[ozmidwifery] Job Vacancy at Katherine NT

[Anne Smith]

There's a vacancy with the Katherine West Health Board for a Maternal &
Women's Health Coordinator.  It's for a midwife with a strong interest
in working with Aboriginal people and experience in coordinating and
developing population health programs utilizing a primary health care
model.
The reason I'm sending this is that I'm just finishing a very short-term
contract to complete a project in this area.  It would be a great job
for someone who is comfortable with lots of traveling and an enthusiasm
for working with the female members of the communities.  Katherine is
also ideally situated as a base for all the wonderful attractions of
this area including the Nitmiluk, Gregory and Kakadu National Parks.
 
If you're interested contact the Human Resource Coordinator on (08) 8971
9300 or email [EMAIL PROTECTED]
 
Anne

[ozmidwifery] Pregnancy testing

[Anne Smith]

I have a question for you wise women - will give you some background
first.

 

Young woman with a concealed or unacknowledged pregnancy at 26 weeks
presented with acute abdominal pain to a remote area health clinic.  No
midwife was present and doctor had not practiced obstetrics for "years".

 

The woman did not appear pregnant at all.  They did a pregnancy test and
it was negative. They thought that renal colic may have been the cause.
No one could palpate contractions but eventually the doctor did a VE and
discovered "something there".

 

A very experienced nurse then "delivered" (and I use the word
advisedly), the baby which was in a breech position.  Traumatic for
everyone especially the woman, who was then transferred by plane to the
nearest hospital.  I will be attending a debriefing session on Friday
and would like to be able to at least explain the negative pregnancy
test.

 

 Was this due to the demise of the baby (perhaps up to a week
previously) or have the hormones altered so much that the test will not
react -   

   a. because of FDIU or

   b. advanced pregnancy or

   c. was there a technical problem with the test
itself

 

Your input would be much appreciated.

 

Keep up the discussions on why women don't choose or don't know to
choose more wisely when contemplating pregnancy because we do have a
responsibility as midwives for disseminating this knowledge.

 

Many thanks

 

Anne (in the NT) 

RE: [ozmidwifery] Misoprostol

[Anne Smith]

Joy,

While working in Mildura we used it often for PPH.  2-4 tablets pr.  It
seemed to be effective.  It was never used for IOL.  

Anne


I work in a very small hospital, covering acute, aged care, emergency,
as
well as midwifery.
One of our GP obstetricians has requested that we have Misoprostol in
stock
(which we already have for acute patients) as "all the hospitals now use
it
for post-partum bleeding".  I would be interested to know how common
this is
as it is another off label use.  I'm also concerned that it will then be
a
small step to use if for cervical ripening/IOL.
I notice in Hale that it is a category L3 (moderately safe) whereas
Ergometrine is L4 (possibly hazardous) in breastfeeding mothers.  I'm
remembering the "olden days" when Ergometrine tablets were used fairly
routinely for women with incomplete 3rd stage or were passing clots - I
don't remember the exact dose - but it was used over several days in
reducing doses (I even had it myself 30 yrs ago!).
Interested to hear any comments or research that anyone has regarding
Misoprostol and post-partum bleeding (I'm assuming he means haemorrhage,
not
normal bleeding).
Thanks,
Joy

Joy Cocks RN (Div 1) RM CBE IBCLC
BRIGHT Vic 3741
email:[EMAIL PROTECTED]


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Re: [ozmidwifery] weighing babies on Day 3

[Anne smith]

  Hi Jennifer,
   
  At Mildura (Vic) we too have changed our practices.  All babies 
  are weighed at birth and again when the Newborn Screening Test is 
  done in the 48 to 72 hour range.  At that time we also do the only 
  length and head circumference measurement.  The cord clamp is also 
  removed and Hep B given if requested.
   
  If a baby has lost over 10% of its weight we would offer EBM as a 
  comp, fed with a syringe or cup or if there were obvious problems - 
  sleepy, jaundiced baby - a gavage feed or two, preferably with EBM or 
  reluctantly, formula. We would also encourage 3hrly breast 
  feeds.  All after discussion with the mother. 
   
  These decisions are made by 2 midwives in consultation so formula is 
  avoided if at all possible.
   
  We have an excellent Dom Mid service who see almost all 
  women after discharge especially those with any problems. 
   
  We have also changed our numbering of days after birth.  The day 
  of birth is known as birth day (BD) and the defined change over time is 
  now midnight. This is also easier for the parents.
   
  Hope this helps.
   
  Regards,
  Anne Smith
   
   
   
  I have been a subscriber for several years 
  and love the list but this is my first email to all you wise people 
  
  I am seeking your views to feedback to our LC 
  and Unit Manager of the Post Natal Ward of my medium sized maternity unit; 
  about 1500 births per year and a level 2 nursery. 
  Babies born after mid-day are day 0 that day and are called Day 1 the next 
  day if you get my drift!
  Weighed at birth and again on Day 3, but for 
  some they are not 72 hours old when weighed on day 3.  Then if they 
  have lost more that 10% of birth weight there may be more intervention, 
  i.e. refer to paed, test weigh and comp to quote.  Comp to quote 
  would be with EBM or formula if not sufficient ebm.  Given usually 
  with a nasogastric tube or a "finger feed" , rarely a bottle.  We are 
  looking into benchmarking what other Units/hospitals are doing about 
  followup weighing of babies.   Our visiting midwifery service 
  cannot home visit all mothers who go home on day 3, 4 or 5 etc. only those 
  with problems that need some followup.
  Others are asked to go to the child health 
  clinic.  All babies are weighed on discharge.  Some mums do stay 
  4 or 5 days or longer if need be.    What should we do 
  about the traditonal day 3 bare weighs??
  Looking forward to getting some help to 
  clarify this issue.
  We do NST when the baby is over 48 hours old 
  and it used to be day 3 this was done but now its earlier and some go home 
  after this.    What happens in your area.  Thankyou 
  for your replies to this.   Much happinessto you.  Jennifer 
  Smyth
   





	
	
	
	
	
	
	




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[ozmidwifery] Cord Blood Storage

[Anne smith]

  I have a client living in North-west Victoria who is keen to keep and 
  store her baby's cord blood for use at a later date if required.  Has 
  anyone had any experience of this and can you give me a contact?
   
  Thanks
   
  Anne





	
	
	
	
	
	
	




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Nola and midwife/hospital practice

[anne smith]

Dear Nola,

What a difficult situation to be in. Advocating for women in the hospital 
system often seems like a battle when it should be plain common sense.  
While it would be easier to give in and conform it takes strength and 
knowledge to support appropriate care.  Hope your colleagues were there for 
you as we are.

Well done Nola and know that your students also appreciate your teaching and 
support.

Regards

Anne Smith

Mildura

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primip breech for vaginal birth

[anne smith]

Hi everyone,

I currently have a client whom I'll name Heide, who had planned a homebirth 
for her first baby.

At 31 weeks Heide's baby was in a breech position and has remained so 
despite acupuncture, massage and emotional exploration.  Now at 37 weeks she 
continues to explore her options and the seemingly limited choice available 
to her.

Heide is also two hours drive from the nearest hospital that has 
obstetrician cover. As a "public patient" she is in a dilemma as to how to 
persue her quest for a vaginal birth when there is little or no support for 
vaginal breech birthing in this area.

I would value input and ideas from all you listners out there.

Anne


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