[ozmidwifery] Neonatal BSLs

[Ross W Timbs]

Dear Jo,
 
I hope you are successful at stopping BSLs at your 
place of work.
 
I know a lot of people complain about policies / 
clinical protocols, and often with good reason, but if we work within the health 
system, we are always going to have to deal with them.  And even if you do 
get this one changed, there will be others that you need to work 
with.
 
Clinical protocols are there as a guideline - they 
are not to be slavishly followed regardless of the situation.  And 
informed consent is still required.  You said this woman 
was reluctant to have her baby given artificial baby milk, and her response 
was  "If he has to then I guess he has to... 
.  And yet you were convinced that he didn't need it.  I 
suggest that if you gave the mother all of the information, then she would 
possibly have declined the BSL and the TBG, and likely have declined the 
artificial feed.  She needs to be informed that BSLs are inaccurate, what 
'diabetic' babies vs genetically large babies look like, what the signs 
of hypoglycaemia in a baby are, and the impact of giving artificial feeds 
vs breastfeeds.
 
The other part of your letter that concerns me is 
that it sounds like the mother and baby were separated.  If so, this is 
something that also needs to be looked at.  There needs to be strong 
reasons for separating a mother and her baby.
 
Hope this helps.
 
Jacky Eales
 
 
 

[ozmidwifery] Neonatal BSLs

[Ross W Timbs]

Dear Jo,
 
Your work situation sounds truly yukky - it gives 
me heartburn just reading about it (must be those nearly-suppressed memories 
breaking through!).  I don't think policies are the only problem - perhaps 
the SCN staff could do with some updates on evidence-based practice & 
informed consent.
 
I agree with Mary that the poor 
little thing's tachypnoea was probably a response to his 
separation from his mother, etc - had probably been crying his lungs 
out too!
 
I know it's difficult, but the most important thing 
you can do is to continue to support and educate the women with 
whom you have contact.  
(and when it gets too much for you, find somewhere 
better to work! - there are places out there where this kind of thing is at 
least uncommon).
 
Jacky
 
 

[ozmidwifery] Qld NMAP Launch

[Ross W Timbs]

Dear List,
 
On the ABC news last night it said there was a 
rally, and that women were wanting greater access to homebirth, including in 
rural areas, and midwives were wanting medicare provider numbers.  They 
finished with a comment that the government had rejected giving midwives 
provider numbers, and that the government was committed to increasing the number 
of GPs in rural areas.
 
I assume this was the NMAP launch they were talking 
about, but they never mentioned NMAP or continuity of midwife carer.  It 
seems to me they were side-tracked by the homebirth issue, and missed the main 
point.
 
I also find it very frustrating, that all health 
issues get hijacked by medical issues.
How is it that the launch of the NMAP ends up being 
about rural GPs?
 
Can the Maternity Coalition contact the ABC & 
try again to get the point across?
 
Jacky 
 

[ozmidwifery] Mareeba Vacancy

[Ross W Timbs]

Mareeba Maternity Unit requires the services of an 
experienced and passionate midwife.
(We need to try to replace the wonderful Kathryn 
Borrie who left us for love in S.A.)
 
We are a 13 bed Maternity Unit, and have about 
200 births per year.  We work on a midwifery model of 
care. 
 
Mareeba is a small town in Far North 
Queensland.  It has a population of about 10,000 people, and is largely a 
farming community.  It is about 60 km from Cairns, but with much nicer 
weather!  
 
If anyone is interested or would like more 
information, you can email me off list.
 
Jacky Eales
[EMAIL PROTECTED]

Re: [ozmidwifery] Placenta cream

[Ross W Timbs]

I'm fairly sure Ella Bache used to make a placenta mask/cream - more than 10
years ago.  Don't know whether they still do.
Jacky

- Original Message -
From: "Lesley Kuliukas" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Thursday, October 24, 2002 12:38 AM
Subject: Re: [ozmidwifery] Placenta cream


