RE: [ozmidwifery] Bottle feeding hard poos and blood from belly button.
Hi Philippa Fruit juice adds little to a newborn's diet except fluid and this will stop the babe from drinking milk. The newborn's gut is not equipped to deal with fruit juice until around 6 months, as per the WHO guidelines Despite apparent logic there is very little/no fibre in fruit juice and it has high sugar levels compared to fresh fruit. Pureed fruit can be given after 6 months of age. Brown (concentrated) sugar is an `old wives/old wise woman's' tale. It works by irritating the gut which is not advisable for all the reasons outlined by WHO So for the formula fed infant under 6 months check the formula is made up correctly, if so it may be worth looking for a formula that is less constipating (eg. one with Bifidus, or HA - partially hydrolysed). fran sheean From: [EMAIL PROTECTED] on behalf of Philippa Scott Sent: Fri 17/11/2006 6:39 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Bottle feeding hard poos and blood from belly button. Two questions. Have a mum who is formula feeding a 2.5week old and has found that bubs poos have turned hard but not terribly dry. Is this just normal or is it possible a different formula would be better. Also what is the research on things like adding Brown sugar and giving fruit juice? It does not sound evidenced based to me. She has also noticed blood weeping from belly button (cord stump came off a week ago) and whilst there is no redness or temp and baby does not seem sore there she is wondering if this is normal? Have you any answers for us? Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville winmail.dat
Re: [ozmidwifery] Pap smears while pregnant?
Hi Sam, One of our obstetricians said it wasn't worthwhile doing them in pregnancy as they are not accurate due to the changes in the cervix. Even women with CIN I did not have repeat paps during their pregnancy. Not sure how evidence based this is. Cheers Michelle - Original Message From: [EMAIL PROTECTED] [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, 17 November, 2006 12:46:41 PM Subject: Re: [ozmidwifery] Pap smears while pregnant? Thanks Brenda and Megan. I recently heard a (first hand) story about a girl in early pregnancy suffering a miscarriage immediately after a PS was done. Apparently the instruments used were smeared with blood and she started to miscarry immediately? Understandably, she is very upset and believes the GP may have somehow caused it. The GP has said it was a very unfortunate coincidence. Not being a midwife(yet!), I was unsure about the safety of PS during preg., and whether it would be possible for a miscarriage to occur as a result. Regards, Sam. Yes, they are safe to do in pregnancy however if I remember correctly they are only performed in the second trimester, or 8 weeks postpartum. Megan - Original Message - From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Thursday, November 16, 2006 1:18 PM Subject: [ozmidwifery] Pap smears while pregnant? Is it safe to have a PS whilst pregnant and is there any risk with having it done - particularly in early pregnancy? Regards, Sam. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Send instant messages to your online friends http://au.messenger.yahoo.com
RE: [ozmidwifery] Cord clamping and waterbirth
Thank you Angela for your thorough reply. I always forget the very detailed anatomy of the circulatory changes and have to look it up and don't keep the right book at home. . I was thinking more of a convincing explanation as to why the blood doesn't run backwards from the baby towards the placenta, which is obviously still filled with blood. This appears to be the worry for the doctor. Doesn't she know the anatomy/physiology of the placenta, or is she just trying to bamboozle the woman? As an aside, I am of the impression that the cord vessels don't have any valves. Is that correct? MM From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Angela Rayner This is easier to follow when looking at a 'circulatory changes at birth' diagram, but I'll try to give a brief summary. Following birth the baby's circulatory system makes major adjustments in order to divert deoxygenated blood to the lungs for re-oxygenation. During fetal life approximately 10% of the cardiac output is circulated to the lungs through the pulmonary artery. With the expansion of the lungs and lowered pulmonary vascular resistance, virtually all of the cardiac output is sent to the lungs. Oxygenated blood returning to the heart from the lungs increases the pressure within the left atrium. At almost the same time, pressure in the right atrium is lowered because blood ceases to flow through the cord. As a result, a functional closure of the foramen ovale is achieved. During the first days of life this closure is reversible. Reopening may occur if pulmonary vascular resistance is high, for example when crying, resulting in transient cyanotic episodes in the baby. The septa completely fuses within the first year of life. The ductus arteriosus, which is nearly as wide as the aorta, provides a significant bypass of the lungs for the fetus. Contraction occurs almost immediately after birth. This is thought to be caused by sensitivity to increased oxygen tension and the reduction in circulating prostaglandin. As a result of altered pressure gradients between the aorta and pulmonary artery, a temporary reverse left to right shunt through the ductus may persist for a few hours although there is usually functional closure of the ductus within 8-10 hours of birth. _ The paediatrician who has never attended a waterbirth before is saying that she would have to clamp right away because if the woman is holding the baby on her chest, the blood can flow back through the cord to the placenta increasing her risk of PPH.
RE: [ozmidwifery] Cord clamping and waterbirth
Lieve writes: Yesterday I attended a waterbirth and the cord continued pulsing another 15 min after the birth of the placenta, 20 min after the birth of the baby. This can occur as a rebound pulse from the baby's heart beat. Obviously it can't be from a placenta pumping more blood to the baby, because there is no mechanism for this to happen. Am I right? MM
RE: [ozmidwifery] getting synto etc
Hi Philippa, Misoprostol has a lot of side effects, just search the web on CYTOTEC (the American name). It is used in areas where refrigeration is not possible. When this is possible Syntocinon and/or Syntometrine are better options. Whatever you decide: good luck. Love Anke -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Philippa Scott Sent: Wednesday, 15 November 2006 6:57 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] getting synto etc Ok I need some more info I guess. I have had some midwives locally say that this is a better option to have at home for an emergency. This is my own birth I am talking about I am not a midwife, I am a doula and will be birthing unassisted due to the non-existence of MIPP up here, I am wanting something on hand for just in case. I have been told Misoprostol is very effective with few side effects. It will be for me a last resort whilst waiting for an ambo if things like shepherds purse and eating placenta do not work (if I have another PPH). Would anyone be able to tell me a bit more about the side effect and why you would/would not recommend it. I am due in a couple of months so want to start getting something organized and a decision made about which way to go. Thank you, Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Amanda W Sent: Wednesday, 15 November 2006 4:41 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc We use Misoprostol at the hospital where I work and it is kept in the fridge next to the syntocinon and syntometrine and the prostins etc. Why would you want to use it at your homebirth but. Syntocinon should be just fine. Misoprostol is a fairly heavy drug of choice with a fair few side effects and we only use it for large PPH's Amanda Ward Creative Memories Consultant Ph. (07) 3261 4354 Mob, 0417 009 648 Email. [EMAIL PROTECTED] From: Lisa Barrett [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc Date: Wed, 15 Nov 2006 16:18:45 +1030 misoprostal isn't licenced here is Australia. I wouldn't be prescribing it if I were a GP. When I was Working at a private Hospital the Obs kept it in their own possesion. It isn't licenced to be kept at the hospital as far as I know. The pharmacy at the hospital wouldn't touch it. It's not the sort of drug you should have at a homebirth anyway. Lisa Barrett - Original Message - From: Philippa Scott [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 15, 2006 3:55 PM Subject: RE: [ozmidwifery] getting synto etc I am hoping to get a script for Misoprostal (sp) for my homebirth. Any ideas. Should I just ask a GP? What are they liable for if they do prescribe it. