Re: [ozmidwifery] new idea

[Rachele Meredith]

Isn't the chance of losing a baby to a uterine rupture in VBAC approximately 
0.03%?  Approximately 1 in ten ruptures?


I'll just go look it up

Rachele

- Original Message - 
From: "Dean & Jo" <[EMAIL PROTECTED]>

To: 
Sent: Thursday, May 04, 2006 3:15 PM
Subject: RE: [ozmidwifery] new idea



Great letters everyone!

But remember when anyone is spouting stats on rupture rates, the 1 in
200 ruptures are not all fatal ruptures.  In fact the .2% was an
'estimated' rate (quote) from the 2001 Australian vbac management study.
There were NO maternal deaths, only hysterectomies and there were no
feotal mortalities: only morbidities.

So we must be very clear that when we discuss vbac that by using the 1
in 200 stat, we are not confusing women to think they have a 1 in 200
chance of having their baby die due to rupture.

Cheers
Jo

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Re: [ozmidwifery] Re: theatre "greens"

[Rachele Meredith]

Similarly, in the USA, when a Kansas HMO (health fund) started paying OBs 
the same regardless of method of delivery, the CS rate dropped from 28.7% to 
13.5% in a year.


Rachele

An obst from argentina recently told me that to lower the countries 
ridiculously high caesar rate the government made the schedule benefits 
(as in money given for procedure) the same for both c/s and vaginal birth, 
c/s rate dropped very quickly!


nicole

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Re: [ozmidwifery] "Midwifery led units"

[Rachele Meredith]

- Original Message - 

  From: 
  Vedrana 
  Valčić 
   
  
  “Nick, I've had 30 years of experience and the 
  disaster can come out of the clear blue sky in a patient who's been assessed 
  as low risk and they happen in a heartbeat. They happen so rapidly that they 
  are stunning.”
   
  This is what we hear in 
  Croatia as well. To my knowledge, 
  this is true when there was a previous intervention, which interfered with the 
  natural process. What is your opinion? What can one say to 
  this?
  
  
  
  Vedrana,
   
  I am not a midwife, "just" a 
  consumer, but this is something I wondered myself when considering 
  homebirth.  My father is a physician and my mum was an obstetric nurse 
  and both had told me that in birth "when things go wrong they go wrong very 
  quickly and you don't have 20 mintues to get to hospital".  I wondered 
  what would happen if complications arose at home and these questions were 
  answered very well by Marsden Wagner in his piece "Fish Can't See 
  Water".  Apologies for the long quote but I feel he addresses the issue 
  extremely well:
   
  Many clinicians and their organizations 
  continue to believe in the dangers of planned out-of-hospital birth, either in 
  a center birth or at home, rejecting the overwhelming evidence that planned 
  out-of-hospital birth for low risk women is safe. The clinician's response to 
  this evidence is "But what if there is an out-of-hospital birth and something 
  happens?" Since most clinicians have never attended an out-of-hospital birth, 
  their 'what if' question contains several false assumptions. The first 
  assumption is that in birth things happen fast. In fact, with very few 
  exceptions, things happen slowly during labour and birth and a true emergency 
  when seconds count is extremely rare and, as we will see below, often in these 
  cases the midwife in the birth center or home can take care of the emergency. 
  
  The second false assumption, that when 
  trouble develops there is nothing an out-of-hospital midwife can do, can only 
  be made by someone who has never observed midwives at out-of-hospital births. 
  A trained midwife can anticipate trouble and usually prevent it from happening 
  in the first place as she is providing constant one-on-one care to the 
  birthing woman, unlike in the hospital where usually nurses or midwives can 
  only look in occasionally on the several women in labour for which they are 
  responsible. If trouble does develop, with few exceptions the out-of-hospital 
  midwife can do everything which can be done in the hospital including giving 
  oxygen, etc. For example, when a baby's head comes out but the shoulders get 
  stuck, there is nothing which can be done in the hospital except certain 
  maneuvers of the woman and baby, all of which can be done just as well by the 
  out-of-hospital midwife. The most recent successful maneuver for such shoulder 
  dystocia reported in the medical literature is named after the home birth 
  midwife who first described it (Gaskin maneuver).[10] 
  The third false assumption is there can 
  be faster action in the hospital. The truth is that in private care the 
  woman's doctor often is not even in the hospital most of the time during her 
  labour and must be called in by the nurse when trouble develops. The doctor 
  'transport time' is as much as the 'transport time' of a woman having a birth 
  center or home birth. Even when a caesarian section is indicated, it takes on 
  average 20 minutes for the hospital to set up for surgery, locate the 
  anesthesiologist, etc. and during this 20 minutes either the doctor or the 
  birth center or home birthing woman are in transit to the hospital. This is 
  why it is important for a good collaborative relationship between the 
  out-of-hospital midwife and the hospital so when the midwife calls the 
  hospital to inform them of the transport, the hospital will waste no time in 
  making arrangements for the incoming birthing woman. These are the reasons 
  there are no data whatsoever to support the single case, anecdotal 'what if' 
  scenario used by some doctors to scare the public and politicians about 
  out-of-hospital birth. 
   