> Hi
> In England we used to send them off to cosmetic companies to do I don't
know
> what with but after HIV it all stopped.
> Lesley
> - Original Message -
> From: "Jennifer Semple" <[EMAIL PROTECTED]>
> To: <[EMAIL PROTECTED]>
> Sent: Wednesday, October 23, 2002 7:06 AM
> Subject: [ozmidwifery] Placenta cream
>
>
> > I think I remember a midwife who used to live in France saying that
> > human placentas are actually made in to cream.  I can't remember if she
> > said that the cream is sold in France or if it's exported.  Hmmm... I'll
> > have to double check.
> >
> > Has anyone else ever heard of anything like this?
> >
> > Jen
> >
> > - Original Message -
> > From: "Tom, Tania and Sam Smallwood" <[EMAIL PROTECTED]>
> > Date: Friday, October 18, 2002 2:27 pm
> > Subject: Re: [ozmidwifery] animals eating Placenta
> >
> >
> > > sheep's placenta cream, which is
> > > very good for dermatitis and eczema.  Interesting!
> >
> >
> > --
> > This mailing list is sponsored by ACE Graphics.
> > Visit  to subscribe or unsubscribe.
>
> --
> This mailing list is sponsored by ACE Graphics.
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Re: [ozmidwifery] iliostomy and birth

[Ross W Timbs]

Janine,
 
I know a woman who had a colostomy as a result of a 
car accident.  She had a normal birth with no problems related to the 
colostomy.
The only concern by some doctors was that it 
might cause problems if she needed a caesarean, though this was considered 
unlikely as it was situated quite high on her abdomen.
 
Jacky

  - Original Message - 
  From: 
  Janine and 
  Steve Clark 
  To: Ozmid 
  Sent: Thursday, October 24, 2002 8:02 
  PM
  Subject: [ozmidwifery] iliostomy and 
  birth
  
  Hello list,
   
  I'm currently working with a woman as part of our 
  BMid follow through program. She is 23yrs old, with an iliostomy. Currently 28 
  weeks. They are a delightful couple who are planning a natural, active birth. 
  Their obstetrician (who is quite relaxed about it all) says he sees no problem 
  whatsoever about birthing normally following her surgery (which was done 2 yrs 
  ago).
   
  She is really healthy and well, and the pregnancy 
  has been wonderful so far (she expected maybe some pain due to adhesions, 
  which hasn't happened).
   
  I've asked around lots, and the general consensus 
  is that she will have no problems birthing vaginally. However, can anyone 
  point me to any research or articles regarding this? She cannot find any info 
  about other women who have done this. They are going ahead as normal, but I 
  guess the doubt is in her mind just slightly about her ability to stretch up 
  during second stage with all that scar tissue. She is quite open about it all 
  and very keen to be as normal as possible. I really believe this normal birth 
  will do wonders for her esteem and body image (even more so than the average 
  woman).
   
  Anyone have any experience or articles about 
  this?
   
  Regards,
  Janine

[ozmidwifery] Ultrasounds

[Ross W Timbs]

Dear Jodie & List,
 
I agree with Marilyn that there are lots of other 
signs that make the pregnancy real - fetal movements are not the only 
ones.  There are plenty of changes in your body & mind.
 
Another negative aspect of ultrasound that hasn't 
really been discussed is the amount of times they get it wrong, or see something 
'unusual' but have no idea what it means.
 
Here's just a small selection of ultrasound 
stuff-ups that I have seen in my practice
 
- a baby with only two chambers in it's heart - 
this was missed on 2 ultrasounds
- a woman with a Grade 4 placenta previa - missed 
on 3-4 ultrasounds
- a baby that had 'ascites' detected on ultrasound 
- this woman was transferred to the capital city thousands of kms away from 
family & friends, and the baby delivered prematurely.  It didn't have 
ascites or any other detectable abnormality, but now has a host of problems 
resulting from prematurity and long separations from its mother.
Imagine the different scenario if she's never had 
the routine ultrasound in the first place.
- a baby that had 'shadows' on its heart on 
ultrasound.  No-one could tell the woman what this meant.  This 
considerably increased her anxiety levels - not reduced them.  The baby was 
and is perfectly healthy.
- There have also been a number of cleft palates 
that have been missed, countless heart defects that have either been missed or 
are not detectable on ultrasound, a missed spinal defect.
- Weight predictions that are often wrong - by up 
to 1.5kg.
 