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Robyn Dempsey Sent: Wednesday, 15 November 2006 12:10 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc Yes, the synto is about $100 a box. So what I do, is buy/pay for one box, which lasts for the next women ( does that make sense?), I only use Synto about once a year! ( and then there are the years you need it 3 times in a row!) Robyn D - Original Message - From: Jennifairy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 15, 2006 8:47 AM Subject: Re: [ozmidwifery] getting synto etc I have a few births at home coming up and was wondering about synto and other drugs in my kit. How do others purchase them? Do I have to have a script from a doctor? The other issue that I do find difficult is the issue of cost for homebirth.Others I have been involved in have been for friends and colleagues. Does anyone have a schedule of payment and cost that they use? I am meeting with a couple on Monday and would love to have a bit more idea. Any feedback will be greatly appreciated, Thanks Cath Had a client recently who I sent to her GP for a script for synt. She got the script, went to the chemist to fill it found it was going to cost her around $80 to get it - they only sold it in the boxes of five vials. I ended up asking around my MIPP friends managed to find some that way (dint need it anyway so its still in my fridge). If you give me your postal address Im happy to post some to you - my understanding is that its ok to keep it out of the fridge for a time. cheers -- Jennifairy Gillett RM Midwife in Private Practice Women's Health Teaching Associate ITShare volunteer
Re: RE: [ozmidwifery] Cord clamping and waterbirth
She doesn't mean cutting the cord right away does she? Like when bubs is still underwater?? By her flawed idea of anatomy and physiology she may think that is appropriate?? I find it so hard to see how this kind of 'professional' can be a care provider for birthing mums. Abby xo The paediatrician who has never attended a waterbirth before is saying that she would have to clamp right away because if the woman is holding the baby on her chest, the blood can flow back through the cord to the placenta increasing her risk of PPH. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] getting synto etc
Hi Anke Have seen shivering diarhoea and increased temp in women having termination with misoprostol... But this is a 6th hrly dose...when used for pph it would be a one of dose... Much of the bad press it has gotton has been because the doses used in iol are varied (and the 'correct' dose is unknown) and I think it increases the chance of uterine rupture in VBAC. Certainly agree that in the long run an oxytocic is a better choice but when these aren't available it may be quite useful. Lisa -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Anke Dalman Sent: Friday, 17 November 2006 7:07 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] getting synto etc Hi Philippa, Misoprostol has a lot of side effects, just search the web on CYTOTEC (the American name). It is used in areas where refrigeration is not possible. When this is possible Syntocinon and/or Syntometrine are better options. Whatever you decide: good luck. Love Anke -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Philippa Scott Sent: Wednesday, 15 November 2006 6:57 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] getting synto etc Ok I need some more info I guess. I have had some midwives locally say that this is a better option to have at home for an emergency. This is my own birth I am talking about I am not a midwife, I am a doula and will be birthing unassisted due to the non-existence of MIPP up here, I am wanting something on hand for just in case. I have been told Misoprostol is very effective with few side effects. It will be for me a last resort whilst waiting for an ambo if things like shepherds purse and eating placenta do not work (if I have another PPH). Would anyone be able to tell me a bit more about the side effect and why you would/would not recommend it. I am due in a couple of months so want to start getting something organized and a decision made about which way to go. Thank you, Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Amanda W Sent: Wednesday, 15 November 2006 4:41 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc We use Misoprostol at the hospital where I work and it is kept in the fridge next to the syntocinon and syntometrine and the prostins etc. Why would you want to use it at your homebirth but. Syntocinon should be just fine. Misoprostol is a fairly heavy drug of choice with a fair few side effects and we only use it for large PPH's Amanda Ward Creative Memories Consultant Ph. (07) 3261 4354 Mob, 0417 009 648 Email. [EMAIL PROTECTED] From: Lisa Barrett [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc Date: Wed, 15 Nov 2006 16:18:45 +1030 misoprostal isn't licenced here is Australia. I wouldn't be prescribing it if I were a GP. When I was Working at a private Hospital the Obs kept it in their own possesion. It isn't licenced to be kept at the hospital as far as I know. The pharmacy at the hospital wouldn't touch it. It's not the sort of drug you should have at a homebirth anyway. Lisa Barrett - Original Message - From: Philippa Scott [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 15, 2006 3:55 PM Subject: RE: [ozmidwifery] getting synto etc I am hoping to get a script for Misoprostal (sp) for my homebirth. Any ideas. Should I just ask a GP? What are they liable for if they do prescribe it. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Robyn Dempsey Sent: Wednesday, 15 November 2006 12:10 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc Yes, the synto is about $100 a box. So what I do, is buy/pay for one box, which lasts for the next women ( does that make sense?), I only use Synto about once a year! ( and then there are the years you need it 3 times in a row!) Robyn D - Original Message - From: Jennifairy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 15, 2006 8:47 AM Subject: Re: [ozmidwifery] getting synto etc I have a few births at home coming up and was wondering about synto and other drugs in my kit. How do others purchase them? Do I have to have a script from a doctor? The other issue that I do find difficult is the issue of cost for homebirth.Others I have been involved in have been for friends and colleagues. Does anyone have a schedule of payment and cost that they use? I am meeting
RE: [ozmidwifery] getting synto etc
I know the tablets are used for TOPs. Is it therefore that often women miscarry after TOPs? Or have prems? It would NOT be my choice of medicine because I have seen too many problems after use. Anke -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of LJG Sent: Wednesday, 15 November 2006 7:49 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] getting synto etc Used for gastirc ulcers? -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jo Watson Sent: Wednesday, 15 November 2006 7:33 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc From what I've heard, it is a drug not licensed for use in obstetrics (but it is used, obviously) ... I can't remember it's primary function though. And I can't be bothered googling right now. Jo On 15/11/2006, at 5:02 PM, meg wrote: I work at a major tertiary hospital-we stock misoprostil and use it with pph's so I think it is licenced. Meg - Original Message - From: Lisa Barrett [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 15, 2006 4:48 PM Subject: Re: [ozmidwifery] getting synto etc misoprostal isn't licenced here is Australia. I wouldn't be prescribing it if I were a GP. When I was Working at a private Hospital the Obs kept it in their own possesion. It isn't licenced to be kept at the hospital as far as I know. The pharmacy at the hospital wouldn't touch it. It's not the sort of drug you should have at a homebirth anyway. Lisa Barrett - Original Message - From: Philippa Scott [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 15, 2006 3:55 PM Subject: RE: [ozmidwifery] getting synto etc I am hoping to get a script for Misoprostal (sp) for my homebirth. Any ideas. Should I just ask a GP? What are they liable for if they do prescribe it. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Robyn Dempsey Sent: Wednesday, 15 November 2006 12:10 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] getting synto etc Yes, the synto is about $100 a box. So what I do, is buy/pay for one box, which lasts for the next women ( does that make sense?), I only use Synto about once a year! ( and then there are the years you need it 3 times in a row!) Robyn D - Original Message - From: Jennifairy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 15, 2006 8:47 AM Subject: Re: [ozmidwifery] getting synto etc I have a few births at home coming up and was wondering about synto and other drugs in my kit. How do others purchase them? Do I have to have a script from a doctor? The other issue that I do find difficult is the issue of cost for homebirth.Others I have been involved in have been for friends and colleagues. Does anyone have a schedule of payment and cost that they use? I am meeting with a couple on Monday and would love to have a bit more idea. Any feedback will be greatly appreciated, Thanks Cath Had a client recently who I sent to her GP for a script for synt. She got the script, went to the chemist to fill it found it was going to cost her around $80 to get it - they only sold it in the boxes of five vials. I ended up asking around my MIPP friends managed to find some that way (dint need it anyway so its still in my fridge). If you give me your postal address Im happy to post some to you - my understanding is that its ok to keep it out of the fridge for a time. cheers -- Jennifairy Gillett RM Midwife in Private Practice Women's Health Teaching Associate ITShare volunteer - Santos Project Co-ordinator ITShare SA Inc - http://itshare.org.au/ ITShare SA provides computer systems to individuals groups, created from donated hardware and opensource software -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. __ NOD32 1866 (20061114) Information __ This message was checked by NOD32 antivirus system. http://www.eset.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to
RE: [ozmidwifery] Misoprostol the Third stage of Labour
It always amazes me that these trials are on such a small number of women. While they are interesting, surely they are not able to be applied to the wider population of women? MM Results for the intravenous oxytocin (n = 311) and oral misoprostol (n = 311) groups are as follows -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Cord clamping and waterbirth
you are very right. The baby is in charge and decides when to shut the doors to the cord :-). It is the heart of the baby that pumpes the blood to the placenta. I don't hav prove of this but I think that waiting for the baby to decide to close the cord is the reason why I never had a baby with a heartwisper the first week as often happens in practices with early clamping. Lieve .- Oorspronkelijk bericht - .Van: Mary Murphy [mailto:[EMAIL PROTECTED] .Verzonden: vrijdag, november 17, 2006 09:54 AM .Aan: ozmidwifery@acegraphics.com.au .Onderwerp: RE: [ozmidwifery] Cord clamping and waterbirth . .Lieve writes: . .Yesterday I attended a waterbirth and the cord continued pulsing another 15 .min after the birth of the placenta, 20 min after the birth of the baby. . . . .This can occur as a rebound pulse from the baby's heart beat. Obviously it .can't be from a placenta pumping more blood to the baby, because there is no .mechanism for this to happen. Am I right? MM . . -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Misoprostol the Third stage of Labour
Mary there are some systematic reviews which include these studies but am unable to get a hold of the full text..will try at work. L -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary Murphy Sent: Friday, 17 November 2006 6:51 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Misoprostol the Third stage of Labour It always amazes me that these trials are on such a small number of women. While they are interesting, surely they are not able to be applied to the wider population of women? MM Results for the intravenous oxytocin (n = 311) and oral misoprostol (n = 311) groups are as follows -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] getting synto etc
Am not sure what you mean Anke? Would be interested to hear your experiences. Lisa Is it therefore that often women miscarry after TOPs? Or have prems? It would NOT be my choice of medicine because I have seen too many problems after use. Anke -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Cord clamping and waterbirth
As an aside, I am of the impression that the cord vessels don’t have any valves. This is a really interesting point Mary. An article I read some time ago believed that the respiratory distress sometimes seen with caesar babies was related to hypovolemia, from when the baby was held above the mother and the placenta and the blood flowed back to the placenta. It seems unlikely given how quickly they clamp the cord. However I have seen articles as well that recommend resusing a baby with the cord intact, to have the baby at the same level or lower than the mother to recieve more blood/oxygen. I'm yet to work out how you could resus with the cord intact at a higher level : ) On the other hand, there was a case of polycythemia after a waterbirth with was contributed to the cord being left intact and the baby recieving too much blood. Anyone else confused??!! Cheers Michelle Send instant messages to your online friends http://au.messenger.yahoo.com
RE: [ozmidwifery] Misoprostol the Third stage of Labour
Hi Abby Completely agree...ALL drugs used during labour and birth can have nasty effects especially when misused...I am by no means promoting it, these posts were of interest in terms of appropriate use...some would say that the warnings placed on this drug by its makers are because they have no further need to spend money researching and marketing it's use in obstetrics, because it is so widely used...if they supported this use, they would need to spend money supporting their recommendations! I'm not sure if it is used anywhere in Oz for induction?this is where most of the concerns with uterine rupture occur especially with a uterine scar. Lisa -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Friday, 17 November 2006 7:48 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Misoprostol the Third stage of Labour There seems to be a lot of posts about Misoprostol but no talk of the increased risk this drug puts women at for uterine rupture. It can be quite a nasty drug and the pharmaceutical company that manufacture misoprostol aka cytotec have issued warnings against using the drug for women during childbirth. Love Abby -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Alternative GBS
Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Bottle feeding hard poos and blood from belly button.
Hi, No, this is not normal. This is the consequence of feeding a baby an abnormal diet, sadly. When did she stop breastfeeding? Is there any chance of her beginning to breastfeed her baby again, even partially? At this age it is normally possible to begin to breastfeed again. If this is not the case, in the first instance I would ascertain whether or not the formula is being made exactly to directions on the can - it's easy to make mistakes. Then, I would try 30mls of cooled boiled water after feeds. Is there any family history of allergies? Does it seem to hurt the baby to poo? Is the baby getting adequate milk? Barb - Original Message - From: Philippa Scott To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 6:39 PM Subject: [ozmidwifery] Bottle feeding hard poos and blood from belly button. Two questions. Have a mum who is formula feeding a 2.5week old and has found that bubs poos have turned hard but not terribly dry. Is this just normal or is it possible a different formula would be better. Also what is the research on things like adding Brown sugar and giving fruit juice? It does not sound evidenced based to me. She has also noticed blood weeping from belly button (cord stump came off a week ago) and whilst there is no redness or temp and baby does not seem sore there she is wondering if this is normal? Have you any answers for us? Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville
RE: [ozmidwifery] Alternative GBS
Hi Melanie, I suppose it is all about comparing the risks associated with having antibiotics with the risk of the baby being affected by GBS. The antibiotics are unlikely to do harm, except perhaps by damaging the woman's normal flora for a time. The consequences of things going wrong with the baby should it contract GBS are devastating. The chance of complications of either is small but the complications of GBS are so devastating as to warrant giving the antibiotics, I believe. Not all intervention is bad. All the best, Nicole. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Melanie Sommeling Sent: Friday, November 17, 2006 10:15 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Alternative GBS Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Bottle feeding hard poos and blood from belly button.
