[ozmidwifery] interesting studies

[Mary Murphy]

 

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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RE: [ozmidwifery] interesting article 2

[Julie Clarke]

Hi
Mary,

 

Yes it
is an interesting article of opinion; it makes me feel sick that there is not
one word about safety, outcomes, maternal morbidity, maternal mortality…

And then the statement:

“the cesarean rate is a consequence of individual
value-laden clinical decisions, and that it is not amenable to the methods of evidence-based
medicine.”

Is reflective of the lack of professional accountability
within the obstetric field – they are unable and unwilling to perform to recommended
standards, particularly when the rewards are financial and legal security. It
worries me that an opinion paper can be published in a journal of strong
influence and yet omit these serious and important details.

 

What is also interesting is that many lay people are quite
aware, even before they attend classes, of the above concerns. In a group
situation, there is always an interesting mix of people from all sorts of different
backgrounds, and once they start talking specifically about medical
interventions, within minutes the above issues emerge, so in my opinion unethical
Obstetricians and their unethical supporters, can avoid the truth of the matter
as much as they like, but it will only serve in the long term to completely
undermine the respect that the community has had for them in the past and
replace it with distrust.

 

Warm hug



Julie

www.julieclarke.com.au

 

 



 









From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy
Sent: Thursday, 12 October 2006
7:26 PM
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] interesting
article 2



 

CLINICAL
OPINION  American Journal of Obstetrics and Gynecology
(2006) 194, 932–6

 

Myth
of the ideal cesarean section rate: Commentary

and
historic perspective

Ronald
M. Cyr, MD*

Department of Obstetrics and Gynecology, University
of Michigan, Ann Arbor, MI

Received
for publication July 10, 2005; revised September 12, 2005; accepted October 8,
2005

KEY
WORDS

Cesarean
section rate

Myth

History
of cesarean

section

John
Whitridge

Williams

Evidence-based

medicine

Attempts
to define, or enforce, an ‘‘ideal’’ cesarean section
rate are futile, and should be abandoned.

The
cesarean rate is a consequence of individual value-laden clinical decisions,
and is

not
amenable to the methods of evidence-based medicine. The influence of academic
authority

figures
on the cesarean rate in the US
is placed in historic context. Like other population health

indices,
the cesarean section rate is an indirect result of American public policy
during the last

century.
Without major changes in the way health and maternity care are delivered in the
US,

the
rate will continue to increase without improving population outcomes.

_ 2006 Mosby, Inc. All rights reserved.

Since
the earliest days of the modern cesarean

sectiondthe 1880sdthere has raged
within the profession

a
debate about the appropriate indications for this

operation.1,2 For
several decades after the availability of

antibiotics
and blood banking, the cesarean section rate

in
the US
remained in the 4% to 6% range. Between

1968
and 1978, the rate tripled to 15.2%, and discussion

of
cesarean section moved permanently into the public

domain.
A 1981 report commissioned by the National

Institutes
of Health (NIH) expressed concern about

the
rising rate, and its recommendations for reducing cesareans

included
qualified support for VBAC.3
By the

1990s,
individual hospital cesarean section and VBAC

rates
were being published, and interpreted by consumer

groups
as indicators of obstetric care quality. In 1991,

the
Healthy People 2000 initiative advocated a 15% cesarean

rate
as a US
health promotion objective by the

year
2000.4

Despite
expert and lay opinion that many cesareans

are
unnecessary, the rate continues to increase in the

USdexceeding 27% in 2004dand shows no sign of

abating.5,6 Indeed,
there is growing discussion and acceptance

of
patient-choice cesarean section as a legitimate

birth
option.7,8 A recent editorial opined that ‘‘It’s
time

to
target a new cesarean delivery rate.’’9

It
is the premise of this essay that attempts to define, or

enforce,
an ‘‘ideal’’ cesarean section rate are futile, and

should
be abandoned. It will be argued that the cesarean

rate
is a consequence of individual value-laden clinical

decisions,
and that it is not amenable to the methods of

evidence-based
medicine. The influence of academic

authority
figures on the cesarean rate in the US will be

placed
in historic context. Like other population health

indices,
the cesarean section rate is an indirect result of

American
public policy during the last century. Without

Dr
Cyr is the 2003 ACOG/ORTHO-McNEIL Fellow in the

History
of American Obstetrics and Gynecology.

*
Reprint requests: Ronald M. Cyr, MD, Department of Obstetrics

and
Gynecology, University of Michigan, 1500 E Medical Center

Drive,
Ann Arbor, MI 48109-0276.

E-mail

[ozmidwifery] interesting article 2

[Mary Murphy]

CLINICAL
OPINION  American Journal of Obstetrics and Gynecology (2006) 194, 932–6

 

Myth
of the ideal cesarean section rate: Commentary

and
historic perspective

Ronald
M. Cyr, MD*

Department of Obstetrics and Gynecology, University
of Michigan, Ann Arbor, MI

Received
for publication July 10, 2005; revised September 12, 2005; accepted October 8,
2005

KEY
WORDS

Cesarean
section rate

Myth

History
of cesarean

section

John
Whitridge

Williams

Evidence-based

medicine

Attempts
to define, or enforce, an ‘‘ideal’’ cesarean section
rate are futile, and should be abandoned.

The
cesarean rate is a consequence of individual value-laden clinical decisions,
and is

not
amenable to the methods of evidence-based medicine. The influence of academic
authority

figures
on the cesarean rate in the US
is placed in historic context. Like other population health

indices,
the cesarean section rate is an indirect result of American public policy during
the last

century.
Without major changes in the way health and maternity care are delivered in the
US,

the
rate will continue to increase without improving population outcomes.

_ 2006 Mosby, Inc. All rights reserved.

Since
the earliest days of the modern cesarean

sectiondthe 1880sdthere has raged
within the profession

a
debate about the appropriate indications for this

operation.1,2 For
several decades after the availability of

antibiotics
and blood banking, the cesarean section rate

in
the US
remained in the 4% to 6% range. Between

1968
and 1978, the rate tripled to 15.2%, and discussion

of
cesarean section moved permanently into the public

domain.
A 1981 report commissioned by the National

Institutes
of Health (NIH) expressed concern about

the
rising rate, and its recommendations for reducing cesareans

included
qualified support for VBAC.3
By the

1990s,
individual hospital cesarean section and VBAC

rates
were being published, and interpreted by consumer

groups
as indicators of obstetric care quality. In 1991,

the
Healthy People 2000 initiative advocated a 15% cesarean

rate
as a US
health promotion objective by the

year
2000.4

Despite
expert and lay opinion that many cesareans

are
unnecessary, the rate continues to increase in the

USdexceeding 27% in 2004dand shows no sign of

abating.5,6 Indeed,
there is growing discussion and acceptance

of
patient-choice cesarean section as a legitimate

birth
option.7,8 A recent editorial opined that ‘‘It’s
time

to
target a new cesarean delivery rate.’’9

It
is the premise of this essay that attempts to define, or

enforce,
an ‘‘ideal’’ cesarean section rate are futile, and

should
be abandoned. It will be argued that the cesarean

rate
is a consequence of individual value-laden clinical

decisions,
and that it is not amenable to the methods of

evidence-based
medicine. The influence of academic

authority
figures on the cesarean rate in the US will be

placed
in historic context. Like other population health

indices,
the cesarean section rate is an indirect result of

American
public policy during the last century. Without

Dr
Cyr is the 2003 ACOG/ORTHO-McNEIL Fellow in the

History
of American Obstetrics and Gynecology.

*
Reprint requests: Ronald M. Cyr, MD, Department of Obstetrics

and
Gynecology, University of Michigan, 1500 E Medical Center

Drive,
Ann Arbor, MI 48109-0276.

E-mail:
[EMAIL PROTECTED]

0002-9378/$
- see front matter _ 2006 Mosby, Inc. All rights reserved.

doi:10.1016/j.ajog.2005.10.199

 

[ozmidwifery] Interesting article

[Mary Murphy]

British Journal oi Obstetrics and Gynaecology

April
1993, Vol. 100, pp. 303-306

COMMENTARIES

In Australia,
approximately 50% of women carry some

form of private health
insurance for childbirth, with some

variation between States.
This gives them access to an

obstetrician of their
choice and to either private hospital

accommodation or to a
private bed in a public hospital as

an intermediate patient.
The obstetrician (or in a rural setting,

a general practitioner/obstetrician) is remunerated

on a fee-for-service
basis by the Federal Government,

receiving a global
schedule fee for obstetric care regardless

of complications of
pregnancy or the type of delivery.

The obstetric specialist’s
fee currently amounts to

$AU600. The patient is
responsible for meeting any

difference between the
private obstetrician’s fee and the

schedule fee. This extra
fee varies between obstetricians

and may be as high as an
extra $AU600 but on average is

an extra $AU110 (Deeble
1991). The average fee-forservice

payment to private obstetricians
and gynaecologists

in Australia in
1991 was $AU291 600 which does

not include income from
extra billing (O’Reilly 1992).

The other 50% of Australian women who do not carry

private health insurance
have their medical and hospital

charges covered by a
compulsory levy applied to all

income earning
Australians (1.25% of gross salary); there

are no direct charges for public health services. This gives

obst‘etric patients
access to a public hospital where care is

provided by salaried doctors
and midwives. Almost no

private obstetric
hospitals in Australia
produce annual

clinical reports and most
mixed hospitals produce information

in which public and
private data are combined.

However, in those
hospitals from which data are available

an approximate doubling
of caesarean section and instrumental

delivery rates is seen
for private births compared

to public births with
caesarean section rates for private

patients often in the
range of 30 to 35%. A similar doubling

of intervention rates for
private patients has been

observed in the United Kingdom
with 10.4% caesarean

section rates for NHS
patients compared to 22.5% for

patients in pay beds
(Macfarlane 1988).

It is probable that these
higher intervention rates are

not due to the biological
or medical differences between

private and public
obstetric patients. If anything, private

patients are, in general,
better nourished, better educated

and better prepared for
birth; they might be expected to

require (and wish for)
less intervention in childbirth. Not

surprisingly, there is no
evidence to show that these higher

intervention rates confer
any improvement in outcome

for the mother or her
baby (Cary
1990).

When testing the strength
of an association between

two variables, a
doselresponse relationship increases the

likelihood of a causal
effect. The data from Australia
and

the USA indicate
such a dose/response relationship in the

association of private
insurance and high intervention

Obstetric intervention
and the economic imperative

 

[ozmidwifery] Interesting article

[Helen and Graham]

Encouraging parents too rare

September 12, 2006 09:00am
Article from: 

 

SMACKING should be outlawed, crying can't be photographed and 
children are getting fatter, but are parents really getting it so wrong, asks 
Sue Dunlevy
You can't trust parents these days. They put junk food in the lunch box, 
think it's OK to smack and are not making their kids eat their vegetables. 
Then there are those child abusers who allowed their children to be snapped 
in distress after their lollipops were taken away by US photographer Jill 
Greenberg. 
Give birth to a child these days and it's a licence to be criticised. 
You don't even have to be a trained expert to get into the blame game, just 
having a kid of your own is enough to qualify you as a critic of someone else's 
parenting style. 
It's even better if you're a celebrity with children. 
That's all that was needed for celebrity chef Jamie Oliver to equate parents 
who feed their kids Red Bull to drug pushers. 
"You might as well give them a line of coke," he said last week. 
When was the last time you heard anyone congratulating a parent for doing a 
fair job at raising their kids? 
We all get blamed for the 25 per cent of kids who are overweight or obese, 
even though 75 per cent of us have children who aren't fat. 
We never hear a good word about all those mums and dads who volunteer to run 
children's sport – just abuse about the few who can't control their behaviour on 
the sidelines. 
It might surprise you to hear that the Australian Institute of Health and 
Welfare reports the nation's children are healthier than ever. 
Child mortality rates have halved in the past 20 years and 90 per cent of our 
kids are now vaccinated against killer diseases. 
The gurus who tell us to focus on praising kids for doing the right thing 
rather than punishing them for doing bad never seem to apply their message to 
dealing with parents. 
In the past week, parents have been blamed for turning their kids into fussy 
eaters because they don't force them to eat vegetables. 
Experts have reeled in horror at a survey showing 69 per cent of parents 
support smacking naughty children – even though it didn't mean nearly 70 per 
cent actually did it. 
And then there was the bizarre claim that an artist who wanted to capture 
emotion on a child's face was an abuser because she did so by taking a lollipop 
out of their mouths. 
The parental punishers didn't stop to consider whether she was striking a 
blow not just for art, but against childhood obesity and dental decay – two 
other issues we're blamed for. 
Online parenting magazine Motherinc chief executive Claudia Keech said today's 
parents are being run over by a juggernaut of parenting advice. 
"Parenting has gone from almost a secret job where people at home read Dr 
Spock or did what their mum taught them to being public and trendy," Ms Keech 
said. "We've created a monster with a whole lot of experts and a whole lot of 
products." 
Much of the advice is a great help for parents and covers issues from 
behaviour management to correct nutrition. 
But sifting the good advice from the bad has become a major chore for parents 
trying to do their best. 
And Ms Keech says parents should make sure anyone they rely on is qualified 
as a doctor, psychologist or dietician rather than a celebrity. 
Parenting is not something you can learn from a book or from your own 
parents, who also made mistakes. 
All parents make bad choices about food, about discipline and about how hard 
to push their children. 
But any good parenting guru should know you won't get parents to turn around 
these bad choices by criticising them. 
Compare them to a drug pusher or a child abuser and they are going to switch 
off, not heed your message. 
Trying to make their mistakes illegal by passing laws to ban smacking or 
feeding children junk food will not work either. 
Support parents with some sound evidence-based advice and you are more likely 
to get the result you want. 
Showing them how resorting to violence to solve a problem teaches their 
children to do the same will work better than any law. 
Giving them information on how many calories their kid needs in a day is more 
likely to result in thinner kids than abuse about lunch box choices. 
University of Queensland psychology professor Matt Sanders has proven that 
sound advice gets results using a new reality TV program called Driving Mum 
And Dad Mad. 
The program, which has run in Britain, featured five families working through 
the Positive Parenting Program set up by Professor Sanders. 
Professor Sanders then studied 500 viewers of the program to see whether it 
helped improve their parenting skills and the behaviour of their children. 
More than half those parents were better at managing tasks such as getting 
children to bed and 44 per cent of children's behaviour improved. 
He found the key to creating good parents is the same as that used in raising 
happy children – be positive! 
So if you 

Re: [ozmidwifery] Interesting article about declining rural birthing services

[jesse/jayne]

Tom Price Hosp seems to accept very few birthing 
women.  My friend was sent to Perth for being over 35!  Another 
deemed unacceptable high risk because she was birthing her 6th child!  And 
another because she was attempting VBAC.  The GP tried to put the fear of 
god knows what into each of these women and succeeded with their partners 
:(
 
Jayne
 
 

  - Original Message - 
  From: 
  Helen and Graham 
  To: ozmidwifery 
  Sent: Tuesday, August 08, 2006 11:27 
  PM
  Subject: [ozmidwifery] Interesting 
  article about declining rural birthing services
  