  THe whole article can be accessed at http://www.acegraphics.com.au/articles/wagner03.html.  
  Incidentally, Marsden Wagner is the former head of Maternal and Child Health 
  with the World Health Organisation.
   
  Rachele

[ozmidwifery] Time Interval in Twin Births-For Yvette

[Rachele Meredith]

Yvette,

Regarding the time interval in twin births, these articles may be of 
interest to you.


http://www.naturalchildbirth.org/natural/resources/risk/risk09.htm

http://www.scielo.br/scielo.php?pid=S0100-7203200100073&script=sci_abstract

http://www.greenjournal.org/cgi/content/abstract/63/4/502

Regards,
Rachele 



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Re: [ozmidwifery] Dramatic women

[Rachele Meredith]

Mary,
 
I have read Gloria's remark in the past and I must 
say that I do not agree.  My observation is purely anecdotal and not at all 
scientific, but from what I have observed, women end up with a high rate of 
intervention because they are told they need it.
 
When I was younger and poorer and myself and my 
friends did not have private health insurance, we went to the public hospital to 
have our babies.  We went through the midwives clinic and most of us had 
straightforward births.  Very few c-secs, epidurals and 
dramas.
 
I now have a uni degree and a job that goes along 
with it.  My colleagues have private health insurance and nearly every one 
of them - several women at my work have had babies in the last two years - has 
had a c-sec.  The *one* who had a vaginal birth had a long labour with 
epidural and instrumental delivery, lots of stitches, a full term baby who ended 
up in NICU for a week due to epidural fever which *could have* meant an 
infection, prophylactic abx, breastfeeding issues, etc.  This woman is so 
traumatised by her experience that she insists she will never have another baby 
unless it is by c-sec.  Those that DID have c-secs had them because they 
were told they were necessary.  Every one of those women planned a 
"natural" birth and enrolled in birth classes with this in mind.
 
The reasons they were given for *needing* a 
c-sec?  One was 7 days past EDD ("very dangerous" said Dr) so she was 
sectioned - not even induced!  One was told that her baby was way too big 
to be born vaginally - bubs turned out to be the same size as the woman's first 
baby!  Another was a failed induction, she was 7 days past EDD and was 
told this is "very dangerous".  Her doctor also told her he had never, in 
his decades of practice, seen an induction that didn't work.  Another was 
diagnosed with GD and told baby was too big and due to the GD the birth could be 
complicated.  Another had pre-eclampsia and the babies (twins) were 
delivered via c-sec at 28 weeks (she was told vaginal birth is too risky for 
premmies).  Another was told she had to have a c-sec because she was 
"high-risk" due to an incident of spotting in her tenth week of pregnancy and 
the RSI in her wrists.  Another was sectioned because the baby would be too 
big - bubs was 5lb 11oz.
 
Incidentally, all but two of these women were in 
their 20s when they had their babies.  Also, most of them were told after 
the sugery that it was a good thing the c-sec had been done because the baby was 
facing the wrong way and had the cord around its neck so it could not have been 
born vaginally (or would have been stillborn).
 
There are three women currently pregnant at my work, including 
myself.  The other two are seeing private OBs and planning "natural" births 
in the private hospital.  One has already been told that she may have 
problems as she had such severe morning sickness it could mean something is 
wrong.  The other is due around the same time as me (October) and told me 
recently that she believes a doctor's advice NOT to read or research during 
pregnancy is a good thing.  We talked about prenatal testing and she feels 
that it is important to have all the tests (becuase her doctor siad to)  
and that she will trust him to act appropriately on the results.  She will 
not do any research into any of this herself but trust him to do his job.
 
In my last pregnancy (my daughter is 21 months old) I had the scans and 
tests I was told to have (until I changed my caregiver halfway through the 
pregnancy).  Early bloods revealed high AFP levels which meant my baby 
*could* have a neural tube defect.  The 18 week scan revealed my baby's 
kidneys *may* be a bit on the small side which *could* mean a problem.  
Also I had a low-lying placenta which *could* mean dramas at the birth.  
Turned out bubs was normal, her kidneys are fine and the placenta was closer to 
my ribs than my cervix by the time I was full term.  But what an emotional 
roller coaster!  When I told my doctor halfway through the pregnancy that I 
was changing my care option and planning a homebirth she lectured me on pain 
relief; how would I possibly cope if there were none availble??  According 
to her I wouldn't be able to relax without pain relief and the labour could 
be complicated.
 
I do see and hear women being overly dramatic about 
their pregnancies and births... but because they were led to believe - by their 
care providers - that it was a dangerous situation!  I have been told over 
and over again that the doctor said if the c-sec hadn't been done the baby, and 
possibly the mother, would have died.  I think these women all think I am 
some sort of freak of nature as I have had three striaghtforward - in fact 
beautiful! - vaginal births, the last a planned homebirth.  Nary a 
complication or obstetrician in sight at any of my births.
 
I have read, on this list, of a midwife who tells 
her patients that if she doesn't hop up on the bed for exa