Thanks Fran and Barb, This mum did not continue to BF past 4 days as after a placenta accretia manual removal and a pph of 1200mls her milk was deemed to have not come in. The stress then of not getting it in compounded the no milk situation. There is still a little concern over any remaining placenta although no signs of it at this stage. She has a script for motilium I believe or max something. Not entirely sure but she has chosen to leave it till stress levels are reduced. We have spoken about the hard poo being formula related and I am not covering up any truths from her, she says she would like to re-establish bf but her actions at this point do not back that up. Baby is being feed on demand and the first thing she did was check to make sure that it was made up correctly. Is it really safe to give babies water as I have read about nasty side effects for those under 4 months? Will find out the other things. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville _ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Barbara Glare Chris Bright Sent: Friday, 17 November 2006 9:58 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Bottle feeding hard poos and blood from belly button. Hi, No, this is not normal. This is the consequence of feeding a baby an abnormal diet, sadly. When did she stop breastfeeding? Is there any chance of her beginning to breastfeed her baby again, even partially? At this age it is normally possible to begin to breastfeed again. If this is not the case, in the first instance I would ascertain whether or not the formula is being made exactly to directions on the can - it's easy to make mistakes. Then, I would try 30mls of cooled boiled water after feeds. Is there any family history of allergies? Does it seem to hurt the baby to poo? Is the baby getting adequate milk? Barb - Original Message - From: Philippa mailto:[EMAIL PROTECTED] Scott To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 6:39 PM Subject: [ozmidwifery] Bottle feeding hard poos and blood from belly button. Two questions. Have a mum who is formula feeding a 2.5week old and has found that bubs poos have turned hard but not terribly dry. Is this just normal or is it possible a different formula would be better. Also what is the research on things like adding Brown sugar and giving fruit juice? It does not sound evidenced based to me. She has also noticed blood weeping from belly button (cord stump came off a week ago) and whilst there is no redness or temp and baby does not seem sore there she is wondering if this is normal? Have you any answers for us? Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville
RE: [ozmidwifery] Alternative GBS
Some women use garlic vaginally to kill the GSB. There are other natural remedies too. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Nicole Carver Sent: Friday, 17 November 2006 10:01 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Alternative GBS Hi Melanie, I suppose it is all about comparing the risks associated with having antibiotics with the risk of the baby being affected by GBS. The antibiotics are unlikely to do harm, except perhaps by damaging the woman's normal flora for a time. The consequences of things going wrong with the baby should it contract GBS are devastating. The chance of complications of either is small but the complications of GBS are so devastating as to warrant giving the antibiotics, I believe. Not all intervention is bad. All the best, Nicole. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Melanie Sommeling Sent: Friday, November 17, 2006 10:15 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Alternative GBS Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Alternative GBS
Melanie By any chance did this mother have artifical rupture of membranes or a fetal scalp electrode applied? Briege Melanie Sommeling [EMAIL PROTECTED] wrote: Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe. - All New Yahoo! Mail Tired of [EMAIL PROTECTED]@! come-ons? Let our SpamGuard protect you.
Re: [ozmidwifery] Bottle feeding hard poos and blood from belly button.
Hi, It's a tough situation, for sure. If the baby is otherwise happy and well, I wouldn't be worrying about the poo. True constipation in infants, regardless of the method of feeding, is rare . I know parents do seem to get very worried about the poo. Formula fed poo is not normal, but may not be really problematic at this time. The mother may find it useful to get some counselling from a breastfeeding counsellor soon. On formula she knows the baby is getting fed, there need be no pressure - put the baby to the breast and see what happens. Stick with it, it can be a pleasant bonding time, anyway. It doesn't have to be an all or nothing thing. - even a little bit of breastmilk is a good thing. Did the mother notice any changes in her breasts at all? Any fullness? Any leaking? Any colostrum? 4 days is early to pull the pin on breastfeeding, though understandable given the stressful situation. Water is not necessary for breastfed infants, but formula feeding is not the exact science that the manufacturers would have us believe. Water is a problem if it's contaminated or if it displaces milk feeds, but sometimes formula may be a little too hard to digest for an individual baby, and a little water seems to help. It seems less problematic than juice or brown sugar. Still, I would check the quantities the baby is having, esp if poos are scant. Some 2.5 week old babies can be quite undemanding, esp if they've been jaundiced etc. I would first just wait and see, if the poo is not causing a problem, then no action is probably necessary. Barb - Original Message - From: Philippa Scott To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 11:30 PM Subject: RE: [ozmidwifery] Bottle feeding hard poos and blood from belly button. Thanks Fran and Barb, This mum did not continue to BF past 4 days as after a placenta accretia manual removal and a pph of 1200mls her milk was deemed to have not come in. The stress then of not getting it in compounded the no milk situation. There is still a little concern over any remaining placenta although no signs of it at this stage. She has a script for motilium I believe or max something. Not entirely sure but she has chosen to leave it till stress levels are reduced. We have spoken about the hard poo being formula related and I am not covering up any truths from her, she says she would like to re-establish bf but her actions at this point do not back that up. Baby is being feed on demand and the first thing she did was check to make sure that it was made up correctly. Is it really safe to give babies water as I have read about nasty side effects for those under 4 months? Will find out the other things. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville -- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Barbara Glare Chris Bright Sent: Friday, 17 November 2006 9:58 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Bottle feeding hard poos and blood from belly button. Hi, No, this is not normal. This is the consequence of feeding a baby an abnormal diet, sadly. When did she stop breastfeeding? Is there any chance of her beginning to breastfeed her baby again, even partially? At this age it is normally possible to begin to breastfeed again. If this is not the case, in the first instance I would ascertain whether or not the formula is being made exactly to directions on the can - it's easy to make mistakes. Then, I would try 30mls of cooled boiled water after feeds. Is there any family history of allergies? Does it seem to hurt the baby to poo? Is the baby getting adequate milk? Barb - Original Message - From: Philippa Scott To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 6:39 PM Subject: [ozmidwifery] Bottle feeding hard poos and blood from belly button. Two questions. Have a mum who is formula feeding a 2.5week old and has found that bubs poos have turned hard but not terribly dry. Is this just normal or is it possible a different formula would be better. Also what is the research on things like adding Brown sugar and giving fruit juice? It does not sound evidenced based to me. She has also noticed blood weeping from belly button (cord stump came off a week ago) and whilst there is no redness or temp and baby does not seem sore there she is wondering if this is normal? Have you any answers for us? Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of
Re: [ozmidwifery] Alternative GBS
Nicole, There has been some research done on the effects of antibiotics in labour to prevent the transmission of GBS to babies. What appears to be the case from current research is that the rates of GBS transmission do not change significantly as a result of the antibiotics but the babies who are exposed to the GBS are less liekly to become ill from GBS infection. However, there is an increase in the risk of e-coli and other infections that are resistent to the antibiotics, and therefore can result in more devastating infeections as they cannot be treated with standard antibiotics. So yes, the risk of GBS illness is reduced, but the risk of other antibiotic resitent infections is increased. I am fascinated to note that having now worked in the UK, Australia and Asia as a doula and in my role as a doula trainer have students from all over the world, the risk of GBS illness is so much higher in the USA than other comparitive developed countries. Another thing I struggle to understand on the topic of GBS. If the GBS is diagnosed it is determined that it came from the mother if she was GBS positive. However, a significant portion of woman can be GBS at any given time. If the baby is separated from the mother at birth and taken to the nursery, as is the case in the USA in most birth settings, and increasingly happening in other countries, or if the baby is routinely handled by staff at birth who may have been exposed to other babies or woman with GBS (e.g. handling soiled materials from a mother who had already delivered and was GBS positive), how do we know that the GBS was transmitted by the mother and not by the staff? I noted when I worked in the UK that GBS was rare, and babies were not handled by the staff as much as in the USA and certainly never went to nurseries because there weren't any in the public hospital system. here in Singapore, I have never seen a GBS affected baby amongst our clients, despite having had clients who were GBS positive (some took abx and some did not), but it is seen more commonly amongst other women here - the difference? The clients we work with have their babies roomed in, have minimal handling of their babies by staff etc, whereas the majority of woman have their babies taken to the nursery and held, bathed, fed etc by staff. Would be interested in seeing research that compares GBS infection rates amongst woman having low intervention births in settings that have close mother/baby contact compared to those rates in more actively managed settings. Nikki Macfarlane Childbirth International www.childbirthinternational.com - Original Message - From: Nicole Carver [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 8:01 PM Subject: RE: [ozmidwifery] Alternative GBS Hi Melanie, I suppose it is all about comparing the risks associated with having antibiotics with the risk of the baby being affected by GBS. The antibiotics are unlikely to do harm, except perhaps by damaging the woman's normal flora for a time. The consequences of things going wrong with the baby should it contract GBS are devastating. The chance of complications of either is small but the complications of GBS are so devastating as to warrant giving the antibiotics, I believe. Not all intervention is bad. All the best, Nicole. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Alternative GBS