  
  
  http://www.news.com.au/story/0,23599,20063886-2,00.html#
  Mum-to-be travels 2000km to give birth
  By Liza Kappelle
  August 08, 2006 08:15pm
  Article from: AAP
  
  Font size: + -
  Send this article: Print Email 
  
  
  A MUM-to-be has been shunted more than 2000km around Western 
  Australia for somewhere to have her baby.Kirsti Sweetman, 24, 
  eventually gave birth to a boy in a Perth hospital on Sunday night after being 
  turned away by two hospitals a long way north in WA's Pilbara region. 
  She initially went to her local hospital at Tom Price, 1556km north of 
  Perth, on Saturday, after her waters broke four weeks early.
  But she was not in labour and the hospital wasn't equipped to induce 
  pregnancies, said her stepfather Steve Turner.
  The flying doctor was called and Kirsti was taken another 360km further 
  north to Port Hedland hospital while her anxious partner, Tony Bassett, 27, 
  and their three-year-old daughter Imogen followed by road.
  Mr Turner said he and his wife Teresa – Kirsti's mum – also drove to Port 
  Hedland for the birth only to be told when they got there Kirsti would have to 
  go to Perth.
  It is understood the doctors in Port Hedland thought it would be safer for 
  her to have the baby induced in Perth.
  Mr Turner, however, said he believed it was because the hospital was flat 
  out.
  “She got to Port Hedland and they couldn't handle her ‘cause they were too 
  busy,” he said.
  By now it was late, so Kirsti spent the night in the Port Hedland hospital 
  before being flown to a Perth hospital the next morning.
  “They induced her that night and her partner had to fly out there on a 
  commercial flight while my wife and I brought the cars back,” Mr Turner 
  said.
  Mr Bassett described Kirsti's ordeal as very traumatic.
  “The thought of missing the birth of my son, Tarkyn, that was the worst,” 
  Mr Bassett said.
  “And the last thing that Kirsti wanted to do was go though it on her 
  own.”
  Mr Turner said he believed the family was shunted around because the 
  government was stripping services out of rural and regional areas.
  “They are taking all our services away in the country and putting them in 
  the cities,” he said.
  But the news on the new bub couldn't be better.
  Mr Bassett said his son was growing stronger by the hour and he hoped he'd 
  soon be able to take his family back home – another 1556km trip.
  Pilbara Health Service regional director Patrik Mellberg said Tom Price 
  Hospital did not have the facilities to manage high-risk deliveries and a 
  local GP had made the decision to send Ms Sweetman to the Port Headland 
  regional hospital via the Royal Flying Doctor Service free of charge.
  “Upon arrival at Port Hedland it was assessed that due to the patient's 
  condition and available capacity at the hospital, it would be necessary to fly 
  her to Perth free of charge again, for reasons of clinical safety,” Mr 
  Mellberg said.
  “The patient was under constant medical supervision.” 
  

Re: [ozmidwifery] Interesting article about declining rural birthing services

[cath nolan]

way too familiar to me after having worked in the 
Kimberley for the past 3 years. It is awful how the "necessity"of being shipped 
out is worded to these women. It is one of the reasons that I left there. 
Cath

  - Original Message - 
  From: 
  Helen and Graham 
  To: ozmidwifery 
  Sent: Tuesday, August 08, 2006 11:27 
  PM
  Subject: [Norton AntiSpam] [ozmidwifery] 
  Interesting article about declining rural birthing services
  
  
  
  http://www.news.com.au/story/0,23599,20063886-2,00.html#
  Mum-to-be travels 2000km to give birth
  By Liza Kappelle
  August 08, 2006 08:15pm
  Article from: AAP
  
  Font size: + -
  Send this article: Print Email 
  
  
  A MUM-to-be has been shunted more than 2000km around Western 
  Australia for somewhere to have her baby.Kirsti Sweetman, 24, 
  eventually gave birth to a boy in a Perth hospital on Sunday night after being 
  turned away by two hospitals a long way north in WA's Pilbara region. 
  She initially went to her local hospital at Tom Price, 1556km north of 
  Perth, on Saturday, after her waters broke four weeks early.
  But she was not in labour and the hospital wasn't equipped to induce 
  pregnancies, said her stepfather Steve Turner.
  The flying doctor was called and Kirsti was taken another 360km further 
  north to Port Hedland hospital while her anxious partner, Tony Bassett, 27, 
  and their three-year-old daughter Imogen followed by road.
  Mr Turner said he and his wife Teresa – Kirsti's mum – also drove to Port 
  Hedland for the birth only to be told when they got there Kirsti would have to 
  go to Perth.
  It is understood the doctors in Port Hedland thought it would be safer for 
  her to have the baby induced in Perth.
  Mr Turner, however, said he believed it was because the hospital was flat 
  out.
  “She got to Port Hedland and they couldn't handle her ‘cause they were too 
  busy,” he said.
  By now it was late, so Kirsti spent the night in the Port Hedland hospital 
  before being flown to a Perth hospital the next morning.
  “They induced her that night and her partner had to fly out there on a 
  commercial flight while my wife and I brought the cars back,” Mr Turner 
  said.
  Mr Bassett described Kirsti's ordeal as very traumatic.
  “The thought of missing the birth of my son, Tarkyn, that was the worst,” 
  Mr Bassett said.
  “And the last thing that Kirsti wanted to do was go though it on her 
  own.”
  Mr Turner said he believed the family was shunted around because the 
  government was stripping services out of rural and regional areas.
  “They are taking all our services away in the country and putting them in 
  the cities,” he said.
  But the news on the new bub couldn't be better.
  Mr Bassett said his son was growing stronger by the hour and he hoped he'd 
  soon be able to take his family back home – another 1556km trip.
  Pilbara Health Service regional director Patrik Mellberg said Tom Price 
  Hospital did not have the facilities to manage high-risk deliveries and a 
  local GP had made the decision to send Ms Sweetman to the Port Headland 
  regional hospital via the Royal Flying Doctor Service free of charge.
  “Upon arrival at Port Hedland it was assessed that due to the patient's 
  condition and available capacity at the hospital, it would be necessary to fly 
  her to Perth free of charge again, for reasons of clinical safety,” Mr 
  Mellberg said.
  “The patient was under constant medical supervision.” 
  

[ozmidwifery] Interesting article about declining rural birthing services

[Helen and Graham]

http://www.news.com.au/story/0,23599,20063886-2,00.html#
Mum-to-be travels 2000km to give birth
By Liza Kappelle
August 08, 2006 08:15pm
Article from: AAP

Font size: + -
Send this article: Print Email 


A MUM-to-be has been shunted more than 2000km around Western 
Australia for somewhere to have her baby.Kirsti Sweetman, 24, 
eventually gave birth to a boy in a Perth hospital on Sunday night after being 
turned away by two hospitals a long way north in WA's Pilbara region. 
She initially went to her local hospital at Tom Price, 1556km north of Perth, 
on Saturday, after her waters broke four weeks early.
But she was not in labour and the hospital wasn't equipped to induce 
pregnancies, said her stepfather Steve Turner.
The flying doctor was called and Kirsti was taken another 360km further north 
to Port Hedland hospital while her anxious partner, Tony Bassett, 27, and their 
three-year-old daughter Imogen followed by road.
Mr Turner said he and his wife Teresa – Kirsti's mum – also drove to Port 
Hedland for the birth only to be told when they got there Kirsti would have to 
go to Perth.
It is understood the doctors in Port Hedland thought it would be safer for 
her to have the baby induced in Perth.
Mr Turner, however, said he believed it was because the hospital was flat 
out.
“She got to Port Hedland and they couldn't handle her ‘cause they were too 
busy,” he said.
By now it was late, so Kirsti spent the night in the Port Hedland hospital 
before being flown to a Perth hospital the next morning.
“They induced her that night and her partner had to fly out there on a 
commercial flight while my wife and I brought the cars back,” Mr Turner 
said.
Mr Bassett described Kirsti's ordeal as very traumatic.
“The thought of missing the birth of my son, Tarkyn, that was the worst,” Mr 
Bassett said.
“And the last thing that Kirsti wanted to do was go though it on her 
own.”
Mr Turner said he believed the family was shunted around because the 
government was stripping services out of rural and regional areas.
“They are taking all our services away in the country and putting them in the 
cities,” he said.
But the news on the new bub couldn't be better.
Mr Bassett said his son was growing stronger by the hour and he hoped he'd 
soon be able to take his family back home – another 1556km trip.
Pilbara Health Service regional director Patrik Mellberg said Tom Price 
Hospital did not have the facilities to manage high-risk deliveries and a local 
GP had made the decision to send Ms Sweetman to the Port Headland regional 
hospital via the Royal Flying Doctor Service free of charge.
“Upon arrival at Port Hedland it was assessed that due to the patient's 
condition and available capacity at the hospital, it would be necessary to fly 
her to Perth free of charge again, for reasons of clinical safety,” Mr Mellberg 
said.
“The patient was under constant medical supervision.” 

[ozmidwifery] Interesting article

[Mary Murphy]

 Rupture
of uterine scar 3 weeks after vaginal birth after cesarean section (VBAC) - Journal of
Maternal-Fetal and Neonatal Medicine , vol 19, no 6, June 2006, pp
371-373 El-Kehdy GI; Ghanem JK; El-Rahl CC; et al - (2006) Uterine scar rupture in vaginal birth after cesarean section
(VBAC) usually occurs during labor or after placental extraction. We report
herein the case of a patient who had a cesarean section in her first pregnancy
and a VBAC in her second. The present one also ended with a normal VBAC and a
documented intact scar, which then ruptured three weeks later. (5 references)
(Author)

Does anyone know of
similar cases? MM

Re: Fw: [ozmidwifery] Interesting article

[Lisa Barrett]

oops.  I think this was a private message for me.  Sorry it made it to the 
list Nikki posted a reply not realising that wasn't directly to me, 
obviously.  I'm sure any personal stuff won't get forwarded any further.

Thanks Lisa Barrett

Thanks Lisa!  I actually stumbled across another report on this same study 
this morning here: http://racoon.com/dcforum/DCForumID13/343.html
This site is pretty good, along with http://www.ahmf.com.au/default.htm 
(both are good resources if you get other clients with herpes).  I was 
doing some reading this morning on what to do about the script my doctor 
gave me on Monday, and worked out that she's put me on my pre-pregnancy 
dose of 500mg once a day of valtrex (valacyclovir).  In the last month of 
Eleni's pregnancy I took 200mg three times a day of acyclovir.  I found 
the recommended dose for valtrex as suppression therapy in the last month 
of pregnancy is actually 500mg *twice* a day, so I am going to double up 
the dose from what my Dr prescribed, and am much happier now.  She put for 
5 repeats on the script, so there's no way I'll run out - yay!

Cheers
Nikki




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[ozmidwifery] Interesting article

[Mary Murphy]

Antiviral reduces vertical herpes transmission
Source: Obstetrics
& Gynecology 2006; 108: 141-7

Measuring
the efficacy of valacyclovir suppression in late pregnancy for reducing herpes
recurrence and the need for cesarean delivery. 

Treating pregnant
women who have a history of genital herpes with the antiviral valacyclovir
lowers the risk that they will need a cesarean to protect the infant from
infection, a randomized controlled trial suggests. 

Women
with active genital herpes or prodromal symptoms at the time of labor are
currently recommended to have a cesarean. However, 70 percent of cases of
neonatal infection occur in infants born to women who asymptomatically shed the
virus near delivery. 

In the
current study, Jeanne Sheffield (University of Texas Southwestern Medical
Center, Dallas, USA) and colleagues assessed the
prophylactic efficacy of valacyclovir, a prodrug of acyclovir, one of the most
commonly used antiviral drugs. 

In all,
170 women were treated with valacyclovir from 36 weeks' gestation and 168 were
given placebo. At delivery, 13 percent of the women in the placebo group had a
herpes recurrence warranting cesarean delivery, compared with just 4 percent of
those given prophylaxis. 

"I
think this will help immensely in giving doctors stronger evidence in using
this treatment," Sheffield commented. 

"Besides
reducing the number of herpes outbreaks at birth, we also dropped the numbers
of women without symptoms who were shedding the virus into the birth
canal," she explained.

Posted:
12 July 2006

 

[ozmidwifery] Interesting article

[Mary Murphy]

Temporal
trends of preterm birth subtypes and neonatal outcomes - Obstetrics and
Gynecology , vol 107, no 5, May 2006, pp 1035-1041 Barros FC; del Pilar Velez
M - (2006) OBJECTIVE: To describe
temporal trends of preterm birth subtypes, neonatal morbidity, and hospital
neonatal mortality. METHODS: A database of 1.7 million births that occurred in
51 maternity hospitals in Latin America from
1985 to 2003 was studied. Subgroups of preterm births were classified according
to the presence or absence of maternal medical or obstetric complications,
spontaneous labor, preterm labor after premature rupture of membranes,
induction of labor, or elective cesarean. Outcomes studied, for different
periods, were prevalence of small for gestational age, neonatal morbidity, and
neonatal mortality. RESULTS: Spontaneous preterm labor without maternal
complications was the most frequent subtype of preterm birth (60%), followed by
premature rupture of membranes without maternal complications. Preterm births
due to elective induction and delivery by elective cesarean increased markedly
in the last 20 years, from 10% in 1985-1990 to 18.5% in recent years. Neonates
born after spontaneous labor without maternal complications had the lowest
mortality rate, but their large numbers made them responsible for one half of
the preterm mortality. The induction followed by elective cesarean subgroups
accounted for 13.4% of the preterm deaths between 1985 and 1990 and increased
to 21.2% between 1996 and 2003. CONCLUSION: Spontaneous labor in mothers
without maternal complications is the most frequent cause of preterm births and
is also the most important subgroup related to neonatal mortality. However,
preterm births due to induction of labor or elective cesarean are increasing in
Latin America and are becoming important
contributors to neonatal mortality. (22 references) (Author)

[ozmidwifery] Interesting article

[Helen and Graham]

 
Prebiotics 'cut baby's skin risk' Adding prebiotics 
to formula feed can help cut the risk of babies developing a form of eczema, 
research suggests. 
Milan's Center for Infant Nutrition found atopic dermatitis was less likely 
in babies given supplemented formula than those given the standard form. 
Prebiotics encourage the growth of beneficial bacteria in the gut. 
The study, published in Archives of Disease in Childhood, suggests they might 
prevent atopic dermatitis by giving a boost to the immune system. 




