  the mode of delivery. A more recent review from the Cochrane database by 
  Grant does not justify a policy of elective cesarean section for pre-term 
  breech. Vaginal delivery is preferred if the following criteria are met: 
  frank breech only, estimated fetal weight of 2500-3500 g, adequate 
  pelvimetry without hyperextended head, normal progression of labor, no 
  evidence of fetal hypoxia under continuous fetal monitoring, and maternal 
  weight under 90 kg. Vaginal delivery of frank breech at term may be just 
  as safe as cesarean section when careful selection criteria are used. If 
  these criteria are not fulfilled, or fetal monitoring cannot be performed, 
  cesarean section is advisable. (21 references) 
  (Author)

[ozmidwifery] midwifery care

[Mary Murphy]

  
  
20031127-42# Early labour assessment and support at 
  home: a randomized controlled trial - JOGC [Journal of 
  Obstetrics and Gynaecology Canada] , vol 25, no 9, September 
  2003, pp 734-741 Janssen PA; Iker CE; Carty EA - (September 
  2003)
  
 
OBJECTIVE: To compare childbirth 
  outcomes of women prospectively randomized to receive early labour 
  assessment and support either through a home visit or by telephone triage. 
  METHODS: Women in early labour, upon seeking prior telephone advice on 
  whether or not they were ready to be admitted to BC Women's Hospital (as 
  was standard hospital practice), were voluntarily randomized to receive 
  either a home visit by an obstetrical nurse or telephone triage. RESULTS: 
  One hundred seventeen women were randomized to receive home care and 120 
  to receive telephone triage. Significantly fewer women in the home care 
  group arrived at hospital in the latent stage of labour, compared to women 
  in the telephone triage group (odds ratio [OR], 0.37; 95% confidence 
  interval [CI], 0.19-0.72). Significantly fewer women in the home care 
  group received narcotics (OR, 0.55; 95% CI, 0.32-0.96). Differences 
  observed in use of epidural analgesia (OR, 0.64; 95% CI, 0.36-1.16) were 
  not statistically significant. Newborns in the home care group were 
  significantly less likely to be admitted to a level II observation nursery 
  (OR, 0.13; 95% CI, 0.03-0.60). More women in the home care group would 
  recommend this type of care to a friend (P = 0.001). CONCLUSION: Our 
  findings suggest an association of early labour assessment at home with 
  both admission to hospital in the active phase of labour and reduction in 
  use of analgesia during labour. Early labour support at home was 
  associated with reduced rates of admission of neonates to a level II 
  observation nursery, possibly secondary to reduced exposure to analgesics. 
  Early labour care at home by hospital-based obstetrical nurses is 
  safe and acceptable to women, and may offer advantages in terms of reduced 
  interventions and more vigorous neonates. (14 references) 
(Author)

Re: [ozmidwifery] New models of midwifery care

[Jo Bourne]

Andrea, I am a little confused, you seem to have switched from talking about a 
homebirth service run from RHW to one run from St.George, or am I getting my wires 
crossed?