Hello Melanie, A Danish Obstetrician came to John Hunter Hospital (Newcastle NSW) and presented some time ago on the use of Chlorhexidine douche for women with GBS positive swabs. Very popular in Denmark apparently and is being heralded as the treatment for women in third world countries because it is cheap. The Cochrane review is equivocal in its endorsment, but the Danish Obs was very very convincing with her stats. When Belmont Birthing Service first opened, all the women with GBS positive swabs had to go to John Hunter to give birth because we were not credentialled to give IV antibiotics at Belmont. We are a stand alone midwifery service so do not have doctors onsite for assistance if someone had an anaphylaxis. Many of the women were very upset about not being able to have their babies at Belmont, whilst others were very unhappy about using antibiotics for all the good reasons already mentioned, so remembering the chlorhexidine douche presentation, we were able to provide that as an option for those women who were willing to use that as something that was not considered as effective as antibiotics. We have since done the nurse immunisers course and so are also able to give IV antibiotics at Belmont. Interestingly, most women still choose the douche. We can give the women the equipment to take home and they can douche themselves if they think they are going into labour, or if their membranes release. We give them two doses and they let us know what they are doing. The chlorhexidine is a lovely blue colour, so it is interesting to see women's vaginal discharge after the douche - looks different on the partograph :-) We have a GBS policy for us and an instruction sheet for the women. We also have an information sheet for women to read before they do the swab. If you would like a copy, please email me at work and I can send them to you. [EMAIL PROTECTED] warmly, Carolyn - Original Message - From: Melanie Sommeling [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 10:15 PM Subject: [ozmidwifery] Alternative GBS Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: RE: [ozmidwifery] homebirth costs
How come there is such a big difference? I mean, that is a really BIG difference!! Love Abby Mary Murphy [EMAIL PROTECTED] wrote: Same in WA. MM _ Approx $2000-$2500 here in SA I think, from what I know anyway. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Intradermal sacral sterile water injections
Whilst I'm on the soapbox, I was thinking that you may be interested in the intradermal water injections and their efficacy. We had Janice Deocampo come to Belmont and give a seminar on the use of this technique for women with excruciating back pain. Midwives came from Gosford, Maitland, John Hunter and Taree. Janice presented her information and we all practised on each other (OUCH). It feels like a wasp sting. One of the midwives had back pain which was cured for six hours with the injection she received that day! It took us MONTHS to get the procedure through clinical governance. However, it is through. We have used the injections for about eight women since only one was not completely successful. We have even found them fantastic for late first stage when the backache has stopped the woman from progessing and even second stage when women wouldn't push because the backache was too bad. After the injections, voila - baby! John Hunter midwives are also now using this technique too with great success. Janice Deo Campo did a research project and the results are in the Birth Issues Journal from CAPERS. It is a wonderful, effective tool which may just help someone avoid an epidural or even make birth much more manageable for those women with excrutiating backache. If anyone wants the protocol and information sheet, please email me at work [EMAIL PROTECTED] and I will send it to you. warmly, Carolyn Heartlogic www.heartlogic.biz Phone: +61 2 43893919 PO Box 5405 Chittaway Bay, NSW 2261 As a single footstep will not make a path in the earth, so a single thought will not make a pathway in the mind. To make a deep physical path, we walk again and again. To make a deep mental path, we must think over and over again the kind of thoughts we wish to dominate our lives Henry David Thoreau
RE: [ozmidwifery] Alternative GBS
Hi Melanie Try gentlebirth... http://www.gentlebirth.org/archives/gbs.html Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Cord clamping and waterbirth
Thankyou all who replied and sent me info offlist. I have forwarded the info on to my friend. What I love about this list is that you can ask a question but then we can all learn something and it creates really interesting discussion. Warm Regards Honey - Original Message - From: Heartlogic [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, November 18, 2006 12:30 AM Subject: Re: [ozmidwifery] Cord clamping and waterbirth Lieve said: Cordclamping is an intervention and has first to prove that it is better than not clamping instead of the other way of thinking. I agree 100% with you Lieve. It's interesting isn't it, how interfering is the 'norm' with anything to do with birth - at least in western societies. I know that PPH is a real and frightening issue in many third world countries, but what PPH is most associated with is poverty and poor nutrition and non existent family planning options. These women are exhausted. As a society/global community it is important to find ways to address these issues for all women everywhere so they are well fed, relaxed and valued, having babies that are wanted so they can birth well and be healthy women and mothers for themselves and their families. For women in western countries, many have no idea that they even have a placenta to give birth to, and so think that birth is over when the baby is born, thus effectively switching off the hormonal flow for birth. That switching off the process, coupled with our usual ritualised meddling in that precious time of face to face, skin to skin, heart to heart intimacy of mother/baby, interferes with endogenous oxytocin release and baby perfusion whilst distracting the falling in love process. g It is perhaps safer to do the active management of third stage thing in situations when women are kept ignorant about the process because it requires knowledge and conscious awareness at best and a woman to be focused on her baby, rather than the kind of thinking that turns the process off. It's interesting that when women understand the physiology of the third phase of the labouring process, they remain very conscious and birth their placentas very well, usually with minimal blood loss. The midwives at the Birthing Service have all moved from the fragmented medicalised efficient factory model of 'delivery' to a one to one, relationship based model of midwifery practice and over the past year since we started, have all 'fallen in love' (poetic licence!) with undisturbed 'normal' physiology and are very respectful of women's processes. The midwives take great care in ensuring women understand and are fully informed of their natural physiology long before the women are in labour. Many women are choosing to stay in our beautiful big baths to give birth, so birth through water is a common event in our service. The PPH rate is very low and the midwives are fascinated by the threads in women's lives which weave their experiences. warmly, Carolyn -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Alternative GBS
This http://www.gentlebirth.org/archives/gbs.html is a great site and of course, the question about health, wellness and GBS screening rears its head in any thinking person's mind. However, we (working in the 'system') deal with the harsh reality of modern obstetrics and neonatology and until our culture settles down about the concept of 'risk' and our individual and corporate madness about fear of litigation... we comply with the dominant 'status quo' and help create many of the situations we are seeking to 'control'. We have official 'conversations' about whether women who decline (fill in the blank) should be able to give birth at our unit at all. g How I yearn for the day when information about Quantum physics and neuropsychobiophysiology permeates and influences all obstetrics and neonatology and true informed choice is truly valued and the pressure to conform that causes resistence patterns or reluctant compliance, with all the mischief that brings, is avoided. It is coming, it has to. The day of the factory approach to mothers and babies is over. Some people haven't caught up yet. Just to clarify, clearly there are situations where it is very advisable, if not imperative, that women are screened for various phenomena or have intervention(s) that is/are indicated by their particular situation. It is the 'cookie cutter' one size fits all and if you don't 'comply' then you are wrong approach to childbearing that is the issue. Information (unbiased), exploration of ideas as to what things mean to the individual, freedom and supported choices are the answer. warmly, Carolyn - Original Message - From: LJG [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, November 18, 2006 9:44 AM Subject: RE: [ozmidwifery] Alternative GBS Hi Melanie Try gentlebirth... http://www.gentlebirth.org/archives/gbs.html Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Bottle feeding hard poos and blood from belly button.
