RE: [ozmidwifery] big baby

[Nicole Hmelnitsky]

Just a couple of questions first? Has she got polyhydramnios? with such
a sudden increase in fundal height. If her fundal height was larger than
dates i.e. 1cm all along it probably isn't a problem. Is the same person
measuring the fundal height each week? Is she a multip?

I am only 161cm tall, and my second baby was 4.950kg. I was huge. My
fundal height was bigger than dates from about 21 weeks, but I didn't
have any sudden increases as your lady. My midwife was concerned at 21
weeks, had an ultrasound, but everything was O.K. I delivered at
41weeks, vaginally with 1 degree tear. I was on my feet standing and
ambulating around the room and in and out of the shower for 6 hours of
labouring and not stuck to a bed on a CTG (although this was 13years ago
and I guess things have changed). I am glad I was not a midwife then
because I would have been worried about shoulder dystocia etc, but I
obviously had the pelvis for such a big baby.

I hope all goes well for her and just remember that most women with a
bigger than average baby on-board have a pelvis able to deliver him/her.

Just make sure there are resources and skilled people necessary if the
delivery does become difficult.


-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Belinda Maier
Sent: Thursday, 17 March 2005 11:22
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] big baby

Just looking for some ideas to help a woman in my antenatal class today
.
She has apparently got a 4.2 kg baby by ultrasound at 37weeks. She is
very
uncomfortable and now worried. The ultrasound was done because of
increased
fundal height 5cm in 1 week. The baby had no abnormalities although a
high
feta alpha protein early in pregnancy. The parents refused any further
testing. Does anyone know if Downs syndrome could be a factor? also any
tips
I can pass on to her, I have discussed with her the probs with
ultrasound
weights, big babies, birth, she is very tall as is her husband,
stressing
about the size in labour affecting her labour ... I am pretty caught up
in
other stuff at the moment which means my pot is boiling over! I want to
make
sure I can help her. Thnaks
Belinda

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RE: [ozmidwifery] newborn bath

[Nicole Hmelnitsky]

I agree. 

I think that the benefit of educating a couple on bathing their baby is
actually just helping them feel comfortable with holding their baby,
rather than the "bath technique" head first etc etc, because they really
don't need much washing. Another benefit is  advising that a bath is
helpful as a relaxation tool. 

Nicole H


-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Pauline
Sent: Thursday, 3 March 2005 21:20
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] newborn bath

 When i first went back to work 5 years ago i got in trouble for showing
a 
woman the wrong way to bath her baby. Instead of wrapping the baby and 
washing his face and hair, soaping him up then putting him in the bath,
i 
(heaven forbid) put him straight in the bath.  This was much to the
horror 
of the midwife i was working with who had been working in the same unit
for 
over 20 years.Cheers Pauline 

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RE: [ozmidwifery] Analgesia post LUSCS

[Nicole Hmelnitsky]

I work in a tertiary referral hospital. Our women receive Oxycontin 10mg
bd (a long acting opiod tablet) as well as panadol 1g qid, voltaren 50mg
tds and prn Endone q4h. Sometimes pr voltaren is given in recovery. Most
women opt for spinals which also seems to reduce post-op pain and
recovery time compared to GA. Our anaesthetists have moved away from PCA
morphine or fentanyl. The above cocktail works well and if there is
still pain, the Oxycontin can be increased to 20mg bd. Unfortunately
Voltaren (and other antiinflammatories) cannot be given to anyone who is
on antihypertensives such in the case of women with PET as it is
contraindicated. The other benefit of oral meds compared to PCA is the
time factor and the amount of time a woman is disturbed overnight with
constant obs (2/24) which doesn't help the sleep deprivation factor of a
new mum.

Nicole

-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Cheryl LHK
Sent: Wednesday, 2 March 2005 09:24
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] Analgesia post LUSCS

Not exactly natural birth I know, but can you give me some ideas of what

your doctors/obst's order for analgesia days1-2 post LUSCS?  Small
hospital, 
and each doctor tends to have his own ideas, and sometimes we end up
with 
all kinds of concoctions!!  It doesn't make me very happy when I come
onto 
night-duty, find women teary, in pain with nothing more than Panadol
some 
days!

But I'm the first to admit that since I haven't a a LUSCS (three NVB's)
I 
tend to keep up the pain relief because I think it must be very, VERY 
painful having major abdo surgery then up and learning about a baby as
well. 
  Is the LUSCS recovery period any more or less painful than other abdo 
surgery?

Thanks in advance.

Cheryl


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[ozmidwifery] active management of third stage

[Nicole Hmelnitsky]

To those who are interested

 

I am a new grad midwife (6 months out) and we were
taught about active and physiological management. I work in a tertiary referral
hospital and our policy follows the NSW Health recommendations for active
management to prevent PPH. This policy guideline is explicit and defines active
management and I’m sure you will find all the answers to your questions
if you look into it. The website for NSW Health is www.health.nsw.gov.au and if you
search under postpartum haemorrhage it will lead you to the policy. It also
describes not only active management, but guidelines for ppH, recommendation on
how long to leave a placenta in situ etc 

 

Nicole

[ozmidwifery] midwives vs obstetricians

[Nicole Hmelnitsky]

I’m hoping to get some advice and words of
support from midwives working in Sydney
metro area. I am a new grad midwife of 6 months that is currently working on a
postnatal ward and about to rotate to the birthing unit (of a large tertiary
referral hospital in the south west Sydney area).
My fear is the conflict I have with obstetricians who love to make decisions on
behalf of women without any concern/respect/autonomy such as blanket decisions
with comments like: “if she is 5cm rupture her membranes” and “if
not established put up the Synto” etc etc or not allowing a primip to at
least have a fair go at pushing before the ventouse or forceps come out. I know
that obstetricians have their place but I am already feeling the stress thinking
about trying to fight these Men and their decisions. 

 

It is true, the later a woman presents to hospital,
the better it is for her because there is less time to intervene. 

 

My question is this:- How much birthing unit experience
do I need before I am eligible to apply for a birth centre or another lower
risk delivery suite – and does anyone know of anything coming up!

 

Thanks Nicole

[no subject]

[Nicole Hmelnitsky]

I hope someone has an answer to my question.

 

I am a newly graduated Certified Midwife working in a
large teaching hospital. I need to find out other policies regarding the number
of breastfeeds required in the first 24 hours of a healthy term newborn. If a
baby has not breastfed at delivery, some midwives will perform a heel prick
test for a blood glucose level after 6 hours and some will try and give a comp
feed of artificial formula. I don’t believe in either. Some literature has
said that a newborn will feed 3 times in the first 24 hours, and the some WHO literature
says a newborn should feed 8 times in the first 24 hours. I really need to know
if anyone has established a policy and guideline regarding this matter.

 

Thanks, Nicole.