  
  


  ATOPIC DERMATITIS 
  Form of eczema common among young children 
  Causes dry and itchy skin 
  Carries an increased risk of developing other atopic 
  illnesses such as asthma, hay fever and allergy 
  

Lead researcher Professor Guido Moro said the risk of atopic dermatitis was 
reduced by over 50% in the prebiotic-fed infants. 
He said: "To our knowledge this is the first time that it has been shown that 
prebiotics can not only produce favourable changes in the gut flora, but that 
these changes can lead to a genuine clinical benefit. 
"It appears that prebiotics can strengthen the immune system and so reduce 
the risk of atopic dermatitis during the first months of life." 
The research focused on 192 healthy children considered to be at high risk of 
developing allergies. 
At least one parent of each child had been diagnosed with an allergic 
disease. 
Breastfeeding advice 
Parents of every child considered for the study were advised to breastfeed 
their children. 
However, none of the children who ended up taking part was breastfed. 
The children of those who, nevertheless, decided to start with formula 
feeding were assigned to one of two groups. 
Half the children received formula milk supplemented with a prebiotic mixture 
made up of two types of carbohydrates called galacto-oligosaccharides and long 
chain fructo-oligosaccharides. 
Previous research has suggested this mixture has a similar impact to breast 
milk on the bacteria living in the gut, boosting beneficial bugs, and inhibiting 
growth of bugs that can cause disease. 
After six months, 10.6% of the group given prebiotics showed signs of atopic 
dermatitis, compared with 22.4% of those given formula supplemented with a 
placebo. 
Analysis showed the proportion of "friendly" bifidobacteria was significantly 
higher in the stools of infants fed on the prebiotic. 
Muriel Symmons, of the charity UK Allergy, said: "This study adds to our 
knowledge of the role of prebiotics in helping to prevent the development of 
eczema in infants. 
"More work of this kind is needed to establish whether prebiotic supplements 
can help those babies whose mothers are unable or choose not to breast feed." 
Nina Goad, of the British Skin Foundation, said: "We know that atopic 
dermatitis is a condition in which many factors can influence its development 
and severity." 
Details of the study were presented at the Royal College of Paediatrics and 
Child Health Spring Meeting in York. 


Story from BBC 
NEWS:http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/5109234.stmPublished: 
2006/06/23 23:55:58 GMT

Re: [ozmidwifery] Interesting article - old wives tales to bring on labour

[Bowman Family]

Hi Helen, 
This was a little disappointing to read, however I 
think I will continue to suggest nipple stimulation to my mums who are 
overdue.
 
It may have been a coincidence recently, but 
following reading on this forum about the time for nipple stimulation - (I 
think 20 minutes and have a rest repeat if desired), I suggested this 
timing to one of my mothers (41weeks) who phoned me for any tips to bring 
her into labour.  I later got another phone call to say she was 
in labour. Mum and her partner couldn't wait to tell me that they 
had tried it and it worked, 
 
Helen you might recall this one as you were the 
midwife who took over from me as I worked over my 12 hours.  
(disappointed to have to leave, but it's hospital policy and 
ANF's ) 
Perhaps I should have encouraged further nipple 
stimulation during her labour to assist Oxytocin production. It might have 
shortened 1st stage and who knows I may have been there to be a part of the 
beautiful birth.
Thanks for being there and giving such great 
care.
Linda

  - Original Message - 
  From: 
  Helen and Graham 
  To: ozmidwifery 
  Sent: Tuesday, June 06, 2006 6:24 
PM
  Subject: [ozmidwifery] Interesting 
  article - old wives tales to bring on labour
  
  
  Note the statement that classify fullterm pregnancy as being from 37 
  weeks onwards! 
  http://www.webmd.com/content/Article/123/115026.htm?printing=true
   
  June 2, 2006 – The notion that having sex late in pregnancypregnancy will hasten labor and 
  deliverylabor and delivery is 
  among the oldest of old wives' tales. But it looks like the old wives were 
  wrong.
  Women with a low risk of complications who had sex in the final weeks of 
  pregnancy actually carried their babies slightly longer than those who 
  abstained from sex during that time, according to a new study reported in the 
  June issue of Obstetrics and Gynecology.
  And the full-term babies born to women who had late-pregnancy sex were just 
  as healthy as those born to women who did not.
  "This study should reassure low-risk women that there is probably no harm 
  in engaging in intercourse late in pregnancy," says obstetrician Jonathan 
  Schaffir, MD, of the Ohio State University Medical Center. "But it showed no 
  particular benefit, either, in terms of inducing labor."
  Sex Wasn't a Factor
  There is actually sound medical reasoning for the idea that sex might bring 
  on labor. Male semen contains hormone-like chemicals known as prostaglandins. 
  Prostaglandins can be used for cervical ripening, in which the cervix 
  physically changes in preparation for labor. Also, female orgasm can bring on 
  uterine contractions.
  But there is little clinical evidence that intercourse influences the 
  outcome of normal pregnancies. The study cites one analysis of 59 studies that 
  found no association between sex and preterm birth, premature amniotic sac 
  rupture, or low birth weight in low-risk pregnancies.
  Schaffir's study included 93 low-risk pregnant women past the 37th week of 
  their pregnancy. (At 37 weeks a pregnancy is considered full term.) The women 
  were asked during weekly doctor's office visits about their sexual activity. 
  
  Half the women reported having sex involving penetration after that time. 
  
  Cervical examinations were performed at each weekly visit to determine if 
  sexual activity affected cervical ripening. No correlation was seen between 
  the frequency of sexual intercourse and cervical change.
  And the sexually active women in the study actually carried their babies an 
  average of four days longer than women who abstained from sex -- 39.9 weeks 
  compared with 39.3 weeks. Schaffir says this small difference could be because 
  women closer to labor simply felt less comfortable and were, therefore, less 
  likely to engage in sex.
  The lack of a difference in cervical changes, combined with the absence of 
  a meaningful difference in delivery dates among women who had sex, suggests 
  sexual intercourse had no effect on inducing labor, the researchers concluded. 
  
  High-Risk Women Should Abstain
  The findings do not suggest all women can safely engage in sex late in 
  pregnancypregnancy. Women with risk factors for preterm 
  delivery should probably avoid sex and should definitely discuss the issue 
  with their health care provider. Risk factors for preterm delivery include 
  having had a previous preterm birth, having uterine bleeding during pregnancy, 
  contracting certain vaginal infections, and having other pregnancy-related 
  complications.
  For most normal pregnancies, however, if a woman feels like having sex late 
  in pregnancy there is probably no medical reason to keep her from doing so, 
  based on the study. But there is no medical benefit either.
  Schaffir says doctors and other pregnancy caregivers should talk with their 
  patients about sex during pregnancy.
  “T

[ozmidwifery] Interesting article - old wives tales to bring on labour

[Helen and Graham]

Note the statement that classify fullterm pregnancy as being from 37 
weeks onwards! 
http://www.webmd.com/content/Article/123/115026.htm?printing=true
 
June 2, 2006 – The notion that having sex late in pregnancypregnancy will hasten labor and 
deliverylabor and delivery is among 
the oldest of old wives' tales. But it looks like the old wives were wrong.
Women with a low risk of complications who had sex in the final weeks of 
pregnancy actually carried their babies slightly longer than those who abstained 
from sex during that time, according to a new study reported in the June issue 
of Obstetrics and Gynecology.
And the full-term babies born to women who had late-pregnancy sex were just 
as healthy as those born to women who did not.
"This study should reassure low-risk women that there is probably no harm in 
engaging in intercourse late in pregnancy," says obstetrician Jonathan Schaffir, 
MD, of the Ohio State University Medical Center. "But it showed no particular 
benefit, either, in terms of inducing labor."
Sex Wasn't a Factor
There is actually sound medical reasoning for the idea that sex might bring 
on labor. Male semen contains hormone-like chemicals known as prostaglandins. 
Prostaglandins can be used for cervical ripening, in which the cervix physically 
changes in preparation for labor. Also, female orgasm can bring on uterine 
contractions.
But there is little clinical evidence that intercourse influences the outcome 
of normal pregnancies. The study cites one analysis of 59 studies that found no 
association between sex and preterm birth, premature amniotic sac rupture, or 
low birth weight in low-risk pregnancies.
Schaffir's study included 93 low-risk pregnant women past the 37th week of 
their pregnancy. (At 37 weeks a pregnancy is considered full term.) The women 
were asked during weekly doctor's office visits about their sexual activity. 

Half the women reported having sex involving penetration after that time. 

Cervical examinations were performed at each weekly visit to determine if 
sexual activity affected cervical ripening. No correlation was seen between the 
frequency of sexual intercourse and cervical change.
And the sexually active women in the study actually carried their babies an 
average of four days longer than women who abstained from sex -- 39.9 weeks 
compared with 39.3 weeks. Schaffir says this small difference could be because 
women closer to labor simply felt less comfortable and were, therefore, less 
likely to engage in sex.
The lack of a difference in cervical changes, combined with the absence of a 
meaningful difference in delivery dates among women who had sex, suggests sexual 
intercourse had no effect on inducing labor, the researchers concluded. 
High-Risk Women Should Abstain
The findings do not suggest all women can safely engage in sex late in pregnancypregnancy. Women with risk factors for preterm 
delivery should probably avoid sex and should definitely discuss the issue with 
their health care provider. Risk factors for preterm delivery include having had 
a previous preterm birth, having uterine bleeding during pregnancy, contracting 
certain vaginal infections, and having other pregnancy-related 
complications.
For most normal pregnancies, however, if a woman feels like having sex late 
in pregnancy there is probably no medical reason to keep her from doing so, 
based on the study. But there is no medical benefit either.
Schaffir says doctors and other pregnancy caregivers should talk with their 
patients about sex during pregnancy.
“This discussion should not lead patients to believe that sexual intercourse 
will initiate labor sooner,” he wrote. “Patients may continue to hear from 
relatives and other ‘old wives’ that intercourse will hasten labor, but it 
should not be given credence by the medical community.” 
Hope Ricciotti, MD, an ob-gyn at Beth Israel Deaconess Medical Center, says 
she is surprised by the findings.
“This is one that many of us believed because of the hormonal involvement,” 
she tells WebMD.
Other Things to Try
Another method to hasten delivery that doctors often suggest to women is 
nipple stimulation, since it promotes the production of another hormone involved 
in labor induction known as oxytocin.
Nipple stimulation does cause contractions while the woman is doing it, 
Ricciotti says. But once the woman stops, so do the contractions. Ricciotti 
knows of no case where a woman actually put herself into labor using this 
method.
Other doctors perform a vigorous pelvic exam when the cervix is slightly 
dilated in an effort to get things moving. While there is some evidence this is 
effective, it is not conclusive, Ricciotti says.
Otherwise, you can always try food. Although there is no medical evidence to 
back it up, countless women are convinced eating pizza or Chinese food put them 
into labor.
“The big one is Chinese food,” Ricciotti says. “Eggplant was in vogue for a 
few years, but there was no evidence at al

[ozmidwifery] Interesting article

[Helen and Graham]

http://www.abc.net.au/news/newsitems/200606/s1655871.htm
 

Genital mutilation leads to more child birth deaths, study says

A new Australian study has shows female genital mutilation 
leads to an increased risk of death in newborn babies.
The study has been published in medical journal, The 
Lancet, and involved more than 28,000 women in six African countries: 
Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan.
The author of the study, Australian National University 
Associate Professor Emily Banks, says the procedure causes an extra one to two 
deaths per 100 deliveries. 
Professor Banks says the study's results are being used in 
campaigns to try to stamp out the practice.
"What we're seeing here is something that's happening 
during labour, so I think it's fair to say that there's something about women 
who've had female genital mutilation that means that their labours don't go as 
well and their babies are more likely to be distressed and they're more likely 
to die," she said.
Professor Banks says it is the most reliable study on the 
topic to date.
"There was quite a lot of questions about whether female 
genital mutilation really did impact on child birth, and now we know that it 
does," she said.

[ozmidwifery] Interesting article on proposed increased medicare funding for nurses

[Helen and Graham]

http://www.theaustralian.news.com.au/story/0,20876,18787989-28737,00.html
 






Healing hand extendedAllowing nurses to perform 
tasks now handled by doctors would save money, but it is likely to be fiercely 
resisted by the medical profession, write Adam Cresswell and Patricia 
Karvelas 


April 12, 2006

AFTER 19 years as a nurse at the same medical clinic in Melbourne, Ann 
Salmons has immunised babies who have come back to her as 18-year-olds to be 
vaccinated before they go on their first overseas holiday.
Faces such as Salmons's may soon become more familiar in 
doctors' surgeries, following news the federal Government is keen to expand 
their role. 
As The Australian reported yesterday, federal Health Minister Tony Abbott 
proposes to lift the limitation on what practice nurses can do under Medicare. 
Details about other tasks they may be allowed to perform are yet to emerge. 
Abbott said yesterday there "are all sorts of things which nurses could 
conceivably do". 
"They could perform more health checks for patients, they could perform more 
follow-up work for patients under care plans, and so on," he said. 
Medical and nursing organisations say likely tasks include suturing wounds 
(as well as dressing them, as at present), taking patient histories and 
measurements, administering certain tests such as for lung function, blood 
pressure and blood clotting ability, and providing a wide range of advice and 
support. 
The latter role may include advising new mothers about breastfeeding 
techniques and on how to get young babies to sleep, as well as asthma and 
diabetes education. 
Salmons, who works at the East Bentleigh Medical Group clinic in Melbourne, 
says she is relieved by Abbott's plan. 
"It is a good area to work in," she says. "You're out there in the community, 
but it is a lot more rewarding: you follow up with your patients and with 
children; you see them grow up. I've got patients that I vaccinated as babies 
getting vaccinated to go overseas as adults." 


  
  
NURSES AND DOCTORS 
  

  

  Practice nurses 

Average earnings: $23 to $25 an hour (about $48,000 a year full 
time). 

No specific certification or requirements. It is up to employing GPs 
to satisfy themselves nurses have the required skills. 

Registered nurses and enrolled nurses can work as practice nurses. 
Most states require enrolled nurses to be supervised by registered 
nurses, so the former make up only 6 per cent of GP nurses. 

Registered nurses complete a three-year bachelor of nursing course 
that covers anatomy, chemistry and physics, drugs, side effects, 
bacteria, basic infectious diseases and prevention. The course looks at 
specific contexts, such as caring for children, the elderly, the 
mentally ill and patients with specific needs, such as those being 
treated for heart failure as opposed to those recovering from surgery. 
General practitioners 

Average earnings: Estimates vary but Australian Taxation Office data 
from 2002, released in 2004, puts average GP earnings at $212,833 before 
tax and practice costs (which can be up to 50 per cent). 

Medical students wishing to be GPs must complete a basic medical 
degree, which ranges from four to six years, depending on which 
university is chosen and whether the course is undergraduate or 
postgraduate. 

After the degree is awarded, the doctor has to spend one or two 
years as an intern in a public hospital before applying for one of the 
650 places in the GP training scheme. 