Frances Sheean wrote: Hi Philippa Fruit juice adds little to a newborn's diet except fluid and this will stop the babe from drinking milk. The newborn's gut is not equipped to deal with fruit juice until around 6 months, as per the WHO guidelines Despite apparent logic there is very little/no fibre in fruit juice and it has high sugar levels compared to fresh fruit. Pureed fruit can be given after 6 months of age. Brown (concentrated) sugar is an `old wives/old wise woman's' tale. It works by irritating the gut which is not advisable for all the reasons outlined by WHO So for the formula fed infant under 6 months check the formula is made up correctly, if so it may be worth looking for a formula that is less constipating (eg. one with Bifidus, or HA - partially hydrolysed). fran sheean From: [EMAIL PROTECTED] on behalf of Philippa Scott Sent: Fri 17/11/2006 6:39 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Bottle feeding hard poos and blood from belly button. Two questions. Have a mum who is formula feeding a 2.5week old and has found that bubs poos have turned hard but not terribly dry. Is this just normal or is it possible a different formula would be better. Also what is the research on things like adding Brown sugar and giving fruit juice? It does not sound evidenced based to me. She has also noticed blood weeping from belly button (cord stump came off a week ago) and whilst there is no redness or temp and baby does not seem sore there she is wondering if this is normal? Have you any answers for us? Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville Yes Im bottom-posting again, blame it on the geeks I hang out with... I have no evidence base for this but my LC mentor passed this bit of info to me if the formula is being microwaved to heat it, it can cause or increase risk of constipation... its ok to microwave the water, but not the formula something about the microwaves changing the structure of the protein? Maybe its an urban myth but I have used this in my practice it does make a difference! cheers -- Jennifairy Gillett RM Midwife in Private Practice Women’s Health Teaching Associate ITShare volunteer – Santos Project Co-ordinator ITShare SA Inc - http://itshare.org.au/ ITShare SA provides computer systems to individuals groups, created from donated hardware and opensource software -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: RE: [ozmidwifery] homebirth costs
How come there is such a big difference? I mean, that is a really BIG difference!! Midwives have always worked altruistically and undervalued their services. It takes an enormous emotional step for midwives to believe they are worth it. If midwives actually ask for this larger payment, would women still want to have their services? And then again midwives want women to be able to afford their services. Women now have an income from the Government that would pay for the midwife, but many parents see this as a payment to relieve the mortgage, clear debt or buy a big TV. It is more complex than just putting up the fees. MM Approx $2000-$2500 here in SA I think, from what I know anyway. Same in WA. MM
RE: [ozmidwifery] Alternative GBS
What about the risk of absorption of chlorhexidine? When the cream was used on newborn babies it was toxic. MM A Danish Obstetrician came to John Hunter Hospital (Newcastle NSW) and presented some time ago on the use of Chlorhexidine douche for women with GBS positive swabs. Very popular in Denmark apparently and is being heralded as the treatment for women in third world countries because it is cheap. The Cochrane review is equivocal in its endorsment, but the Danish Obs was very very convincing with her stats. When Belmont Birthing Service first opened, all the women with GBS positive swabs had to go to John Hunter to give birth because we were not credentialled to give IV antibiotics at Belmont. We are a stand alone midwifery service so do not have doctors onsite for assistance if someone had an anaphylaxis. Many of the women were very upset about not being able to have their babies at Belmont, whilst others were very unhappy about using antibiotics for all the good reasons already mentioned, so remembering the chlorhexidine douche presentation, we were able to provide that as an option for those women who were willing to use that as something that was not considered as effective as antibiotics. We have since done the nurse immunisers course and so are also able to give IV antibiotics at Belmont. Interestingly, most women still choose the douche. We can give the women the equipment to take home and they can douche themselves if they think they are going into labour, or if their membranes release. We give them two doses and they let us know what they are doing. The chlorhexidine is a lovely blue colour, so it is interesting to see women's vaginal discharge after the douche - looks different on the partograph :-) We have a GBS policy for us and an instruction sheet for the women. We also have an information sheet for women to read before they do the swab. If you would like a copy, please email me at work and I can send them to you. [EMAIL PROTECTED] warmly, Carolyn - Original Message - From: Melanie Sommeling [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 10:15 PM Subject: [ozmidwifery] Alternative GBS Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: RE: [ozmidwifery] homebirth costs
Hi, I paid about $2200 8 years ago for my home birth. Honestly I can't remember. It was around that - 2 midwives, antenatal and a couple of postnatal visits. Best money I ever spent! As I say, I cant quite remember the money, but I can absolutely remember every detail of that fabulous birth. And, you get paid $4000 to have a child these days. Midwifery care at home? It's a bargain. Barb - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Saturday, November 18, 2006 1:42 PM Subject: RE: RE: [ozmidwifery] homebirth costs How come there is such a big difference? I mean, that is a really BIG difference!! Midwives have always worked altruistically and undervalued their services. It takes an enormous emotional step for midwives to believe they are worth it. If midwives actually ask for this larger payment, would women still want to have their services? And then again midwives want women to be able to afford their services. Women now have an income from the Government that would pay for the midwife, but many parents see this as a payment to relieve the mortgage, clear debt or buy a big TV. It is more complex than just putting up the fees. MM Approx $2000-$2500 here in SA I think, from what I know anyway. Same in WA. MM
Re: [ozmidwifery] Bottle feeding hard poos and blood from belly button.
Hi Phillipa,
People who formula feed babies must realise that the solute load of formula is
much heavier than breastmilk and takes 3-4hrs to digest as opposed to
breastmilk's 20mins or so. Formula fed babies also need to have water
separately as opposed to breastfed bubs.
I have often found that Mums will 'top up' their babies at 2-3 hrs('because
they are hungry') with formula adding to an incompletely digested formula from
the feed before. This will cause constipation, obesity and a very uncomfortable
baby. I tell Mum's to give them some boiled water if they are'hungry' 2 hours
after a feed and that will tide them over to 3-4 hrs between feeds.
You will also need to check the proper making up of formula and the amount the
baby is offered per feed and also total volume for the day etc etc.
I encourage every Mum to breastfeed but I think it is essential that if they
choose to formula feed they must be given appropriate information. A lot of
times they are ignored and left to fend for themselves.
Cheers
Di M
[ozmidwifery] SIDS- possible cure interesting article
Sids study American researchers are closer to developing a cure for Sudden Infant Death Syndrome after identifying an important brain defect in its young victims. The researchers at the Boston Children's Hospital believe the problem is related to the brain chemical 'serotonin' which regulates breathing, body temperature and blood pressure. They compared autopsy results of babies who died of SIDS with infants who died of other causes and found that in the SIDS babies, the serotonin system was missing. They say this causes the baby not to wake up because the serotonin system doesn't sense carbon dioxide or low oxygen. Doctors believe this explains why smoking and alcohol consumption during pregnancy leads to a greater risk of SIDS, because it alters the same brain area. http://www.skynews.com.au/health/story.asp?id=138793
[ozmidwifery] interesting studies
20061113-87# Acupuncture administered after spontaneous rupture of membranes
at term significantly reduces the length of birth and use of oxytocin. A
randomized controlled trial - Acta Obstetricia et Gynecologica Scandinavica
, vol 85, no 11, 2006, pp 1348-1353 Gaudernack LC; Forbord S; Hole E -
(2006)
Background. The objective was to investigate whether acupuncture could be a
reasonable option for augmentation in labor after spontaneous rupture of
membranes at term and to look for possible effects on the progress of labor.
Methods. In a randomized controlled trial 100 healthy parturients, with
spontaneous rupture of membranes at term, were assigned to receive either
acupuncture or no acupuncture. The main response variables were the duration
of active labor, the amount of oxytocin given, and number of inductions.