cheers
Jo

At 8:41 +1100 1/12/03, Andrea Robertson wrote:
>Hello everyone,
>
>It is very good to see such a useful debate on the proposed home birth services that 
>are in the wind.  I think everyone has had something very useful to offer to the 
>discussion and here are my thoughts on some of those responses.
>
>The reason that I raised the way home birth works in the UK is firstly because I have 
>had a lot of exposure to its variations across the UK and therefore feel we can learn 
>a lot from the way it works there. The fact that home birth rates are rising steadily 
>in Britain comes down to the commitment fo the system to home birth as an option andn 
>its availability as a free service to every woman wo wants it. Yes, some women don't 
>get to choose their midwife but at the end of the day, research has shown that for 
>the majority of women, it is not just the person (midwife) who matters to women but 
>the quality of the care. As long as the midwife is caring, and the woman's needs are 
>met, most women are happy - they realise that midwives too have lives and may not be 
>able to be the beck and call of women 24/7. If a colleague arrives instead of the 
>expected midwife, as long as the care remains the same women will accept this.
>
>The remarkable outcomes achieved by the Albany midwives (43% home birth rate) is with 
>a population of women who would not even be considered for a home birth by most 
>services because of existing risk factors. This services does not set out to offer 
>"home births" as such, but woman centred care. The decision about where to give birth 
>is made during the labour, and because of the flexibility of the midwives and the 
>service, many woman are able to elect to stay put and have an "unplanned" homebirth.
>
>In constrast, the CMWA is working with a select group of women, who are very unlikely 
>to have the social risks that the Albany team work with (homeless, poor, drug users, 
>teenagers, non-English speaking etc). It could be argued that in such a select group, 
>who start out wanting a homebirth, that a 75% home birth (or even higher) would be 
>expected. A lower rate than this would be a cause for concern.
>
>I agree that we should use our own home grown service in WA as a model of care for 
>other community based programs. It is exemplary and an ideal model to follow. But it 
>is not the only model, and there must be other choices available for women, 
>especially those who book into a Birth Centre because they want to avoid a 
>medicalised birth and then discover along the way that they could actually give birth 
>at home quite safely. A hosptial based service that offers either birth centre or 
>home births could make this a reality for many women.
>
>I also quoted the UK experience because many people are using it as an argument to 
>stymie the proposed program at St George, quoting anecdotal evidence rather than hard 
>facts to strengthen their opposition. Many assumptions are being made, without 
>investigating the facts, and unfounded fears are being used as a basis for doubting 
>the commitment and philosophy of those striving to initiate much needed change within 
>the system.
>
>The bottom line is that the SESAHS has still not signed off on the proposed service 
>and unless there is overwhelming support (and pressure) from the community (including 
>the IPMs) for its establishment then they may well choose to spend their money not on 
>providing an "elite" service for a relatively small number of women but on much 
>needed services for a larger number of women in their jurisdiction.
>
>It may not be the "perfect" service, but it is a start, and will set a precedent that 
>can be used as a foundation for building home birth awareness in the community that 
>will help drive change elsewhere. Most of you may not remember that 25 years ago 
>birth centres were an unknown concept and it took a lot of community pressure to get 
>the first one opened. It was not publicisied bcause the doctors feasred competition 
>and it has very strict selection criteria, but it survived and spawned others. Birth 
>Centres are now "mainstream" health care. Wouldn't it be wonderful if this small 
>beginning led to the wider recognition of home birth as a "mainstream" option (as it 
>is in the UK and elsewhere)?
>
>The criteria for the operation of the service are still being discussed. At St 
>George, the heads of both the midwifery services and the obstetric services are very 
>supportive of home birth and are committed to evidence based care and woman-centred 
>care. There is no reason to suspect that they will be putting highly restrictive 
>practice policies in place - in fact it could be argued that a successful service, 
>utilised by a good number of women will enhance their status and support the

RE: [ozmidwifery] New models of midwifery care

[Wayne and Cas]

Title: Message



Heard 
another anecdote the other day ... 2 women experienced UR during labour. The 
first had attempted a hospital VBAC the second had planned a homebirth. In the 
first, the woman was monitored on ctg and the problem noticed too late. 
Consequently the baby died because no one really watched the woman carefully 
enough. In the second one though, the midwife noticed something different in the 
woman's behaviour, movments, ctx etc and promptly called an ambulance. When they 
arrived at hospital she told them the woman's uterus was about to rupture and 
the doctors went all haughty on her saying "how could you know anything?" but 
the midwife ignored them and began prepping her client for caesarean, soon after 
they concurred and as they were about to cut her open the woman's uterus 
ruptured. The baby lived.
 
Just 
goes to show that continuity of care is more about having someone really pay 
attention to your needs and take notice of what is going on on a human level 
than it is about where you give birth and how you give 
birth.
 
These 
are rare instances but I thought you all might find this story interesting. And 
if the homebirth midwife who helped this woman is on this list, I commend 
you.
 
Cheers,
 
Cas.
 

Cas McCullough
info@casmccullough.com
www.casmccullough.com
 

  
  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] On Behalf Of Judy 
  ChapmanSent: Monday, 1 December 2003 5:51 PMTo: 
  [EMAIL PROTECTED]Subject: Re: [ozmidwifery] New models 
  of midwifery care
  
  
  Heard an anecdote the other day about a woman who had 3 vaginal births 
  after a CS and they it was found out the CS was Classical. 