GP training lasts three years for those intending to work in the 
city and four years for those aiming to be rural GPs (who often need to 
be able to give anaesthetics and deliver 
  babies).
Salmons is in the vanguard of change: for the past six years she's been 
conducting health assessments in the homes of people over 75. "Every day I do 
wound management and immunisations, I assist doctors doing surgical procedures," 
she says. "I also do education for asthma, diabetes and heart disease." 
Salmons says it is a team effort in her practice. "It is a collaboration, we 
work in a team. If a patient comes in with five different problems, the GP can 
handball things like asthma education, all vaccines, all immunisations, all 
wounds, to me. 
"Because the GP doesn't have time to do that in 15 minutes, there's a role 
for us." 
The Australian Nursing Federation's national secretary Jill Iliffe says the 
proposed change makes sense. "There's such a wide range of things that nurses 
can do to help improve the health of a community in general medical practice," 
she says. 
Iliffe also believes the expansion will improve job satisfaction for nurses: 
"The partnership between doctors and nurse

[ozmidwifery] interesting

[Mary Murphy]

“S. has spent her
entire midwifery career at [an Oregon
hospital] She developed a woman-centered practice with a noninterventive
philosophy. She has never been to a homebirth S.'s devotion to the
protection of normal labor and birth is bolstered by her consistent attention
to research in medicine and obstetrics. However, the things I saw her do to
make a birth in a hospital labor and delivery ward home-like were simple and
basic. For one, she took the monitor out of the room. It was surprising to me,
a midwife who has attended many hundreds of home and hospital births, how much
difference this made. It felt different than just not using the monitor. It was
gone. The room was simplified, the energy purified.

 

She went on to create a
private space for the parents. On the floor behind the hospital bed a futon was
placed, and a large cushion was added for comfort and support. The door to the
room was closed and access monitored by the midwife. I was reminded of Dr.
Michel Odent's advice to decrease the adrenaline levels in the laboring mother
by providing a quiet, private place with the lights turned down low, the kind
of place animals seek out for their births.”

 

~ Marion Toepke McLean

  excerpted from her column,
"Marion's
Message"

  Midwifery Today Issue 50

 

Re: [ozmidwifery] Interesting article about rogue expert witnesses

[Justine Caines]

Title: Re: [ozmidwifery] Interesting article about rogue expert witnesses



The research found that some cases of cerebral palsy could be caused by a virus shortly before or after birth. Traditionally, oxygen starvation during birth was thought to be the main culprit. 


I have been saying this for years and didn’t the Drs shout me down!!

OK so now that’s the cerebral palsy stuff is biting them, it’s not their fault!!

Considering it is rarely caused as a direct result of birth then let’s stop all the routine CTG’s, cause we know the only thing they do is increase the c/s rate.

So who’s game enough to start using their own words against them in the interests of women??

JC

RE: [ozmidwifery] Interesting article about rogue expert witnesses

[Dean & Jo]

Title: Message




Another prominent obstetrician, David Molloy, said there was "a very 
difficult group of known rogue expert witnesses" who could not currently be 
dealt with any other way than to discredit their views in court. 
"There's a very substantial amount of money being made by a small group of 
doctors, when, in many cases, it's been a decade since they laid hands on a 
patient," he said. 
 
Hmm... I 
would be worried about his expert opinion also considering it has probably been 
years since he last witnessed a vaginal birth!  
Sorry, 
slanderous comments should be kept to the coffee table...cuppa 
anyone?
 
Jo

  
  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] On Behalf Of Helen and 
  GrahamSent: Tuesday, January 10, 2006 8:05 AMTo: 
  ozmidwiferySubject: [ozmidwifery] Interesting article about rogue 
  expert witnesses
  http://www.theaustralian.news.com.au/common/story_page/0,5744,17776253%255E601,00.html
   
  Sin bin for rogue 
  witnessesAdam Cresswell, Health 
  editorJanuary 10, 2006 
  
  A SPORT-STYLE system of red and yellow cards is being 
  considered to deal with rogue expert witnesses whose eccentric or irrational 
  views are skewing medical negligence cases.Retired medical experts can earn tens of thousands of dollars 
  each time they testify about whether other doctors' treatments were negligent. 

  Their role has been mired in renewed controversy after an Australian study 
  suggested last week that some obstetricians were being unfairly blamed for 
  cases of cerebral palsy - a condition behind 60 per cent ofnegligence payouts 
  in obstetric cases. 
  The research found that some cases of cerebral palsy could be caused by a 
  virus shortly before or after birth. Traditionally, oxygen starvation during 
  birth was thought to be the main culprit. 
  Alastair MacLennan, leader of the South Australian Cerebral Palsy Research 
  Group, which published the findings in the British Medical Journal, blamed the 
  courts' willingness to find doctors at fault for cerebral palsy partly on 
  "hired-gun expert witnesses" prepared to make groundless claims that the 
  injury could have been avoided. 
  He has proposed the red-card scheme as a way to bring errant experts to 
  heel. 
  Under the plan, the Royal Australian and New Zealand College of 
  Obstetricians and Gynaecologists would audit and train expert witnesses, and 
  monitor their opinions for statements deemed impractical, dangerous or 
  extreme. 
  Those giving evidence without being registered, or giving opinions not 
  backed by the college, would receive a warning, and a steeper penalty such as 
  loss of college membership on a repeat offence. 
  "Several of the American colleges have this red card, yellow card system, 
  and anecdotally I am told this is reining in some of the more rogue expert 
  witnesses," Professor MacLennan said. 
  "In Australia at the moment, they can say what the hell they like, which is 
  a real worry. It's fairly easy to fool a judge who's never judged a cerebral 
  palsy case before." 
  The chairman of the RANZCOG's medico-legal committee, Robert Lyneham, said 
  the college was considering the plan, and was developing its own proposals to 
  allow obstetricians to register as expert witnesses and receive training. 
  Professor MacLennan said fewer than 1 per cent of cerebral palsy cases were 
  caused during birth. 
  Two international expert panels had agreed that proving the cause was a 
  sudden deprivation of oxygen during labour - something that could be blamed on 
  an obstetrician - would require nine specific pieces of evidence, but rogue 
  experts ignored these, he said. 
  "There's no policing of medico-legal opinion - people in their retirement 
  can sit and give outrageous opinions without peer review, and do," he said. 
  "They're often quite out of touch, and in particular in cerebral palsy they 
  almost never mention the modern literature. 
  "What we're looking for is nine pieces of objective evidence, not somebody 
  saying, 'Oh, this baby was crook at delivery, it must be due to a bad delivery 
  and in my opinion it would not have had cerebral palsy half an hour 
  beforehand'." 
  Another prominent obstetrician, David Molloy, said there was "a very 
  difficult group of known rogue expert witnesses" who could not currently be 
  dealt with any other way than to discredit their views in court. 
  "There's a very substantial amount of money being made by a small group of 
  doctors, when, in many cases, it's been a decade since they laid hands on a 
  patient," he said. 
  --No virus found in this incoming message.Checked by 
  AVG Free Edition.Version: 7.1.371 / Virus Database: 267.14.14/222 - 
  Release Date: 1/5/2006


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RE: [ozmidwifery] Interesting article about rogue expert witnesses

[B & G]

Title: Message



Interesting article. Further evidence we, as a group need to talk to 
governments to have legislation changed to ensure these hire guns are harnessed. 
Letting RANZCOG tutor experts will be dangerous and will continue the 
abuse.
Hired 
guns- Medical officers that can be brought for their 'expert' opinion are so 
available. The problem is how can their views be discredited when the AMA and 
the Medical Registration Boards of all the states continue to allow them to be 
registered and 

 to call themselves Dr's. Many 
of these 'experts' have removed themselves from hands on practice for many 
reasons - think about some of those as I cannot write 
it.
Their 'evidence' or statements are considered to be 
protected and cannot be referred to the Health Rights Commission as it is 
collected for forensic cases i.e.. for the 
courts.
I experienced a vicious assault and torture from a 
prisoner in an ICU resulting in chronic PTSD. I sued Work Cover, my employer's 
insurer for negligence. I settled out of court primarily because I kept on being 
sent to various hired guns for an assessment. When the insurer wasn't happy with 
what report they wrote they would then send me to another and so on. My own Dr 
would warn me prior of what this Dr would be like and he had reported their 
behaviour to his own professional college on numerous occasions prior to my 
case. Luckily I was warned about video surveillance that Work Cover also used, 
not that it mattered as my Dr said I had to stay 'with' people- safest place was 
the casino as it had security. Looked like I was having 'fun' at the clubs and 
casino yet I was so scared of been attacked 
again!
The insurer just keeps getting away with this 
abominable behaviour, the courts continue to ignore blatant manipulation of 
their system meanwhile the injured continue to be subjected to horrific 
re-traumatising that if one did not have a strong sense of justice or sense of 
well being and of self worth would be left a complete mess. NZ no fault 
insurer ACC system would remove all this and it is there for the injured 
when they need it most, lawyers don't get fat, investigators wouldn't have hours 
of 'evidence' collected to discredit victims and it removes hired 
guns.
How can we address 
this?
Cheers Barb
 
 
 -Original 
Message-From: [EMAIL PROTECTED] 
[mailto:[EMAIL PROTECTED] On Behalf Of Helen and 
GrahamSent: Tuesday, 10 January 2006 7:35 AMTo: 
ozmidwiferySubject: [ozmidwifery] Interesting article about rogue 
expert witnesses

  http://www.theaustralian.news.com.au/common/story_page/0,5744,17776253%255E601,00.html
   
  Sin bin for rogue 
  witnessesAdam Cresswell, Health 
  editorJanuary 10, 2006 
  
  A SPORT-STYLE system of red and yellow cards is being 
  considered to deal with rogue expert witnesses whose eccentric or irrational 
  views are skewing medical negligence cases.Retired medical experts can earn tens of thousands of dollars 
  each time they testify about whether other doctors' treatments were negligent. 

  Their role has been mired in renewed controversy after an Australian study 
  suggested last week that some obstetricians were being unfairly blamed for 
  cases of cerebral palsy - a condition behind 60 per cent ofnegligence payouts 
  in obstetric cases. 
  The research found that some cases of cerebral palsy could be caused by a 
  virus shortly before or after birth. Traditionally, oxygen starvation during 
  birth was thought to be the main culprit. 
  Alastair MacLennan, leader of the South Australian Cerebral Palsy Research 
  Group, which published the findings in the British Medical Journal, blamed the 
  courts' willingness to find doctors at fault for cerebral palsy partly on 
  "hired-gun expert witnesses" prepared to make groundless claims that the 
  injury could have been avoided. 
  He has proposed the red-card scheme as a way to bring errant experts to 
  heel. 
  Under the plan, the Royal Australian and New Zealand College of 
  Obstetricians and Gynaecologists would audit and train expert witnesses, and 
  monitor their opinions for statements deemed impractical, dangerous or 
  extreme. 
  Those giving evidence without being registered, or giving opinions not 
  backed by the college, would receive a warning, and a steeper penalty such as 
  loss of college membership on a repeat offence. 
  "Several of the American colleges have this red card, yellow card system, 
  and anecdotally I am told this is reining in some of the more rogue expert 
  witnesses," Professor MacLennan said. 
  "In Australia at the moment, they can say what the hell they like, which is 
  a real worry. It's fairly easy to fool a judge who's never judged a cerebral 
  palsy case before." 
  The chairman of the RANZCOG's medico-legal committee, Robert Lyneham, said 
  the college w

[ozmidwifery] Interesting article about rogue expert witnesses

[Helen and Graham]

http://www.theaustralian.news.com.au/common/story_page/0,5744,17776253%255E601,00.html
 
Sin bin for rogue witnessesAdam 
Cresswell, Health editorJanuary 10, 2006 

A SPORT-STYLE system of red and yellow cards is being 
considered to deal with rogue expert witnesses whose eccentric or irrational 
views are skewing medical negligence cases.Retired medical experts can earn tens of thousands of dollars 
each time they testify about whether other doctors' treatments were negligent. 
Their role has been mired in renewed controversy after an Australian study 
suggested last week that some obstetricians were being unfairly blamed for cases 
of cerebral palsy - a condition behind 60 per cent ofnegligence payouts in 
obstetric cases. 
The research found that some cases of cerebral palsy could be caused by a 
virus shortly before or after birth. Traditionally, oxygen starvation during 
birth was thought to be the main culprit. 
Alastair MacLennan, leader of the South Australian Cerebral Palsy Research 
Group, which published the findings in the British Medical Journal, blamed the 
courts' willingness to find doctors at fault for cerebral palsy partly on 
"hired-gun expert witnesses" prepared to make groundless claims that the injury 
could have been avoided. 
He has proposed the red-card scheme as a way to bring errant experts to heel. 

Under the plan, the Royal Australian and New Zealand College of Obstetricians 
and Gynaecologists would audit and train expert witnesses, and monitor their 
opinions for statements deemed impractical, dangerous or extreme. 
Those giving evidence without being registered, or giving opinions not backed 
by the college, would receive a warning, and a steeper penalty such as loss of 
college membership on a repeat offence. 
"Several of the American colleges have this red card, yellow card system, and 
anecdotally I am told this is reining in some of the more rogue expert 
witnesses," Professor MacLennan said. 
"In Australia at the moment, they can say what the hell they like, which is a 
real worry. It's fairly easy to fool a judge who's never judged a cerebral palsy 
case before." 
The chairman of the RANZCOG's medico-legal committee, Robert Lyneham, said 
the college was considering the plan, and was developing its own proposals to 
allow obstetricians to register as expert witnesses and receive training. 
Professor MacLennan said fewer than 1 per cent of cerebral palsy cases were 
caused during birth. 
Two international expert panels had agreed that proving the cause was a 
sudden deprivation of oxygen during labour - something that could be blamed on 
an obstetrician - would require nine specific pieces of evidence, but rogue 
experts ignored these, he said. 
"There's no policing of medico-legal opinion - people in their retirement can 
sit and give outrageous opinions without peer review, and do," he said. "They're 
often quite out of touch, and in particular in cerebral palsy they almost never 
mention the modern literature. 
"What we're looking for is nine pieces of objective evidence, not somebody 
saying, 'Oh, this baby was crook at delivery, it must be due to a bad delivery 
and in my opinion it would not have had cerebral palsy half an hour 
beforehand'." 
Another prominent obstetrician, David Molloy, said there was "a very 
difficult group of known rogue expert witnesses" who could not currently be 
dealt with any other way than to discredit their views in court. 
"There's a very substantial amount of money being made by a small group of 
doctors, when, in many cases, it's been a decade since they laid hands on a 
patient," he said. 

[ozmidwifery] Interesting article FYI

[Helen and Graham]

http://www.abc.net.au/news/newsitems/200512/s1527271.htm
 

Caesarean sections up 40 per cent

A new report on the birth of Australian children shows the 
rate of caesarean sections has increased nearly 40 per cent over the past 
decade. 
The Australian Institute of Health and Welfare study shows 
that 23 per cent of Indigenous women now deliver by caesarean section compared 
to 28 per cent of non-Indigenous women.
Professor Michael Chapman from the University of New South 
Wales says the figures also show that an Indigenous baby is twice as likely to 
die before it is a month old. 
"The other factor that comes into play is that girls in 
their teens also have a very high loss of babies either in late pregnancy or in 
the early neo-natal time and that may be a co-factor in why the Indigenous 
population do seem to be doing badly," he said.
He says increasing caesarean rates will put more pressure 
on hospitals, especially those in remote areas with relatively few 
resources.
Professor Chapman says the women who deliver by caesarean 
section are generally unable to have a natural birth again. 
"Once you've had a caesarean section the implications for 
the next pregnancy is that if you have a vaginal delivery there is an increased 
risk both for the mother and for the baby in terms of complications," he 
said.