Results. Duration of labor was significantly reduced (mean difference 1.7 h,
p=0.03) and there was significant reduction in the need for oxytocin
infusion to augment labor in the study group compared to the control group
(odds ratio 2.0, p=0.018). We also discovered that the participants in the
acupuncture group who needed labor induction had a significantly shorter
duration of active phase than the ones induced in the control group (mean
difference 3.6 h, p=0.002). These findings remained significant also when
multiple regression was performed, controlling for potentially confounding
factors like parity, epidural analgesia, and birth weight. Conclusion.
Acupuncture may be a good alternative or complement to pharmacological
methods in the effort to facilitate birth and provide normal delivery for
women with prelabor rupture of membranes. (17 references) (Author)
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6.
20061116-67* Reducing Cesarean Delivery Rates: An Active Management Labor
Program in a Setting with Limited Resources - Journal of the Medical
Association of Thailand , Vol 88, no 1, January 2005, pp 20-25 Somprasit C;
Tanprasertkul C; Atiwut Kamudhamas - (2005)
Objective: To determine the effect of an active management of a labor
program on the rate of cesarean section and labor outcomes in low-risk
nulliparous pregnancies in a setting with limited resources. Material and
Method: Nine hundred and seventy-five low risk nulliparous pregnant women
were randomized to receive either active management of a labor program (n =
325) or conventional management (n = 650). The rate of cesarean section and
labor outcomes were compared between the two groups using Chi-square and
t-tests. Results: The subjects in the active management program had
significantly shortened first stage of labor and total duration of labor
compared with the conventional group (538.0 + 242.9 min vs 589.4 + 263.8
min, p 0.05, 539.3 + 261.4 min vs 610.3 + 264.4 min, p 0.001,
respectively). There was no statistical difference found in the rate of
cesarean section and other labor outcomes. Conclusion: The active management
program shortened the first stage and duration of labor in low-risk
nulliparous pregnant women. (The full text is available at:
http://www.medassocthai.org/journal/files/Vol88_No1_20.pdf) (22 references)
(Author)
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[ozmidwifery] PPH
20061113-80# Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergo metrine in the management of the thirs stage of labor - Acta Obstetricia et Gynecologica Scandinavica , vol 85, no 11, 2006, pp 1310-1314 Fujimoto M; Takeuchi K; Sugimoto M; et al - (2006) Objectives. To determine the efficacy of intravenous oxytocin administration compared with intravenous methylergometrine administration for the prevention of postpartum hemorrhage (PPH), and the significance of administration at the end of the second stage of labor compared with that after the third stage. Methods. A prospective study was undertaken: two major groups (oxytocin group and methylergometrine group) of 438 women with singleton pregnancy and vaginal delivery were studied during a 15-month period. These two groups were subdivided into three subgroups: 1. intravenous injection (two minutes) group immediately after the delivery of the fetal anterior shoulder, 2. intravenous injection (two minutes) group immediately after the delivery of the placenta, and 3. drip infusion (20 min) group immediately after the delivery of the fetal head. In each group, quantitative postpartum blood loss, frequencies of blood loss 500 ml, and need of additional uterotonic treatment were evaluated. Results. As compared with methylergometrine, oxytocin administration was associated with a significant reduction in postpartum blood loss and in frequency of blood loss 500 ml. The risk of PPH was significantly reduced with intravenous injection of oxytocin after delivery of the fetal anterior shoulder, compared with intravenous injection of oxytocin after expulsion of the placenta (OR 0.33, 95%CI 0.11-0.98) and intravenous injection of methylergometrine after delivery of the fetal anterior shoulder (OR 0.31, 95%CI 0.11-0.85). Conclusions. Intravenous injection of 5 IU oxytocin immediately after delivery of fetal anterior shoulder is the treatment of choice for prevention of PPH in patients with natural course of labor. (6 references) (Author)
[ozmidwifery] Blood gasses
20061113-79# The effects of time on pH and gas values in the blood contained in the umbilical cord - Acta Obstetricia et Gynecologica Scandinavica , vol 85, no 11, 2006, pp 1307-1309 Valenzuela P; Guijarro R - (2006) Background. The pH and gas analysis of umbilical cord blood is an accepted practice in most maternity hospitals. The data that is obtained after a latency period in processing the cord blood samples is evaluated to determine whether it is useful for the clinic. Methods. The umbilical cords from 50 term infants were clamped immediately after delivery. Samples of artery and vein blood were drawn 5, 60, and 120 min postpartum and pH, pO2, and pCO2 levels were measured. Results.No significant differences were found after 60 min in the average values for pH in the arterial and venous paired samples, though the arterial and venous pCO2 values declined significantly. The arterial pO2 values increased significantly. After 120 min, no significant differences in the average values for the venous pH and pO2 paired samples were found. The arterial pH values increased significantly, however, and the arterial and venous pCO2 values declined significantly. The arterial pO2 values increased significantly. Conclusions. Though statistically significant differences occurred over time, these changes were so modest clinically that the data could still be used even when an immediate analysis of the umbilical cord was not possible. (12 references) (Author)
[ozmidwifery] placental abruption
Guess who is on the browser? MM Prepregnancy risk factors for placental abruption Minna Tikkanen A1, Mika Nuutila A1, Vilho Hiilesmaa A1, Jorma Paavonen A1, Olavi Ylikorkala A1 A1 Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland Abstract: Background. To define the prepregnancy risk factors for placental abruption. Methods. One hundred and ninety-eight women with placental abruption and 396 control women without placental abruption were retrospectively identified among 46,742 women who delivered at a tertiary referral university hospital between 1997 and 2001. Relevant historical and clinical variables were compared between the groups. Multivariate logistic regression analysis was applied to identify independent risk factors. Results. The overall incidence of placental abruption was 0.42%. Placental abruption recurred in 8.8% of the cases. The independent risk factors were smoking (OR 1.7; 95% CI 1.1, 2.7), uterine malformation (OR 8.1; 1.7, 40), previous cesarean section (OR 1.7; 1.1, 2.8), and history of placental abruption (OR 4.5; 1.1, 18). Conclusions. Although univariate analysis identified many risk factors, only smoking, uterine malformation, previous cesarean section, and history of placental abruption remained significant after multivariate analysis, increasing the risk of placental abruption in subsequent pregnancy. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors. _ Keywords: Placental abruption, placenta, risk factors
Re: [ozmidwifery] Cord clamping and waterbirth
Lieve Just want to say that I love both your wisdom and your wonderfully original English! Heart whisper sounds so much nicer than 'murmer' :-) Love Sue - Original Message - From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 6:05 PM Subject: Re: [ozmidwifery] Cord clamping and waterbirth you are very right. The baby is in charge and decides when to shut the doors to the cord :-). It is the heart of the baby that pumpes the blood to the placenta. I don't hav prove of this but I think that waiting for the baby to decide to close the cord is the reason why I never had a baby with a heartwisper the first week as often happens in practices with early clamping. Lieve .- Oorspronkelijk bericht - .Van: Mary Murphy [mailto:[EMAIL PROTECTED] .Verzonden: vrijdag, november 17, 2006 09:54 AM .Aan: ozmidwifery@acegraphics.com.au .Onderwerp: RE: [ozmidwifery] Cord clamping and waterbirth . .Lieve writes: . .Yesterday I attended a waterbirth and the cord continued pulsing another 15 .min after the birth of the placenta, 20 min after the birth of the baby. . . . .This can occur as a rebound pulse from the baby's heart beat. Obviously it .can't be from a placenta pumping more blood to the baby, because there is no .mechanism for this to happen. Am I right? MM . . -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.430 / Virus Database: 268.14.7/537 - Release Date: 17/11/2006 5:56 PM -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Alternative GBS
I'd consult with a herbalist. Echinacea tinctures/ douches etc can be mixed up. I also have heard that a clove of garlic inserted into the vagina ( peeled clove) for 3 nights in a row also aids in reducing GBS. Robyn D - Original Message - From: Melanie Sommeling [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 10:15 PM Subject: [ozmidwifery] Alternative GBS Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] ask for 2nd opinion
Journal of Obstetrics Gynaecology Publisher: Taylor Francis Issue: Volume 25, Number 2 / February 2005 Pages: 115 - 116 URL: Linking http://journalsonline.tandf.co.uk/%28a0anjt55lj5eqq45gdgc4dfy%29/app/home/l inking.asp?referrer=linkingtarget=contributionid=K314384NL611LM79backto=c ontribution,1,1;issue,3,47;journal,15,75;linkingpublicationresults,1:100389, 1; Options DOI: 10.1080/01443610500040547 Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment KS Oláh Department of Obstetrics and Gynaecology, Warwick Hospital, Lakin Road, Warwick, CV34 6BW, UK Abstract: During a 5-year period there were 32 cases where the vaginal assessment performed by a specialist registrar in the second stage of labour was re-assessed within 15 minutes by a consultant obstetrician. The examination was prompted by a request for permission to perform a caesarean section in the second stage of labour. The results suggest a significant discrepancy between the consultants and the specialist registrar's findings, with 44% of the cases indicating a difference in the position of the head, and 81% a difference in the station of the head. No comment was made about caput or moulding in the majority of cases (94%). The study findings suggest that vaginal examination, like instrumental delivery, is a skill that is being eroded and will require formal instruction to address this problem.