Re: [ozmidwifery] New models of midwifery care

[Mary Murphy]

Andrea wrote:  In constrast, the CMWA is working with a select group 
of women, who are very unlikely to have the social risks that the Albany 
team work with  (homeless, poor, drug users, teenagers, non-English 
speaking etc). I agree that we do not have the high levels of social risk 
that the Albany group does, but that does not mean that we do not have any women 
in those categories.  
 " especially those who book into a Birth Centre because they want to 
avoid a medicalised birth and then discover along the way that  they could 
actually give birth at home quite safely." What happens is that along the 
way they discover some restrictive protocol that excludes them from the Birth 
Centre.  Our only BC in W.A. does not allow waterbirth and 
does not accept VBACs
"A hospital based service that offers either birth centre or home births 
could make this a reality for many women." I agree that this would be good 
if it was based upon midwifery principals and not obstetric ones. "> 
Birth Centres are now "mainstream" health care".  The BC in W.A is not 
mainstream as doctors "forget" to tell women about them.  I have just had a 
client who requested BC care in June.  She was never referred there.  
In Nov. she finally woke up and insisted.
>  At St George, the heads of both the midwifery services and the 
obstetric > services are very supportive of home birth and are committed 
to evidence > based care and woman-centred care"   
Great!.  MM> 
-

[ozmidwifery] Fw: Dance for Choice this Saturday!

[Denise Hynd]

.Dear WA Ozmidlisters
This Saturday there is another opportunity to show support for th Community
Midwifery Program

 DANCE FOR CHOICE
 SATURDAY 6th December 2003
 7pm til late at the Hilton Park Bowling Club in Shepherd St,
 Beaconsfield
 DJs and band "Heads We're Dancing".
 Barbeque food by Birthplace Support Group.
 Tickets $15 per person at the door, $10 per person pre-sale from East
 Fremantle Resource Centre (9319 0843) or CMWA office (9438 1283).
 All profits to Community Midwifery.

 See you there!
 Executive Support Officer
 Community Midwifery WA Inc
 (08) 9438 1283
 PO Box 1336 FREMANTLE WA 6959
 "Homebirth is where the heart is"




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Re: [ozmidwifery] New models of midwifery care

[*G and S*]

Heard an anecdote the other day about a woman who had 3 vaginal births 
after a CS and they it was found out the CS was Classical. 
JudyThanks Judy!  
Sonia W.

Re: [ozmidwifery] New models of midwifery care

[Denise Hynd]

Marilynn 
What is your email again??New computer program 
yet again 
Denise

  - Original Message - 
  From: 
  Marilyn 
  Kleidon 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, December 01, 2003 7:15 
  AM
  Subject: Re: [ozmidwifery] New models of 
  midwifery care
  
  Diedre:
  Were you replying to me? Obviously the inclusion 
  of vbac women as high risk is controversial, I specifically did not list risk 
  factors because the debate can get very very long and somewhat emotional. Just 
  for the record, I have supported many many women both at home and in hospital 
  to vaginal births after c/s and personally do not consider this a high risk 
  labour or pregnancy. I totally understand a woman not wanting to birth in a 
  hospital after having prior c/s. However, I do think consumers have to try to 
  be sensitive to the current insurance climate. I know that is hard especially 
  if you feel confident you are prepared to take the risks if the unimaginable 
  happens. But is not you who will be sued if it does(though you pay a horrible 
  price), it is your care provider and she will be  sued by the authorities 
  regardless of your intent. When I was in seattle  the practice I worked 
  in went from attending vbac at home to attending in hospital in 2001. This was 
  contentious at first, but the success rate was the same as before and the 
  women still had their known midwife; we went with them and managed the birth 
  in the hospital with early discharge. Yes it sucks but it can and does happen 
  and is still midwifery care. Our clients were not strapped to monitors and 
  they birthed in any position etc.. Our practice had hospital privileges. In 
  the state of Washington all childbearing women and their children were govt 
  funded for health insurance, so all women could choose homebirth: 2% did, 
  midwives contracted with health insurance companies to be preferred providers 
  and you had to have insurance (also provided/underwritten by that state)to be 
  eligible.  Our transfer rate varied between 10 and 20%: higher if we were 
  attending more primips.
   