RE: [ozmidwifery] Interesting article sure to cause some ethical debate

[Vedrana Valčić]

If I had a Down syndrom or cystic
fibrosis, I’d be outraged. I mean, you can have a good life today with
Down syndrom or cystic fibrosis, it’s not as it was before, when people didn’t
understand and you had no support or knowledge.

 

Vedrana

 









From: owner-ozmidwifery@acegraphics.com.au
[mailto:owner-ozmidwifery@acegraphics.com.au]
On Behalf Of Ken WArd
Sent: Friday, December 02, 2005
8:18 AM
To: ozmidwifery@acegraphics.com.au
Subject: RE: [ozmidwifery]
Interesting article sure to cause some ethical debate



 



I wonder what all those people with Down
Syndrome and other problems would say





-Original Message-
From: owner-ozmidwifery@acegraphics.com.au
[mailto:owner-ozmidwifery@acegraphics.com.au]On Behalf Of sharon
Sent: Friday, 2 December 2005 7:59
AM
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery]
Interesting article sure to cause some ethical debate



i would also have to agree with that last statement as my
sons girlfriend has this disease. he knows that she may not be alive when she
is older and they need to enjoy each other now.







- Original Message - 





From: Nicole
Carver 





To: ozmidwifery@acegraphics.com.au 





Sent: Thursday, December
01, 2005 11:31 PM





Subject: RE: [ozmidwifery]
Interesting article sure to cause some ethical debate





 





How sad. If you asked a person with cystic
fibrosis whether their life had been worth living, even if it is shortened, I
wonder what they would say? 





Nicole.





-Original Message-
From: [EMAIL PROTECTED]
[mailto:owner-ozmidwifery@acegraphics.com.au]On Behalf Of Helen and Graham
Sent: Thursday, December 01, 2005
6:32 PM
To: ozmidwifery
Subject: [ozmidwifery] Interesting
article sure to cause some ethical debate



http://www.abc.net.au/health/thepulse/s1520191.htm

Screening for cystic fibrosis carriers

by Peter Lavelle
Published 01/12/2005







Every
year 70 babies are born in Australia
with cystic fibrosis. The child suffers serious lung and digestive problems -
they don't manufacture a vital protein, which causes secretions to become very
sticky and their lungs and pancreas to literally 'gum up'. The lungs become
susceptible to infection and digestion doesn't work propery.

Treatment
is much more effective than it was 20 years ago. Most children with cystic
fibrosis now can expect to survive into adulthood. But the average life
expectancy is still only in the mid thirties.

Cystic
fibrosis is an inherited condition, but a child has to have an abnormal gene
from both parents to get it. When both parents are 'carriers' of the abnormal
gene, there is a one in four chance of this happening.

About
one person in 25 in Australia
is a carrier. About one in 2,500 kids will be born with the condition.

At
the moment, carriers aren't identified by testing. Instead, newborn babies are
routinely screened for the condition (that's how most new cases are diagnosed).
Only then do most parents become aware they are carriers. Parents are then
routinely offered prenatal testing of a foetus in any subsequent pregnancy and
they have the option of then terminating that pregnancy. But it's too late to
do anything about the first child.

There
is a test to identify carriers of a cystic fibrosis gene. It's fairly reliable
(with an 85 per cent accuracy rate), and it involves a painless cheek swab. But
it's generally not offered to Australian couples unless there's a family
history of the condition. The trouble is, most carriers don't know they are
carriers, and have no history of the condition. The faulty gene has been hidden
away in their ancestry, not expressed.

A
group of doctors from the Royal Children's Hospital, Melbourne, writing in the latest edition of
the Medical Journal of Australia,
say testing for carriers should be more widely available.

The
doctors propose that the genetic test be offered as a prenatal test early in
pregnancy. The couple would both be tested, and if they were both carriers, the
foetus would be tested (via chorionic villus sampling, in which a portion of
the placenta is sampled). If the foetus had both mutations (a one in four
chance), the parents could then be given the option of terminating the
pregnancy.

Ideally,
the researchers say, carrier screening should be offered to partners before
they conceive. Couples could be tested for carrier status, and if both partners
were carriers, they could consider whether they want to conceive in the first
place. If they did, they would have the option of conceiving and terminating
the pregnancy if the foetus had both mutations. Or they could opt for in-vitro
fertilisation - with the embryo conceived and tested in the lab, and only
implanted in the woman's uterus if it was found not to have both mutations.

There
is a successful carrier screening program for cystic fibrosis that's been
operating along these lines in Edinburgh,
 Sc

RE: [ozmidwifery] Interesting article sure to cause some ethical debate

[Ken WArd]

I 
wonder what all those people with Down Syndrome and other problems would 
say

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of 
  sharonSent: Friday, 2 December 2005 7:59 AMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] 
  Interesting article sure to cause some ethical debate
  i would also have to agree with that last 
  statement as my sons girlfriend has this disease. he knows that she may not be 
  alive when she is older and they need to enjoy each other now.
  
- Original Message - 
From: 
Nicole Carver 
To: ozmidwifery@acegraphics.com.au 

Sent: Thursday, December 01, 2005 11:31 
PM
Subject: RE: [ozmidwifery] Interesting 
article sure to cause some ethical debate

How sad. If you asked a person with cystic fibrosis whether their 
life had been worth living, even if it is shortened, I wonder what they 
would say? 
Nicole.

  -Original Message-From: [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Helen and 
  GrahamSent: Thursday, December 01, 2005 6:32 PMTo: 
  ozmidwiferySubject: [ozmidwifery] Interesting article sure to 
  cause some ethical debate
  
  http://www.abc.net.au/health/thepulse/s1520191.htm
  Screening for cystic fibrosis carriers
  by Peter 
  LavellePublished 01/12/2005
  

  
  Every year 70 babies are born in Australia with cystic fibrosis. The 
  child suffers serious lung and digestive problems - they don't manufacture 
  a vital protein, which causes secretions to become very sticky and their 
  lungs and pancreas to literally 'gum up'. The lungs become susceptible to 
  infection and digestion doesn't work propery.
  Treatment is much more effective than it was 20 years ago. Most 
  children with cystic fibrosis now can expect to survive into adulthood. 
  But the average life expectancy is still only in the mid thirties.
  Cystic fibrosis is an inherited condition, but a child has to have an 
  abnormal gene from both parents to get it. When both parents are 
  'carriers' of the abnormal gene, there is a one in four chance of this 
  happening.
  About one person in 25 in Australia is a carrier. About one in 2,500 
  kids will be born with the condition.
  At the moment, carriers aren't identified by testing. Instead, newborn 
  babies are routinely screened for the condition (that's how most new cases 
  are diagnosed). Only then do most parents become aware they are carriers. 
  Parents are then routinely offered prenatal testing of a foetus in any 
  subsequent pregnancy and they have the option of then terminating that 
  pregnancy. But it's too late to do anything about the first child.
  There is a test to identify carriers of a cystic fibrosis gene. It's 
  fairly reliable (with an 85 per cent accuracy rate), and it involves a 
  painless cheek swab. But it's generally not offered to Australian couples 
  unless there's a family history of the condition. The trouble is, most 
  carriers don't know they are carriers, and have no history of the 
  condition. The faulty gene has been hidden away in their ancestry, not 
  expressed.
  A group of doctors from the Royal Children's Hospital, Melbourne, 
  writing in the latest edition of the Medical Journal of Australia, 
  say testing for carriers should be more widely available.
  The doctors propose that the genetic test be offered as a prenatal test 
  early in pregnancy. The couple would both be tested, and if they were both 
  carriers, the foetus would be tested (via chorionic villus sampling, in 
  which a portion of the placenta is sampled). If the foetus had both 
  mutations (a one in four chance), the parents could then be given the 
  option of terminating the pregnancy.
  Ideally, the researchers say, carrier screening should be offered to 
  partners before they conceive. Couples could be tested for carrier status, 
  and if both partners were carriers, they could consider whether they want 
  to conceive in the first place. If they did, they would have the option of 
  conceiving and terminating the pregnancy if the foetus had both mutations. 
  Or they could opt for in-vitro fertilisation - with the embryo conceived 
  and tested in the lab, and only implanted in the woman's uterus if it was 
  found not to have both mutations.
  There is a successful carrier screening program for cystic fibrosis 
  that's been operating along these lines in Edinburgh, Scotland, which has 
  halved the incidence of cystic fibrosis in that community, the researchers 
  say.
  At the very least, they argue, it should be offered as part of routine

Re: [ozmidwifery] Interesting article sure to cause some ethical debate

[sharon]

i would also have to agree with that last statement 
as my sons girlfriend has this disease. he knows that she may not be alive when 
she is older and they need to enjoy each other now.

  - Original Message - 
  From: 
  Nicole 
  Carver 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Thursday, December 01, 2005 11:31 
  PM
  Subject: RE: [ozmidwifery] Interesting 
  article sure to cause some ethical debate
  
  How 
  sad. If you asked a person with cystic fibrosis whether their life had been 
  worth living, even if it is shortened, I wonder what they would say? 
  
  Nicole.
  
-Original Message-From: [EMAIL PROTECTED] 
[mailto:[EMAIL PROTECTED]On Behalf Of Helen and 
GrahamSent: Thursday, December 01, 2005 6:32 PMTo: 
ozmidwiferySubject: [ozmidwifery] Interesting article sure to 
cause some ethical debate

http://www.abc.net.au/health/thepulse/s1520191.htm
Screening for cystic fibrosis carriers
by Peter 
LavellePublished 01/12/2005



Every year 70 babies are born in Australia with cystic fibrosis. The 
child suffers serious lung and digestive problems - they don't manufacture a 
vital protein, which causes secretions to become very sticky and their lungs 
and pancreas to literally 'gum up'. The lungs become susceptible to 
infection and digestion doesn't work propery.
Treatment is much more effective than it was 20 years ago. Most 
children with cystic fibrosis now can expect to survive into adulthood. But 
the average life expectancy is still only in the mid thirties.
Cystic fibrosis is an inherited condition, but a child has to have an 
abnormal gene from both parents to get it. When both parents are 'carriers' 
of the abnormal gene, there is a one in four chance of this happening.
About one person in 25 in Australia is a carrier. About one in 2,500 kids 
will be born with the condition.
At the moment, carriers aren't identified by testing. Instead, newborn 
babies are routinely screened for the condition (that's how most new cases 
are diagnosed). Only then do most parents become aware they are carriers. 
Parents are then routinely offered prenatal testing of a foetus in any 
subsequent pregnancy and they have the option of then terminating that 
pregnancy. But it's too late to do anything about the first child.
There is a test to identify carriers of a cystic fibrosis gene. It's 
fairly reliable (with an 85 per cent accuracy rate), and it involves a 
painless cheek swab. But it's generally not offered to Australian couples 
unless there's a family history of the condition. The trouble is, most 
carriers don't know they are carriers, and have no history of the condition. 
The faulty gene has been hidden away in their ancestry, not expressed.
A group of doctors from the Royal Children's Hospital, Melbourne, writing 
in the latest edition of the Medical Journal of Australia, say 
testing for carriers should be more widely available.
The doctors propose that the genetic test be offered as a prenatal test 
early in pregnancy. The couple would both be tested, and if they were both 
carriers, the foetus would be tested (via chorionic villus sampling, in 
which a portion of the placenta is sampled). If the foetus had both 
mutations (a one in four chance), the parents could then be given the option 
of terminating the pregnancy.
Ideally, the researchers say, carrier screening should be offered to 
partners before they conceive. Couples could be tested for carrier status, 
and if both partners were carriers, they could consider whether they want to 
conceive in the first place. If they did, they would have the option of 
conceiving and terminating the pregnancy if the foetus had both mutations. 
Or they could opt for in-vitro fertilisation - with the embryo conceived and 
tested in the lab, and only implanted in the woman's uterus if it was found 
not to have both mutations.
There is a successful carrier screening program for cystic fibrosis 
that's been operating along these lines in Edinburgh, Scotland, which has 
halved the incidence of cystic fibrosis in that community, the researchers 
say.
At the very least, they argue, it should be offered as part of routine 
prenatal testing, like screening for Down's syndrome. The doctors say it 
should be funded by Medicare, on the grounds of cost-effectiveness (saving 
the resources otherwise spent treating a child with the condition) and 
prevention of future suffering for kids and their 
  families.

RE: [ozmidwifery] Interesting article sure to cause some ethical debate

[Nicole Carver]

How 
sad. If you asked a person with cystic fibrosis whether their life had been 
worth living, even if it is shortened, I wonder what they would say? 

Nicole.

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Helen and 
  GrahamSent: Thursday, December 01, 2005 6:32 PMTo: 
  ozmidwiferySubject: [ozmidwifery] Interesting article sure to cause 
  some ethical debate
  
  http://www.abc.net.au/health/thepulse/s1520191.htm
  Screening for cystic fibrosis carriers
  by Peter 
  LavellePublished 01/12/2005
  

  
  Every year 70 babies are born in Australia with cystic fibrosis. The child 
  suffers serious lung and digestive problems - they don't manufacture a vital 
  protein, which causes secretions to become very sticky and their lungs and 
  pancreas to literally 'gum up'. The lungs become susceptible to infection and 
  digestion doesn't work propery.
  Treatment is much more effective than it was 20 years ago. Most 
  children with cystic fibrosis now can expect to survive into adulthood. But 
  the average life expectancy is still only in the mid thirties.
  Cystic fibrosis is an inherited condition, but a child has to have an 
  abnormal gene from both parents to get it. When both parents are 'carriers' of 
  the abnormal gene, there is a one in four chance of this happening.
  About one person in 25 in Australia is a carrier. About one in 2,500 kids 
  will be born with the condition.
  At the moment, carriers aren't identified by testing. Instead, newborn 
  babies are routinely screened for the condition (that's how most new cases are 
  diagnosed). Only then do most parents become aware they are carriers. Parents 
  are then routinely offered prenatal testing of a foetus in any subsequent 
  pregnancy and they have the option of then terminating that pregnancy. But 
  it's too late to do anything about the first child.
  There is a test to identify carriers of a cystic fibrosis gene. It's fairly 
  reliable (with an 85 per cent accuracy rate), and it involves a painless cheek 
  swab. But it's generally not offered to Australian couples unless there's a 
  family history of the condition. The trouble is, most carriers don't know they 
  are carriers, and have no history of the condition. The faulty gene has been 
  hidden away in their ancestry, not expressed.
  A group of doctors from the Royal Children's Hospital, Melbourne, writing 
  in the latest edition of the Medical Journal of Australia, say testing 
  for carriers should be more widely available.
  The doctors propose that the genetic test be offered as a prenatal test 
  early in pregnancy. The couple would both be tested, and if they were both 
  carriers, the foetus would be tested (via chorionic villus sampling, in which 
  a portion of the placenta is sampled). If the foetus had both mutations (a one 
  in four chance), the parents could then be given the option of terminating the 
  pregnancy.
  Ideally, the researchers say, carrier screening should be offered to 
  partners before they conceive. Couples could be tested for carrier status, and 
  if both partners were carriers, they could consider whether they want to 
  conceive in the first place. If they did, they would have the option of 
  conceiving and terminating the pregnancy if the foetus had both mutations. Or 
  they could opt for in-vitro fertilisation - with the embryo conceived and 
  tested in the lab, and only implanted in the woman's uterus if it was found 
  not to have both mutations.
  There is a successful carrier screening program for cystic fibrosis that's 
  been operating along these lines in Edinburgh, Scotland, which has halved the 
  incidence of cystic fibrosis in that community, the researchers say.
  At the very least, they argue, it should be offered as part of routine 
  prenatal testing, like screening for Down's syndrome. The doctors say it 
  should be funded by Medicare, on the grounds of cost-effectiveness (saving the 
  resources otherwise spent treating a child with the condition) and prevention 
  of future suffering for kids and their 
families.