These were done by a variety of ultrasonongraphers 
using a variety of equipment.
 
How can anyone be reassured by ultrasound, when 
they are so unreliable?
 
They are not a perfect tool, but their use is 
sometimes warranted when there is an indication - then they are not used alone 
in diagnosis, but as one part of a complete assessment.  I don't 
believe that they should be used routinely or for social reasons.  We don't 
give people the choice of having social xrays, CT scans etc - because there are 
potential negative aspects of their use.  We only use these technologies 
when we have an indication, not because someone wants to see a picture of their 
brain, etc.
 
Routine use of ultrasounds only serves to fill the 
pockets of private companies.
 
Well, that's my say.
 
Jacky
 
 
 
 

[ozmidwifery] pain in labour

[Ross W Timbs]

Hello Frank,
 
Women don't need to be rescued from the pain of 
childbirth.  They need to be supported and believe in 
themselves.
The pain is important for all the reasons that 
Andrea listed, but also for the sense of power that it gives the woman (as Megan 
touched on).
 
Women who have come through labour under their own 
steam, really feel an enormous sense of achievement.  They feel that if 
they can get through the pain of labour, then they can do anything - even climb 
Mount Everest!
 
I think this confidence helps them in the early 
days and weeks of parenting.
 
I have seen powerless women in abusive 
relationships, become strong with the pain in labour.  Yes, the power in 
these women does appear to diminish in the days after birth, but who could deny 
these women their experience of strength - perhaps it does help them in less 
obvious ways, or will help them at some future time.
 
Women who have been 'saved' from their pain - with 
epidurals don't have that same sense of power from their births.  I haven't 
seen hypnotherapy first hand in labour, but if the woman feels she couldn't do 
it without the hypnotherapist, I imagine it would also stop the sense of 
achievement & power.
 
Just my two bob's worth!!
 
Jacky

[ozmidwifery] Thrush in the breasts

[Ross W Timbs]

Dear Joy & List,
 
I have had a lot of success using Pau D'arco for 
thrush - it's a herbal remedy available in lots of pharmacies. 
 
Jacky

Re: [ozmidwifery] J K Rowling

[Ross W Timbs]

Yes.  Why do you ask?

Jacky

- Original Message - 
From: "Sally Westbury" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Tuesday, February 04, 2003 9:11 PM
Subject: RE: [ozmidwifery] J K Rowling


> Anybody know of an obs. Micheal Humphrey?? From Cairns??
> 
> Sally Westbury
> 
> Homebirth Midwife
> 
>  
> 
> "You are a midwife, assisting at someone else's birth. Do good without
> show or fuss. Facilitate what is happening rather than what you think
> ought to be happening. If you must take the lead, lead so that the
> mother is helped, yet still free and in charge. When the baby is born,
> the mother will rightly say: "We did it ourselves!"
> 
>  from The Tao Te Ching
> 
> 
> 
> --
> This mailing list is sponsored by ACE Graphics.
> Visit  to subscribe or unsubscribe.
> 


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Re: [ozmidwifery] J K Rowling

[Ross W Timbs]

Yes.  Why do you ask?

Jacky
[EMAIL PROTECTED]

- Original Message - 
From: "Sally Westbury" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Tuesday, February 04, 2003 9:11 PM
Subject: RE: [ozmidwifery] J K Rowling


> Anybody know of an obs. Micheal Humphrey?? From Cairns??
> 
> Sally Westbury
> 
> Homebirth Midwife
> 
>  
> 
> "You are a midwife, assisting at someone else's birth. Do good without
> show or fuss. Facilitate what is happening rather than what you think
> ought to be happening. If you must take the lead, lead so that the
> mother is helped, yet still free and in charge. When the baby is born,
> the mother will rightly say: "We did it ourselves!"
> 
>  from The Tao Te Ching
> 
> 
> 
> --
> This mailing list is sponsored by ACE Graphics.
> Visit  to subscribe or unsubscribe.
> 


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[ozmidwifery] shoulder dystocia??

[Ross W Timbs]

Dear Denise,
In response to your questions on the 19th March - I 
have been pondering, and hoping someone else would start the discussion - I find 
the whole area of classifying degrees of shoulder dystocia very 
hazy.
 