Re: [ozmidwifery] Alternative GBS
Good question Mary. Thanks for your comments. As far as Chlorhexidine cream goes, my memory is that it was an antibacterial lubricant for vaginal examinations and that it irritated too many women's mucosa and that is why we gave that up in favour of the clear gel. As for the creams we put on babies to 'debug' them in the old days - my memory is 'phisohex' and 'steriskin' and yes, they were considered to be toxic after many years of dousing untold thousands of babies with these substances. As I have thought about your question I realise that I have no idea what the active agent was in these cleansers. In thinking further about the issue of the chlorhexidine douche and toxicity, my thinking is that the concentration of active substance in a watery medium is much lower that any preparation that is cream based and quickly 'washed out' by the active vaginal mucosa and if membranes are released, the liquor, so reducing any possiblity of toxic reaction. My other thought that as it is locally given, the absorption rate would be much less than that of antibiotics given intravenously and so provides a satisfactory option for women who chose to use some form of preventative chemical therapy and yet wish to avoid antibiotics. What is interesting for me is that women who are GBS negative, have to transfer if they have SROMS and are over 18 hours without having given birth, but if they are GBS positive and using chlorhexidine they don't transfer ... all very fascinating. What do you think about the douche and toxicity? Is my thinking plausible? warmly, Carolyn - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Saturday, November 18, 2006 1:50 PM Subject: RE: [ozmidwifery] Alternative GBS What about the risk of absorption of chlorhexidine? When the cream was used on newborn babies it was toxic. MM A Danish Obstetrician came to John Hunter Hospital (Newcastle NSW) and presented some time ago on the use of Chlorhexidine douche for women with GBS positive swabs. Very popular in Denmark apparently and is being heralded as the treatment for women in third world countries because it is cheap. The Cochrane review is equivocal in its endorsment, but the Danish Obs was very very convincing with her stats. When Belmont Birthing Service first opened, all the women with GBS positive swabs had to go to John Hunter to give birth because we were not credentialled to give IV antibiotics at Belmont. We are a stand alone midwifery service so do not have doctors onsite for assistance if someone had an anaphylaxis. Many of the women were very upset about not being able to have their babies at Belmont, whilst others were very unhappy about using antibiotics for all the good reasons already mentioned, so remembering the chlorhexidine douche presentation, we were able to provide that as an option for those women who were willing to use that as something that was not considered as effective as antibiotics. We have since done the nurse immunisers course and so are also able to give IV antibiotics at Belmont. Interestingly, most women still choose the douche. We can give the women the equipment to take home and they can douche themselves if they think they are going into labour, or if their membranes release. We give them two doses and they let us know what they are doing. The chlorhexidine is a lovely blue colour, so it is interesting to see women's vaginal discharge after the douche - looks different on the partograph :-) We have a GBS policy for us and an instruction sheet for the women. We also have an information sheet for women to read before they do the swab. If you would like a copy, please email me at work and I can send them to you. [EMAIL PROTECTED] warmly, Carolyn - Original Message - From: Melanie Sommeling [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, November 17, 2006 10:15 PM Subject: [ozmidwifery] Alternative GBS Hi wise women of the list, I am curious if anyone can enlighten me of any alternatives to Antibiotics in labour to decrease GBS transfer from mother to baby. I recollect some info about douching during labour, but the info was sketchy to say the least. I understand the risks of transfer are low and the risk or negative effects are even lower, but alternatively have witnessed a birth of a GBS positive mother where AB's were administered and the baby still developed respiratory distress with several hours of birth and question the validity of using AB'a at all. Any advice on the matter would be greatly appriciated. Melanie -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] GBS
Journal of Obstetrics Gynaecology Publisher: Taylor Francis Issue: Volume 25, Number 5 / July 2005 Pages: 462 - 464 URL: Linking http://journalsonline.tandf.co.uk/%28a0anjt55lj5eqq45gdgc4dfy%29/app/home/linking.asp?referrer=linkingtarget=contributionid=M7633N7UV3130772backto=contribution,1,1;issue,11,42;journal,12,75;linkingpublicationresults,1:100389,1; Options DOI: 10.1080/01443610500160261 Group B streptococcus disease in neonates: To screen or not to screen? O. Subair A1, P. Wagner , F. Omojole , H. Morgan A Department of Obstetrics and Gynaecology, Whittington Hospital, London, UK Abstract: Summary An audit was undertaken of the prevention of early-onset Group B streptococcus (EOGBS) disease in neonates. The prevention strategy in use involved offering Intra-partum Antibiotic Prophylaxis (IAP) to mothers with identified risk factors, which include maternal fever in labour gt; 38°C, previous baby with GBS disease, prolonged rupture of membranes gt; 18 h, pre-term labour, GBS urinary tract infection and known GBS carriage. The most common risk factor identified was GBS carriage (41%) which was known ante-partum but logistical problems prevented these mothers from receiving adequate prophylaxis 4 h before delivery and so were classified as at risk of GBS disease. We found an incidence of GBS in our unit of 0.55 per 1,000 births over the study period. One neonate developed EOGBS disease and the mother had no identifiable risk factor ante-partum/intra-partum. Recent recommendations from the Royal College of Obstetricians and Gynaecologists (RCOG) could reduce the number of babies having sepsis screens performed as the time interval from beginning IAP to delivery has been shortened to 2 h and routine surface cultures or blood cultures are not recommended in well newborns. The evidence is lacking at this point to recommend universal screening for GBS in all pregnant women but patients are increasingly aware of this option and may request anogenital swabs to assess GBS carriage.