  And yes there were 2 serious attempted homebirth 
  vbac's in the seattle area  from 1996 to 2000 that went horribly wrong, 
  both involved midwives and clients (clients sought out the particular midwives 
  who would push the limits) who had pushed the limits of good midwifery care. 
  Everyone involved paid dearly. I did not work with either of these practices 
  but I had a dear friend who did. 
   
  Take a look at the guidelines etc. for midwifery 
  care in the Netherlands, it is quite rigorous the definition of what is normal 
  and it is my understanding that if the midwife says it is time to go to the 
  hospital, there is no negotiation, you go. It has been said many times this is 
  not Holland, clearly it isn't. Yes midwives in the Netherlands, Canada, NZ, 
  and yes the USA (don't know about the UK) do have prescriptive privileges, the 
  ability to order their own path tests, ultrasounds etc., in other word they 
  are autonomous practitioners, to change this I think you need to lobby for 
  legislative changes, these programs in NSW are working within current 
  legalities. 
   
  I do think it will be truly sad if these 
  innovative programs are stopped before they get off the ground. Midwives who a 
  confident and competent to attend births at home should not be restricted to 
  opening their own business, it should be a choice for them too. They should 
  not have to put their livelihoods at risk by practising without insurance. It 
  is this insurance issue that has led midwives to creating these innovative 
  programs. At least that is what i thought. Consumers should be able to have a 
  homebirth on medicare either through a hospital midwifery service or an 
  independent midwife duely accredited to receive a rebate. And if both of those 
  are unacceptable to them, then they can pay independently for the care giver 
  of their choice. And many more shoulds.
   
   Personally i don't think any healthcare 
  practitioner working for a government health service should have to make 
  healthcare decisions based on anything but best practice. Unfortunately we 
  have accepted cost accounting into healthcare and many health decisions are 
  based on cost not best practice/evidence based care. 
   
  regards
  marilyn
  
- Original Message - 
From: 
Dierdre Bowman 
To: [EMAIL PROTECTED] 

Sent: Saturday, November 29, 2003 3:05 
PM
Subject: Re: [ozmidwifery] New models 
of midwifery care

I was one of those women who went on to birth 
vaginally after 2 previous c/s.  I was told, absolutely not, I would 
not be able to have a vaginal birth.  If I had not had a supportive 
midwife with skills that aren't taught in medical or midifery school, skills 
that come by attending women who believe they can birth and work hard at 
achieving that d

Re: [ozmidwifery] New models of midwifery care

[Judy Chapman]

Heard an anecdote the other day about a woman who had 3 vaginal births after a CS and they it was found out the CS was Classical. 
JudyFrom: "*G and S*" <[EMAIL PROTECTED]> 
Reply-To: [EMAIL PROTECTED] 
To: <[EMAIL PROTECTED]>
Subject: Re: [ozmidwifery] New models of midwifery care 
Date: Sun, 30 Nov 2003 18:02:25 +1100 


Dierdre B wrote: 

I was one of those women who went on to birth vaginally after 2 previous c/s. I was told, absolutely not, I would not be able to have a vaginal birth 

Dierdre, 
Were you told this because of a vertical/classic or inverted T scar? 
Need to hear positive stories. 
Love, Sonia W. 


Hot chart ringtones and polyphonics.  Click here 
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RE: [ozmidwifery] Nettle tea

[Larry & Megan]

Hi Cas
I dont know about your question, but my midwife rec Nettle tea for iron
absorption, 4th baby in 5 years so body is a bit exhausted. She said I could
have 3 cups a day, and I'm at the beginning of my journey.
Megan

-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] Behalf Of Wayne and Cas
Sent: Friday, 28 November 2003 11:15
To: [EMAIL PROTECTED]
Subject: [ozmidwifery] Nettle tea


A friend of mine has been advised to drink nettle tea to help reduce her
amniotic fluid by her hb miidwife as her baby keeps turning from ceph to
breech. Has anyone out there any knowledge about this?

The reason I ask is because I drank nettle tea all the time late in my
pregnancy to keep fluid retention at bay and wonder if that could be
responsible for my amnio fluid dissappearing like it did in the 43rd
week. If that was the case then at least I know there are things I can
do to avoid this prob. next time.

I would appreciate any thoughts on this.

Cheers,

Cas

Cas McCullough
[EMAIL PROTECTED]
www.casmccullough.com


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