It is very subjective, and the skill and experience 
of the midwife makes a big difference.
 
I think there is a reluctance to classify mild 
shoulder dystocia as dystocia at all - because of the potential negative impact 
that this might have on future births - ie elective CS.
 
I think the moderate - severe shoulder dystocias 
are easier to label - because there is invariably some compromise or 
injury to the baby, which kind of "justifies" the label, and any 
management of future births. 
 
I guess I also use the condition of the baby as a 
guide - if I am caring for a woman whose previous birth notes say she had a 
moderate shoulder dystocia, but the baby had good Apgars, etc, I'd be inclined 
to believe that it was only mild.
 
I don't know of any specific definitions or 
boundaries to classify degrees of dystocia.
 
Jacky

Re: [ozmidwifery] Re: Isolated birth

[Ross W Timbs]

Jan,
Could I have a copy of your birth plan too please.
Jacky
[EMAIL PROTECTED]

- Original Message -
From: "Jan Robinson" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Saturday, June 14, 2003 8:57 AM
Subject: Re: [ozmidwifery] Re: Isolated birth



Hi Lyle
You can count me in too if you can get me there! The closest I have ever
been to Pitcairn is Norfolk and that's a long way from you.

However, the reality is that you will probably be unassisted except for the
woman's immediate family and the priority now would be to prepare them all
for a natural birth (if natural birth is unfamiliar to them and you). It is
important to work out the role of each family member in supporting the woman
through her labour and possibly assisting you if unexpected circumstances
occur.

Have you got lots of resources, videos, pictures, books depicting natural
birth so you can all get together and discuss options and prepare this
woman's birth plan with her? Also discuss what will be focused on as pain
management. The woman will do much better without drugs and needs to have a
plan on how she will achieve this.  Verbal analgesia from her family will
help.

I can send you a copy of a really good birth plan electronically that will
guide you in your discussion with this woman if you would like it.
Discussing aspects of the birth plan at each prenatal visit will remind you
to leave no part of the pregnancy, labour/birth and aftercare untouched and
will in fact become your documentation of obtaining informed consent for
your management.

Regards
Jan Robinson

__
 Jan Robinson Phone/fax: 011+ 61+ 2+ 9546 4350
 Independent Midwife Practitioner e-mail: <[EMAIL PROTECTED]>
 8 Robin Crescent www:   midwiferyeducation.com.au
 South Hurstville  NSW  2221  National Coordinator, ASIM
__



On 13/6/03 10:00 AM, "Andrea Quanchi" <[EMAIL PROTECTED]> wrote:

> I'd say go for it. You obviously both understand the limitations of
> isolation and so long as that is the case then it is ultimately her
> decision.  The woman is better with you than without you.  I am assuming
> that you must have someone else on the island who is proficient in CPR
> and I would include them in your birth preperations.  Once the baby is
> born there are two people to be considered and it is reassuring to know
> that there is someone who can care for each in the unlikely event that
> they are needed.  Non birthing people seem to panic at the idea so
> springing it on someone at the last minute is not a good idea but if
> they get to work through the remainder of the pregnancy with you both
> and see that you are making the decision on healthy ideals then they
> will be more comfortable when the time comes.
> What about offering an island holiday to a midwife +/- family around the
> time of birth, Anyway have a great time and keep us informed about the
> plans
> Andrea Quanchi
> On Wednesday, June 11, 2003, at 12:14 PM, Medical Officer wrote:
>
>> Hi everyone,
>> I am at present the sole medical person and midwife on an isolated
>> island where the nearest medical help is seven days away by ship. All
>> mothers over the past 10 years have gone to Auckland to have their
>> babies. I am at present looking after a mother with her second
>> pregnancy (to a new partner) who would like to have this baby on the
>> island where she resides. She had a fairly easy first delivery and
>> this pregnancy has progressed well (she is 24 weeks) with no
>> complications. I am reasonably happy to continue looking after her and
>> delivering on island but I am wondering what other midwives etc. would
>> recommend.
>> Any feedback on this would be great.
>> Thanks,
>> Lyle
>

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Re: [ozmidwifery] Cord Blood Storage

[Ross W Timbs]

Anne,
 
I have had no personal experience with saving cords, but have talked to a 
couple of people who have done it.  I have also recently had a client who 
investigated it and was considering doing it.  
 
After discussions with others who had been involved with it, she decided 
against it.  Her reasons were as follows:-
 
1. It detracts from the birth and the enjoyment of the baby at birth, 
because as soon as the baby's born the focus moves to the cord.  The focus 
is because you need to get X mls, and it needs to be packed for transport, 
couriers arranged and get to designated lab within a limited time frame.  
This is perhaps more of a hassle in rural areas like ours.
 
2.  She came to understand that her main motivation was the guilt she 
would feel if the child became seriously ill at some point in the future, and 
she hadn't saved the cord.  She also then realised that there are no 
guarantees in life, and that saving the cord would not guarantee that her child 
would live a long & healthy life.
 
3.  It's a big expense at a time when your income will be dropping for 
an extended period.
 
These are just a few more issues your client may like to consider before 
she decides.
 
Jacky
 

  - Original Message - 
  From: 
  Anne smith 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, June 30, 2003 12:16 
PM
  Subject: [ozmidwifery] Cord Blood 
  Storage
  
  


  
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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[ozmidwifery] Vaginal wall tearing

[Ross W Timbs]

Isis,
 
I had a 3rd degree tear with the birth of my first 
child.  I believe there were also a number of contributing factors to this 
- mostly crap in my head from other peoples' births (I am a midwife).  The 
tear healed well, but remained tender for about 12 months.
 
My second child was 4585g, 200g+ larger than my 
first, and I had an intact perineum with her birth.  I did have a 
small cystocoele (weakness in the anterior vaginal wall) after her birth.  
I don't know whether this was a result of perineal scar tissue, or my 
mind protecting my perineum.  Whatever, the cystocoele was much better than 
a perineal tear (and obviously much better than a Caesarean).  It never 
caused any problems and disappeared when I stopped breastfeeding.
 
In my practice as a midwife, I have seen many women 
achieve natural births after previous bad experiences, including extensive 
perineal damage.
 
Don't let this dreadful man into your head (or near 
you when birthing).  Keep your belief in yourself.
 
Jacky
 
 

[ozmidwifery] hypnobirthing

[Ross W Timbs]

I've been enjoying the debate about 
hypnobirthing.  I don't like the name, but like most people, I feel 
that anything that helps women birth without drugs is useful.
 
I use quite a lot of the Wintergreen (Common 
Knowledge Trust) techniques in my practice and have done for many years.  I 
find it interesting that these two approaches seem to come from opposite ends of 
the spectrum, but with the same goal.  
 
My understanding of Wintergreen is that she 
believes that women can birth their babies regardless of what's going on in 
their heads - they just need to know how to work their bodies - including the 
breath.  
 
I don't have much knowledge or experience of 
hypnobirthing, but it seems that it is all about what's going on in your head, 
and using the breath to calm the mind.
 
I just thought it was an interesting 
comparison.  I'm sure both techniques would be useful, and knowledge of 
them will give us a greater range of tools and knowledge to use in our 
practice.
 
Jacky Eales

[ozmidwifery] waterbirth pictures

[Ross W Timbs]

Can anyone enlighten me on the rationale / 
motivation for holding the baby under the water after it is born?
 
Also does anyone have any good client information 
pamphlets on group B strep that they would like to share?
 
Thanks in advance
 
Jacky

[ozmidwifery] 3rd Stage Feedback

[Ross W Timbs]

Denise
 
Yes.  At the hospital where I work all the 
women are public - no private at all.  Nearly all women go through 
midwives' clinic & see the same midwife throughout the pregnancy.  
Third stage is discussed with all of them, and they are given a pamphlet that 
lists the pros & cons of active & physiological.
A lot of women opt for physiologic - but the 
majority probably still choose active management.  
As an interesting aside, we went through a patch a 
while back where we had an unusually large number of PPHs.  Just found out 
recently that we had a bodgy batch of syntocinon.    Perhaps it 
was the CCT that was used with the ineffective synto that caused these PPHs. 
 Another point in favour of physiologic 3rd stage!
 
Jacky