[ozmidwifery] Interesting article sure to cause some ethical debate

[Helen and Graham]

http://www.abc.net.au/health/thepulse/s1520191.htm
Screening for cystic fibrosis carriers
by Peter 
LavellePublished 01/12/2005



Every year 70 babies are born in Australia with cystic fibrosis. The child 
suffers serious lung and digestive problems - they don't manufacture a vital 
protein, which causes secretions to become very sticky and their lungs and 
pancreas to literally 'gum up'. The lungs become susceptible to infection and 
digestion doesn't work propery.
Treatment is much more effective than it was 20 years ago. Most children 
with cystic fibrosis now can expect to survive into adulthood. But the average 
life expectancy is still only in the mid thirties.
Cystic fibrosis is an inherited condition, but a child has to have an 
abnormal gene from both parents to get it. When both parents are 'carriers' of 
the abnormal gene, there is a one in four chance of this happening.
About one person in 25 in Australia is a carrier. About one in 2,500 kids 
will be born with the condition.
At the moment, carriers aren't identified by testing. Instead, newborn babies 
are routinely screened for the condition (that's how most new cases are 
diagnosed). Only then do most parents become aware they are carriers. Parents 
are then routinely offered prenatal testing of a foetus in any subsequent 
pregnancy and they have the option of then terminating that pregnancy. But it's 
too late to do anything about the first child.
There is a test to identify carriers of a cystic fibrosis gene. It's fairly 
reliable (with an 85 per cent accuracy rate), and it involves a painless cheek 
swab. But it's generally not offered to Australian couples unless there's a 
family history of the condition. The trouble is, most carriers don't know they 
are carriers, and have no history of the condition. The faulty gene has been 
hidden away in their ancestry, not expressed.
A group of doctors from the Royal Children's Hospital, Melbourne, writing in 
the latest edition of the Medical Journal of Australia, say testing for 
carriers should be more widely available.
The doctors propose that the genetic test be offered as a prenatal test early 
in pregnancy. The couple would both be tested, and if they were both carriers, 
the foetus would be tested (via chorionic villus sampling, in which a portion of 
the placenta is sampled). If the foetus had both mutations (a one in four 
chance), the parents could then be given the option of terminating the 
pregnancy.
Ideally, the researchers say, carrier screening should be offered to partners 
before they conceive. Couples could be tested for carrier status, and if both 
partners were carriers, they could consider whether they want to conceive in the 
first place. If they did, they would have the option of conceiving and 
terminating the pregnancy if the foetus had both mutations. Or they could opt 
for in-vitro fertilisation - with the embryo conceived and tested in the lab, 
and only implanted in the woman's uterus if it was found not to have both 
mutations.
There is a successful carrier screening program for cystic fibrosis that's 
been operating along these lines in Edinburgh, Scotland, which has halved the 
incidence of cystic fibrosis in that community, the researchers say.
At the very least, they argue, it should be offered as part of routine 
prenatal testing, like screening for Down's syndrome. The doctors say it should 
be funded by Medicare, on the grounds of cost-effectiveness (saving the 
resources otherwise spent treating a child with the condition) and prevention of 
future suffering for kids and their families.

[ozmidwifery] Interesting article

[Helen and Graham]

FYI
Helen
 
http://www.msnbc.msn.com/id/8247179/
When Debbie Cargile became pregnant with her first child 
in 1999, she very much wanted a natural childbirth. After seeing a Seattle 
obstetrician for the first few months, she decided to switch to a midwife for 
the rest of her prenatal care to help ensure she got her wish.
She considered a home birth but 
ultimately opted for a birthing center. After three hard days in labor with her 
cervix still not fully dilated, though, Cargile wound up in the hospital and her 
daughter was delivered in a sterile operating room via Caesarean section. “I had 
a real, real hard time with that, the fact that I ended up with a C-section,” 
Cargile says. “It was so far away from what I wanted. I wanted something more 
warm and natural.”


So 
when she became pregnant with her son a couple years later, she decided to try 
again for a vaginal delivery. Doctors call it a VBAC, for vaginal birth after 
Caesarean, and it’s one of the most controversial issues in obstetrics. For 
years, the mantra was “Once a C-section, always a C-section." Then in the 1990s 
doctors pushed to lower the escalating C-section rate by encouraging more VBACs. 
Now, the pendulum seems to have swung the other way, with many doctors — and 
insurers — saying the safest approach, to avoid the risk of uterine rupture or 
other complications, is to do the repeat Caesarean.
Recent research in The New England 
Journal of Medicine shows the risks of a VBAC are only slightly higher than 
those of a repeat C-section. But the outcome can be very bad, including the 
death of the baby. Cargile studied up on VBACs and decided she could live with 
the small chance of problems. “Yes, there’s risk, but there’s risk with any 
childbirth,” she says. The medical community, in her opinion, is “a bit pro 
C-section. It’s the easy thing to do and there’s less liability on everyone’s 
part.”
Although she wanted to try for a 
VBAC at a birthing center, she says, her insurance company refused to cover her 
unless she delivered at a hospital. In the end, Cargile attempted a VBAC at a 
hospital but her placenta ruptured, likely a complication of her previous 
Caesarean, and she needed an emergency C-section.
Even though most women won't face 
this problem, it is experiences like this that have prompted some insurers to 
insist on repeat C-sections and hospital births. Still, Cargile bristled at 
being told where to have her baby.
Confusion all 
aroundCargile's case highlights some of the controversies, 
issues and frustrations that many pregnant women now face. Though women have 
been having babies for millennia, there's still no consensus on the best way to 
go about it. If anything, it seems to be getting more complicated.
"The doctors are confused and so 
are the women," says Dr. Sharon Phelan, an obstetrician at the University of New 
Mexico and a spokesperson for the American College of Obstetricians and 
Gynecologists.
Laura Fields, an Atlanta mother 
who gave birth a year ago, says she was overwhelmed with medical information 
when she became pregnant. She remembers thinking, "Wow, there's so many 
decisions and so many different opinions. There's a lot of controversy out 
there."
One of the most confusing issues 
for her was choosing which of the many prenatal tests to undergo.





There's also disagreement on a 
range of other issues, including whether to use pain drugs in labor and which 
ones, when to perform episiotomies (incisions to widen the birth canal), whether 
elective inductions or C-sections are a good idea, where women should have their 
babies (hospital, birthing center or at home), and what to do when a woman is 
overdue.
Doctors, midwives, nurses, 
insurers, hospital administrators and patients can all have different opinions 
on the best way to go about having a baby.
Take elective C-sections, for 
instance, which are gaining in popularity as busy women want to schedule their 
births rather than wait for nature to take its course. Aside from the 
convenience (for both patients and doctors), proponents claim that C-sections 
are better than vaginal births because they don't cause damage to pelvic tissue 
that may lead to urinary incontinence or sexual problems later in life.
Others, like many midwives and 
physicians such as Dr. Ann Honebrink of the University of Pennsylvania, point 
out that a C-section is major surgery that carries risks of bleeding and 
infection, and requires a longer recovery period. Honebrink also says there's no 
proof that elective C-sections help women avoid incontinence or sexual woes. 

"I think we'll look back [on 
elective C-sections] in 10 years and think that maybe this wasn't so good," 
Honebrink says. She notes that C-sections leave scar tissue and adhesions that 
may make it more difficult for a woman to get a proper colonoscopy or make it 
more likely she'll have complications if she needs additional surgery later in 
life, such as a hysterectomy. 
Honebrink says t

Re: [ozmidwifery] Interesting article about .."Bub Hubs"?

[Denise Hynd]

Sounds like rural women will still be transfered 
out to ? who knows where to birth
and back from the place of birth 
So how would they be better off??
 
A bub hub would be some kind of community-based centre with lots of 
maternity-related services on site, so you might have people being able to go 
there for antenatal care, for advice on breast feeding after the birth of their 
baby, maybe infant care advice and also postnatal check-ups,
Denise Hynd
 
"Let us support one another, not just in philosophy 
but in action, for the sake of freedom for all women to choose exactly how and 
by whom, if by anyone, our bodies will be handled."
 
— Linda Hes

  - Original Message - 
  From: 
  Helen and Graham 
  To: ozmidwifery 
  Sent: Tuesday, October 11, 2005 8:39 
  AM
  Subject: [ozmidwifery] Interesting 
  article about .."Bub Hubs"?
  
  http://www.abc.net.au/news/newsitems/200510/s1479154.htm
   
  
  Doctors' group backs maternity service trial
  
  The Rural Doctors Association is pleased the Queensland 
  Government has agreed to trial a new service for pregnant women.
  State Cabinet has endorsed most recommendations from an 
  independent report to improve maternity services.
  They include the establishment of family centres or "bub 
  hubs" to support women before and after giving birth.
  It is hoped the first one will be set up on a trial basis 
  by the end of next year.
  The association's Queensland branch president, Dr Jon 
  Outridge, says mothers will have access to all kinds of expertise.
  "" he said.
  
  

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  Date: 10/10/2005

[ozmidwifery] Interesting article about .."Bub Hubs"?

[Helen and Graham]

http://www.abc.net.au/news/newsitems/200510/s1479154.htm
 

Doctors' group backs maternity service trial

The Rural Doctors Association is pleased the Queensland 
Government has agreed to trial a new service for pregnant women.
State Cabinet has endorsed most recommendations from an 
independent report to improve maternity services.
They include the establishment of family centres or "bub 
hubs" to support women before and after giving birth.
It is hoped the first one will be set up on a trial basis 
by the end of next year.
The association's Queensland branch president, Dr Jon 
Outridge, says mothers will have access to all kinds of expertise.
"A bub hub would be some kind of community-based centre 
with lots of maternity-related services on site, so you might have people being 
able to go there for antenatal care, for advice on breast feeding after the 
birth of their baby, maybe infant care advice and also postnatal check-ups," he 
said.

Re: [ozmidwifery] interesting article FYI

[brendamanning]

FETAL HEART DOPPLER



ONLY $450



Sonotrax Lite is a low cost unit, designed for auscultation (intermittent 
listening).


Also included carry pouch & mini bottle of gel.



Made by Edan Instruments Inc



OR: SonoTrax Basic a high performance model with FHR digital display & 
waterproof probe $650




BRENDA MANNING

59862535 / 0409194623

[EMAIL PROTECTED]
- Original Message - 
From: "JoFromOz" <[EMAIL PROTECTED]>

To: 
Sent: Saturday, September 10, 2005 9:05 PM
Subject: Re: [ozmidwifery] interesting article FYI



leanne wynne wrote:


Fat Content of Breast Milk Increases with Time
By Amanda Gardner
HealthDay Reporter
TUESDAY, Sept. 6 (HealthDay News) -- The longer a mother breast-feeds, 
the higher the fat and energy content of her breast milk .


That is so good to know! Do you mind if I copy / paste it into a post for 
another group?


Thanks,

Jo (Mum to Will, 3.5 months old)

--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. 


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Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.

Re: [ozmidwifery] interesting article FYI

[brendamanning]

LINA CLERKE

P.O. Box 3039 Cotham Kew Vic 3101



www.wonderfulbirth.com



Regarding the 15th and 16th October Active Birth Workshop.  Congratulations 
on choosing this most positive preparation for your birth. As well as 
offering you an extensive education in birthing skills and inspiring 
confidence for both partners, the workshop is a chance to meet other 
like-minded parents-to-be, a great potential support resource after the 
birth.  Please note that no cheques will be cashed until very close to the 
workshop time.. Please, if for any reason you need to cancel, you must let 
me know ASAP because there is often a waiting list and if people cancel at 
the last minute, other pregnant women could miss out.


WORKSHOP NOTES:

· It is important that you arrive promptly at 9.45 on Saturday 
morning to allow time for registration and introductions. We will start at 
10.00am on Sunday.


· The workshop will be held at Ashburton Library, 154 High Street, 
Ashburton.


· Local parking is easy to find and there are shops and cafes nearby 
if you wish to have a leisurely breakfast before the workshop.


· Be sure to wear loose comfortable clothing that enables full 
physical mobility - i.e. stretch pants/leggings, wide/ long skirts, shorts, 
tracksuits, etc. Please also bring 3 bed pillows if possible.


· Please bring some snacks / fruit to nibble on throughout the day - 
there is a late lunch and an even later tea break - and expectant mothers 
will want to snack. Please bring two litres of juice or similar to share. 
Also bring your own drink bottle to sip on.


· Food will be a coordinated sumptuous affair - I will phone you 
closer to the date with details. Please note: You will also need to bring 
your own cutlery, plate and mug.


· Please bring paper and pen. I know it all sounds like a lot to 
bring, but actually it is a picnic basket and some pillows. (I always 
recognize folks coming to my workshops by these signs, plus the pregnant 
belly!)


· My prenatal relaxation CD's will be available to purchase.  For 
more details about the CD's, please go to www.wonderfulbirth.com.


· Each day will finish at approximately 7.00pm - we usually go 
overtime. Please do not arrange a busy evening schedule for the weekend (or 
to have to dash to get to some evening event). Although the days are long, 
they are action packed and you will leave feeling very inspired!


That's it for now - I look forward to seeing you at the workshop.

.Tania Delahoy..(Lina's assistant) Ph 03 95630996



PS. Please have a look at the many interesting articles, links and wonderful 
stories on my website: www.wonderfulbirth.com.


- Original Message - 
From: "JoFromOz" <[EMAIL PROTECTED]>

To: 
Sent: Saturday, September 10, 2005 9:05 PM
Subject: Re: [ozmidwifery] interesting article FYI



leanne wynne wrote:


Fat Content of Breast Milk Increases with Time
By Amanda Gardner
HealthDay Reporter
TUESDAY, Sept. 6 (HealthDay News) -- The longer a mother breast-feeds, 
the higher the fat and energy content of her breast milk .


That is so good to know! Do you mind if I copy / paste it into a post for 
another group?


Thanks,

Jo (Mum to Will, 3.5 months old)

--
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] interesting article FYI

[leanne wynne]

Go for it - Spread it around!!

Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862





From: JoFromOz <[EMAIL PROTECTED]>
Reply-To: ozmidwifery@acegraphics.com.au
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] interesting article FYI
Date: Sat, 10 Sep 2005 19:05:58 +0800

leanne wynne wrote:


Fat Content of Breast Milk Increases with Time
By Amanda Gardner
HealthDay Reporter
TUESDAY, Sept. 6 (HealthDay News) -- The longer a mother breast-feeds, the 
higher the fat and energy content of her breast milk .


That is so good to know! Do you mind if I copy / paste it into a post for 
another group?


Thanks,

Jo (Mum to Will, 3.5 months old)

--
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] interesting article FYI

[Julie Garratt]

You would think that 10,000 + generations of evidence that its perfect would 
be enough wouldn't you. I am proud that I fed all my three boys till they 
were almost three years old, I just loved every minute of it:)

Cheers Julie Garratt

- Original Message - 
From: "Megan & Larry" <[EMAIL PROTECTED]>

To: 
Sent: Sunday, September 11, 2005 3:02 PM
Subject: RE: [ozmidwifery] interesting article FYI



I'm still, more or less, the only source of food for my 14mth old and have
to say am not surprised by this article. Why else would I have a healthy,
well nourished child?
I know not everything natural is good for us, but why do they presume that
this high fat content could be harmful.
Again the question of "would mother nature get it so wrong" comes to mind.

Megan and a happy, happy Hugo.

-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of leanne wynne
Sent: Saturday, 10 September 2005 7:39 PM
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] interesting article FYI

Fat Content of Breast Milk Increases with Time By Amanda Gardner HealthDay
Reporter TUESDAY, Sept. 6 (HealthDay News) -- The longer a mother
breast-feeds, the higher the fat and energy content of her breast milk .

However, experts are not sure what this finding, which appears in the
September issue of Pediatrics, signifies.

"This is the first study to analyze the fat and energy content of breast
milk of mothers who breast-feed for longer than a year," said study
co-author Dr. Ronit Lubetzky, who is with the department of pediatrics at
Dana Children's Hospital at Tel Aviv Sourasky Medical Center in Israel.
"There are more and more women who choose to breast-feed for longer time
periods, and not many studies about the nutritional value of their milk
during this prolonged lactation."

"This is a nicely done study which looked at a question that really needed
to be answered," added Dr. Ruth Lawrence, a professor of pediatrics at the
University of Rochester School of Medicine and a member of the executive
committee of the American Academy of Pediatrics' section on 
breast-feeding.
"I think many people's general impression is if you continue to 
breast-feed

beyond a year, probably the nutrient value drops, and this is quite
different information and very important."

No one is sure how long mothers should breast-feed, although the American
Academy of Pediatrics recommends that "breast-feeding continue for at 
least

12 months, and thereafter for as long as mutually desired."

A reduction in cardiovascular risks in adulthood is one oft-cited benefit 
of
this practice. Others, however, have said it might have the opposite 
effect.


To determine the fat and energy content of human breast milk at longer
periods, Lubetzky and colleagues sampled the breast milk of 34 mothers who
had been breast-feeding for 12 to 39 months, and compared that with the 
milk

of 27 mothers who had been breast-feeding for only two to six months.

They found a startling difference: the fat content in the mothers who had
breast-fed for longer periods of time was 17.5 percent, versus only 5
percent in the short-term group.

The researchers said that, while it was possible that something other than
duration might be affecting the findings, they still felt this was the 
most

likely explanation for the difference.

It's not clear what the effects of this higher energy and fat content are 
on

a child's health.

"We showed that the milk of mothers who breast-fed more than a year had a
very high fat content," Lubetzky said. "That contradicts the claim that
breast-feeding at this stage has no nutritional contribution. On the other
hand, the long-term effect of such a high-fat intake has not been 
studied."


"The constituents of fat and human milk are very different than what we
provide in formula today. One of the most important constituents of human
milk is cholesterol. Formula does not," Lawrence said. "There are many
people who think that probably one of the problems with cholesterol today
occurs because infants have not had any cholesterol in the first few 
months

of life; perhaps the body doesn't learn to deal with it. There are studies
that show that young adults have much lower cholesterol levels if they 
were

breast-fed than if they were bottle-fed."

Still, Lawrence added, this is an area that needs to be researched 
further.


Lubetzky agreed. "Further studies should analyze this milk fat
qualitatively, and try to sort out the influence of prolonged 
breast-feeding

on cardiovascular issues," she said.

Another study in the same issue of the journal found, not surprisingly, 
that

American hospitals designated as "Baby Friendly" by the World Health
Organization (WHO) and the United Nations Children's Fund had higher
breast-feeding

RE: [ozmidwifery] interesting article FYI

[Megan & Larry]

I'm still, more or less, the only source of food for my 14mth old and have
to say am not surprised by this article. Why else would I have a healthy,
well nourished child? 
I know not everything natural is good for us, but why do they presume that
this high fat content could be harmful.
Again the question of "would mother nature get it so wrong" comes to mind.

Megan and a happy, happy Hugo.

-Original Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of leanne wynne
Sent: Saturday, 10 September 2005 7:39 PM
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] interesting article FYI

Fat Content of Breast Milk Increases with Time By Amanda Gardner HealthDay
Reporter TUESDAY, Sept. 6 (HealthDay News) -- The longer a mother
breast-feeds, the higher the fat and energy content of her breast milk .

However, experts are not sure what this finding, which appears in the
September issue of Pediatrics, signifies.

"This is the first study to analyze the fat and energy content of breast
milk of mothers who breast-feed for longer than a year," said study
co-author Dr. Ronit Lubetzky, who is with the department of pediatrics at
Dana Children's Hospital at Tel Aviv Sourasky Medical Center in Israel. 
"There are more and more women who choose to breast-feed for longer time
periods, and not many studies about the nutritional value of their milk
during this prolonged lactation."

"This is a nicely done study which looked at a question that really needed
to be answered," added Dr. Ruth Lawrence, a professor of pediatrics at the
University of Rochester School of Medicine and a member of the executive
committee of the American Academy of Pediatrics' section on breast-feeding. 
"I think many people's general impression is if you continue to breast-feed
beyond a year, probably the nutrient value drops, and this is quite
different information and very important."

No one is sure how long mothers should breast-feed, although the American
Academy of Pediatrics recommends that "breast-feeding continue for at least
12 months, and thereafter for as long as mutually desired."

A reduction in cardiovascular risks in adulthood is one oft-cited benefit of
this practice. Others, however, have said it might have the opposite effect.

To determine the fat and energy content of human breast milk at longer
periods, Lubetzky and colleagues sampled the breast milk of 34 mothers who
had been breast-feeding for 12 to 39 months, and compared that with the milk
of 27 mothers who had been breast-feeding for only two to six months.

They found a startling difference: the fat content in the mothers who had
breast-fed for longer periods of time was 17.5 percent, versus only 5
percent in the short-term group.

The researchers said that, while it was possible that something other than
duration might be affecting the findings, they still felt this was the most
likely explanation for the difference.

It's not clear what the effects of this higher energy and fat content are on
a child's health.

"We showed that the milk of mothers who breast-fed more than a year had a
very high fat content," Lubetzky said. "That contradicts the claim that
breast-feeding at this stage has no nutritional contribution. On the other
hand, the long-term effect of such a high-fat intake has not been studied."

"The constituents of fat and human milk are very different than what we
provide in formula today. One of the most important constituents of human
milk is cholesterol. Formula does not," Lawrence said. "There are many
people who think that probably one of the problems with cholesterol today
occurs because infants have not had any cholesterol in the first few months
of life; perhaps the body doesn't learn to deal with it. There are studies
that show that young adults have much lower cholesterol levels if they were
breast-fed than if they were bottle-fed."

Still, Lawrence added, this is an area that needs to be researched further.

Lubetzky agreed. "Further studies should analyze this milk fat
qualitatively, and try to sort out the influence of prolonged breast-feeding
on cardiovascular issues," she said.

Another study in the same issue of the journal found, not surprisingly, that
American hospitals designated as "Baby Friendly" by the World Health
Organization (WHO) and the United Nations Children's Fund had higher
breast-feeding rates than other hospitals. These hospitals follow WHO's "Ten
Steps to Successful Breast-feeding."

At Baby Friendly institutions, the rate of women beginning breast-feeding
was 83.8 percent, versus 69.5 percent nationally. The initiation rate at
hospitals with a higher proportion of black patients was only 70.7 percent.

The overall rate of women who breast-fed exclusively during their hospital
stay was 78.4 percent at Baby Friendly hospita

Re: [ozmidwifery] interesting article FYI

[JoFromOz]

leanne wynne wrote:


Fat Content of Breast Milk Increases with Time
By Amanda Gardner
HealthDay Reporter
TUESDAY, Sept. 6 (HealthDay News) -- The longer a mother breast-feeds, 
the higher the fat and energy content of her breast milk .


That is so good to know! Do you mind if I copy / paste it into a post 
for another group?


Thanks,

Jo (Mum to Will, 3.5 months old)

--
This mailing list is sponsored by ACE Graphics.
Visit  to subscribe or unsubscribe.

[ozmidwifery] interesting article FYI

[leanne wynne]

Fat Content of Breast Milk Increases with Time
By Amanda Gardner
HealthDay Reporter
TUESDAY, Sept. 6 (HealthDay News) -- The longer a mother breast-feeds, the 
higher the fat and energy content of her breast milk .


However, experts are not sure what this finding, which appears in the 
September issue of Pediatrics, signifies.


"This is the first study to analyze the fat and energy content of breast 
milk of mothers who breast-feed for longer than a year," said study 
co-author Dr. Ronit Lubetzky, who is with the department of pediatrics at 
Dana Children's Hospital at Tel Aviv Sourasky Medical Center in Israel. 
"There are more and more women who choose to breast-feed for longer time 
periods, and not many studies about the nutritional value of their milk 
during this prolonged lactation."


"This is a nicely done study which looked at a question that really needed 
to be answered," added Dr. Ruth Lawrence, a professor of pediatrics at the 
University of Rochester School of Medicine and a member of the executive 
committee of the American Academy of Pediatrics' section on breast-feeding. 
"I think many people's general impression is if you continue to breast-feed 
beyond a year, probably the nutrient value drops, and this is quite 
different information and very important."


No one is sure how long mothers should breast-feed, although the American 
Academy of Pediatrics recommends that "breast-feeding continue for at least 
12 months, and thereafter for as long as mutually desired."


A reduction in cardiovascular risks in adulthood is one oft-cited benefit of 
this practice. Others, however, have said it might have the opposite effect.


To determine the fat and energy content of human breast milk at longer 
periods, Lubetzky and colleagues sampled the breast milk of 34 mothers who 
had been breast-feeding for 12 to 39 months, and compared that with the milk 
of 27 mothers who had been breast-feeding for only two to six months.


They found a startling difference: the fat content in the mothers who had 
breast-fed for longer periods of time was 17.5 percent, versus only 5 
percent in the short-term group.


The researchers said that, while it was possible that something other than 
duration might be affecting the findings, they still felt this was the most 
likely explanation for the difference.


It's not clear what the effects of this higher energy and fat content are on 
a child's health.


"We showed that the milk of mothers who breast-fed more than a year had a 
very high fat content," Lubetzky said. "That contradicts the claim that 
breast-feeding at this stage has no nutritional contribution. On the other 
hand, the long-term effect of such a high-fat intake has not been studied."


"The constituents of fat and human milk are very different than what we 
provide in formula today. One of the most important constituents of human 
milk is cholesterol. Formula does not," Lawrence said. "There are many 
people who think that probably one of the problems with cholesterol today 
occurs because infants have not had any cholesterol in the first few months 
of life; perhaps the body doesn't learn to deal with it. There are studies 
that show that young adults have much lower cholesterol levels if they were 
breast-fed than if they were bottle-fed."


Still, Lawrence added, this is an area that needs to be researched further.

Lubetzky agreed. "Further studies should analyze this milk fat 
qualitatively, and try to sort out the influence of prolonged breast-feeding 
on cardiovascular issues," she said.


Another study in the same issue of the journal found, not surprisingly, that 
American hospitals designated as "Baby Friendly" by the World Health 
Organization (WHO) and the United Nations Children's Fund had higher 
breast-feeding rates than other hospitals. These hospitals follow WHO's "Ten 
Steps to Successful Breast-feeding."


At Baby Friendly institutions, the rate of women beginning breast-feeding 
was 83.8 percent, versus 69.5 percent nationally. The initiation rate at 
hospitals with a higher proportion of black patients was only 70.7 percent.


The overall rate of women who breast-fed exclusively during their hospital 
stay was 78.4 percent at Baby Friendly hospitals compared with a national 
mean of 46.3 percent.


More information

The American Academy of Pediatrics has a policy statement on breast-feeding.

SOURCES: Ronit Lubetzky, M.D., department of pediatrics, Dana Children's 
Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Ruth Lawrence, 
M.D., professor, pediatrics, University of Rochester School of Medicine, 
Rochester, N.Y., and member, executive committee, section on breast-feeding, 
American Academy of Pediatrics; September 2005 Pediatrics


Copyright © 2005 ScoutNews, LLC. All rights reserved.

Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862


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Visit 

[ozmidwifery] Interesting VBAC information

[Dean & Jo]

Check out www.maternitywise.org and read the American Academy of Family
Physicians on their vbac stuff...it is really interesting...and not what
you would expect!

Jo

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[ozmidwifery] interesting article

[leanne wynne]

This is an interesting article from ObGynWorld.com

Breast-feeding: a win-win game
And finally, a study of new mums in Canada has demonstrated that, further to 
being the best source of nutrition for their child, breast-feeding benefits 
mothers themselves by alleviating their levels of stress.


The work showed that 25 breast-feeding mothers responded less strongly to 
stressful situations, as assessed by cortisol levels in their saliva, than 
25 mothers who bottle-fed their infants. The researchers think this effect 
will free up more energy for the new mothers to dedicate to their child.


"Our study may also have implications for women prone to postpartum 
depression," said lead author Claire-Dominique Walker (Douglas Hospital 
Research Centre). "Postpartum stress is a risk factor for postpartum 
depression. If we can better understand how the breast-feeding moms reduce 
their stress... we may be able to better treat the moms prone to postpartum 
depression."




Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862


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[ozmidwifery] interesting article

[leanne wynne]

This is an interesting article from ObGynWorld.com

Breast-feeding: a win-win game
And finally, a study of new mums in Canada has demonstrated that, further to 
being the best source of nutrition for their child, breast-feeding benefits 
mothers themselves by alleviating their levels of stress.


The work showed that 25 breast-feeding mothers responded less strongly to 
stressful situations, as assessed by cortisol levels in their saliva, than 
25 mothers who bottle-fed their infants. The researchers think this effect 
will free up more energy for the new mothers to dedicate to their child.


"Our study may also have implications for women prone to postpartum 
depression," said lead author Claire-Dominique Walker (Douglas Hospital 
Research Centre). "Postpartum stress is a risk factor for postpartum 
depression. If we can better understand how the breast-feeding moms reduce 
their stress... we may be able to better treat the moms prone to postpartum 
depression."




Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862


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[ozmidwifery] interesting/confusing

[Mary Murphy]

 
  
  Despite its claim to having clear outcomes, this
  does not give us enough information to judge it’s validity. (eg numbers
  of women).  Has anyone access to the article itself?  MM 
  
  
  
  
  
  .
  
 


Antenatal screening for
Group B Streptococcus: A diagnostic cohort study
Janet E Hiller , Helen M McDonald , Philip Darbyshire and Caroline A Crowther 

BMC Pregnancy and Childbirth
2005, 5:12 doi:10.1186/1471-2393-5-12


 
  
  Published
  
  
   
  
  
  22 July 2005
  
 



Abstract
(provisional) 



Background

A range of strategies
have been adopted to prevent early onset Group B Streptococcal (EOGBS) sepsis,
as a consequence of Group B Streptococcal (GBS) vertically acquired infection.
This study was designed to provide a scientific basis for optimum timing and
method of GBS screening in an Australian setting, to determine whether
screening for GBS infection at 35-37 weeks gestation has better predictive
values for colonisation at birth than screening at 31-33 weeks, to examine the
test characteristics of a risk factor strategy and to determine the test
characteristics of low vaginal swabs alone compared with a combination of
perianal plus low vaginal swabs per colonisation during labour. 

Methods

Consented women received
vaginal and perianal swabs at 31-33 weeks gestation, 35-38 weeks gestation and
during labour. Swabs were cultured on layered horse blood agar and inoculated
into selective broth prior to analysis. Test characteristics were calculated
with exact confidence intervals for a high risk strategy and for antenatal
screening at 31-33 and 35-37 weeks gestation for vaginal cultures alone,
perianal cultures alone and combined low vaginal and perianal cultures. 

Results

The high risk strategy
was not informative in predicting GBS status during labour. There is an
unequivocal benefit for the identification of women colonised with GBS during
labour associated with delaying screening until 36 weeks however the results
for method of screening were less definitive with no clear advantage in using a
combined low vaginal and perianal swabbing regimen over the use of a low
vaginal swab alone.

Conclusions

This study can contribute
to the development of prevention strategies in that it provides clear evidence
for optimal timing of swabs. The addition of a perianal swab does not confer
clear benefit. The quantification of advantages and disadvantages provided in
this study will facilitate communication with clinicians and pregnant women
alike. 

 

[ozmidwifery] interesting article

[leanne wynne]

 FYI



Elective Repeat C-Section May Negatively Affect Neonatal Outcomes




NEW YORK (Reuters Health) Jun 09 - Compared with intending to deliver 
vaginally, undergoing a scheduled repeat cesarean delivery apparently raises 
the risk that the newborn will be admitted to an advanced care nursery, 
according to a brief report. The researchers say women should be alerted to 
the possible negative effects.


The study, in the May issue of the American Journal of Obstetrics and 
Gynecology, is the first to directly compare the neonatal outcomes of 
elective c-section with those of a trial of labor in uncomplicated 
pregnancies, note Dr. Nicholas Fogelson and colleagues, from the Medical 
University of South Carolina in Charleston.


In a retrospective cohort analysis, the investigators assessed the neonatal 
outcomes of 3134 mothers intending to deliver vaginally and 117 mothers who 
underwent elective repeat cesarean section.


In the overall analysis, the risk ratio for admission to an advanced care 
nursery was 3.58 for infants in the elective c-section group compared to 
those from the intended vaginal group (p < 0.001). Transient tachypnea was 
also more common in the elective cesarean group (p = 0.0009).


When the analysis was confined to mothers who underwent unscheduled 
c-section after a trial of labor, the advanced care nursery finding was no 
longer statistically significant. Also, infants born to such mothers were 
more likely to have lower APGAR scores than those in the elective c-section 
group.


"The decision to undergo elective cesarean delivery appears to have a 
negative impact on immediate neonatal outcomes," the authors state. They 
advise that for women considering a scheduled cesarean delivery, "physicians 
should counsel patients about potential neonatal issues in addition to 
concern for maternal well-being."


Am J Obstet Gynecol 2005;192:1433-1436.





Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862


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[ozmidwifery] interesting article

[leanne wynne]

Abortions Tied to Subsequent Preterm Delivery
Reuters Health Information 2005. © 2005 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or 
similar means, is expressly prohibited without the prior written consent of 
Reuters. Reuters shall not be liable for any errors or delays in the 
content, or for any actions taken in reliance thereon. Reuters and the 
Reuters sphere logo are registered trademarks and trademarks of the Reuters 
group of companies around the world.


By David Douglas
NEW YORK (Reuters Health) Apr 27 - Having previously had an induced abortion 
is associated with the birth of very preterm (22 to 33 weeks of gestation) 
singletons, French researchers report in the April issue of the British 
Journal of Obstetrics and Gynaecology.

Dr. Caroline Moreau of Hopital de Bicetre, Le Kremlin Bicetre and colleagues 
note that there had been much debate on the effect of induced abortions on 
subsequent pregnancies. However, studies have failed to reach clear 
conclusions.

To investigate further, the researchers examined data on 1943 very preterm 
singletons, 276 moderately preterm singletons and 618 unmatched full-term 
controls.

Women with a history of induced abortion were at a higher risk (odds ratio, 
1.5) of very preterm delivery than those without such a history. 
Furthermore, the risk of deliveries at less than 28 weeks was even higher in 
this group (odds ratio, 1.7).

No association was found between induced abortion and very preterm delivery 
due to hypertension. However, a history of induced abortion was associated 
with an increased risk of premature rupture of the membranes, antepartum 
hemorrhage not associated with hypertension and idiopathic spontaneous 
preterm labor.

Thus the investigators conclude that induced abortion "increases the risk of 
preterm births, particularly extremely preterm deliveries."

The findings suggest the need for further research "in particular to assess 
the differences in the level of risk according to the technique used for 
abortion," Dr. Moreau told Reuters Health.

"As medical abortion is supposed to reduce mechanical injuries," she said, 
"it would be important to know if it also reduces the risk of subsequent 
preterm delivery, compared with surgical abortion."

Br J Obstet Gynaecol 2005;112:430-437.

Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862
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[ozmidwifery] interesting article

[leanne wynne]

Readmission more likely after cesarean than vaginal birth
Source: Obstetrics & Gynecology 2005; 105: 836-42
Investigating the risk of maternal postpartum readmission associated with 
different modes of delivery.

The risk of maternal readmission after delivery is higher for cesarean and 
operative deliveries than it is for vaginal birth, research shows.

Noting that "cesarean delivery is usually considered a safe, low-risk 
procedure," a team of researchers led by Shiliang Liu from the Public Health 
Agency of Canada investigated how maternal rehospitalization, one indicator 
of postpartum morbidity, differed following operative and vaginal 
deliveries.

They studied a population-based cohort of 900,108 women with live singleton 
births using entries in the Canadian Institute for Health Information's 
Discharge Abstract Database for 1997/98 until 2001/02.

Overall, 1.8 percent of women were readmitted within 60 days of discharge. 
Compared with vaginal delivery, the likelihood of such readmission was 
significantly higher after cesarean delivery (odds ratio [OR] = 1.9), 
delivery by forceps (OR = 1.4), and delivery by vacuum (OR = 1.2). This 
increased risk is due to a higher rate of readmission for several serious 
complications, including pelvic injury, wound infection, obstetric 
complications, and major puerperal infection.

"These results add a further dimension of information that should help 
obstetricians and women when discussing the benefits and risks associated 
with spontaneous vaginal delivery, operative vaginal delivery, and cesarean 
delivery," concludes the team.

Posted: 21 April 2005

Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service  Mob 0418 371862
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[ozmidwifery] interesting study on vbac

[Dean & Jo]

First time I have ever heard of an increase in rupture of
women with previous vbac!

 

 


 
  
  Obstet Gynecol.
  2004 Aug;104(2):273-7.
  
  
  Related
  Articles, Links 
  
 


 

Effect of prior vaginal delivery or prior vaginal birth after
cesarean delivery on obstetric outcomes in women undergoing trial of labor.

Hendler I, Bujold
E.

Sainte-Justine Hospital, University of Montreal, Montreal,
Quebec, Canada.

OBJECTIVE: We sought to study the effects of prior vaginal delivery or prior
vaginal birth after cesarean delivery (VBAC) on the success of a trial of labor
after a cesarean delivery. METHODS: An observational study of patients who
underwent a trial of labor after a single low-transverse cesarean delivery.
Patients with a previous cesarean delivery and no vaginal birth were compared
with patients with a single vaginal delivery before or after the previous
cesarean delivery. The rates of successful VBAC, uterine rupture, and scar
dehiscence were analyzed. Multivariable regression was performed to adjust for
confounding variables. RESULTS: Of 2,204 patients, 1,685 (76.4%) had a previous
cesarean delivery and no vaginal delivery, 198 (9.0%) had a vaginal delivery
before the cesarean delivery, and 321 (14.6%) had a prior VBAC. The rate of
successful trial of labor was 70.1%, 81.8%, and 93.1%, respectively (P
<.001). A prior VBAC was associated with fewer third- and fourth-degree
lacerations (8.5% versus 2.5% versus 3.7%, P <.001) and fewer operative
vaginal deliveries (14.7% versus 5.6% versus 1.9%, P <.001) but not with
uterine rupture (1.5% versus 0.5% versus 0.3%, P =.12). Patients with a prior
VBAC had, in addition, a higher rate of uterine scar dehiscence (21.8%)
compared with patients with a previous cesarean delivery and no vaginal
delivery (5.3%; P =.001). CONCLUSION: A prior vaginal delivery and,
particularly, a prior VBAC are associated with a higher rate of successful
trial of labor compared with patients with no prior vaginal delivery. In
addition, prior VBAC is associated with an increased rate of uterine scar
dehiscence.

 








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[ozmidwifery] Interesting

[Mary Murphy]

The Art of Midwifery
After 30 years of assisting mothers in labor at home and in the hospital, I 
have found some techniques that help empower mothers when they are pushing. In 
the beginning and at the time of birthing it is very relaxing and easy for some 
mothers to be on their side. If side-lying pushing does not seem to bring 
progress, then an upright position, preferably a standing squat or kneeling 
squat, can work well. Birth in a squatting position seems to encourage rapid 
expulsion and tearing, so I ask mothers to lean back in a semi-recline for the 
actual birth. I do use gentle perineal support, usually with a warm cloth and 
oil as needed.
But when different positions have been tried and the fetal head is unable to 
come under the pubic arch, I encourage the mother to lie flat on her back with 
just a pillow under her head. I help her bring her legs up with the soles of her 
feet together. I wrap a towel around her feet and have her grasp the ends of the 
towel and pull as she pushes. This motion brings her legs back and the position 
causes a widening of the outlet, even more than squatting. The mother's elbows 
should be out and one should resist the urge to raise her upper body because 
this action seems to make the push less effective. Coaching the mother to "push 
the baby down and then up to the ceiling" seems to help as well.
This position has saved many of my mothers from a c-section. I try to suggest 
it after the mother has tried any positions she prefers and before she becomes 
exhausted. I explain that, while it may seem to be a strange position, it may 
shorten the time needed to push the baby out. At the time of serious crowning, 
the towel can be abandoned and the mother may assume any position desired.
It makes me sad when I see current writings that caution women to refrain 
from lying on their backs at any time during labor. We all know why women are 
told this, but we also know there are exceptions to everything. By the way, this 
position works with or without regional anesthesia, for those practicing in 
hospital settings where anesthesia is common.
— Mary Jo Terrill, RN, BSN, 
MSWSanta Barbara, California

Re: [ozmidwifery] interesting

[Jan Robinson]

Thanks for this Mary
Have just sent a copy to all the women I know who have had vaginal breech births.
They will be overjoyed to see this.
Jan
Jan Robinson Independent Midwife Practitioner
National Coordinator  Australian Society of Independent Midwives
8 Robin Crescent   South Hurstville   NSW   2221 Phone/Fax: 02 9546 4350
e-mail address: <[EMAIL PROTECTED]>  website: www.midwiferyeducation.com.au
On 10 Jan, 2005, at 23:18, Mary Murphy wrote:

From the birthnews list: 
22. EIDE MG, Oyen N, Skjaerven R, Irgens LM, et al.
Breech Delivery and Intelligence: A Population-Based Study of 8,738
Breech 
Infants. 
Obstet Gynecol 2005;105:4-11.
http://amedeo.com/p2.php?id=15625134&s=neo 
ABSTRACT available

[ozmidwifery] interesting

[Mary Murphy]

From the birthnews list: 22. EIDE MG, Oyen N, Skjaerven R, Irgens LM, 
et al.Breech Delivery and Intelligence: A Population-Based Study of 
8,738Breech Infants. Obstet Gynecol 2005;105:4-11. http://amedeo.com/p2.php?id=15625134&s=neo 
ABSTRACT available

[ozmidwifery] Interesting Article

[Abby and Toby]

Hi,

I found this article while searching for info about unassisted birth in
Australia. In light of recent discussions about abortion/ killing etc I
thought it would be an interesting read for some people. While I don't agree
with everything she writes, I think that she makes some very important
points and brings up things I have often wondered about the new age culture
and abortion.
http://www.birthkeeper.com/WomanIsShakti.html

I have often thought the exact same thing, about many vegetarians and earth
lovers, as she writes here, " How ironic it is that some yoginis will forego
the eating of meat out of compassion for animals, yet this same sensitive
compassion is not extended to unwanted babies."

Love Abby


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Re: [ozmidwifery] Interesting article

[Graham and Helen]

Yea you are right, I was probably being a bit 
suspicious!
 
Helen

  - Original Message - 
  From: 
  Ken 
  WArd 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, June 16, 2004 3:13 
  PM
  Subject: RE: [ozmidwifery] Interesting 
  article
  
  I 
  don't know. I have seen a couple of cases with previous vaginal births, and 
  massive pph's resulting in DIC and hysters. We need to remember that vaginal 
  birth can result in tradagy.
  
-Original Message-From: [EMAIL PROTECTED] 
[mailto:[EMAIL PROTECTED]On Behalf Of Graham and 
HelenSent: Tuesday, 15 June 2004 2:00 PMTo: 
[EMAIL PROTECTED]Subject: [ozmidwifery] Interesting 
article
 
Miracle mum thanks 100 
donorsBy Paula 
BeauchampJune 15, 2004
http://www.news.com.au/common/story_page/0,4057,9847532%255E26462,00.html
 
 
As per our previous thread about the rising 
incidence of placenta accreta with the rising caesarian rateI wonder if 
this was the case and whether her previous children were born by 
caesarian?  
 
 
Helen 
Cahill

RE: [ozmidwifery] Interesting article

[Ken WArd]

I 
don't know. I have seen a couple of cases with previous vaginal births, and 
massive pph's resulting in DIC and hysters. We need to remember that vaginal 
birth can result in tradagy.

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Graham and 
  HelenSent: Tuesday, 15 June 2004 2:00 PMTo: 
  [EMAIL PROTECTED]Subject: [ozmidwifery] Interesting 
  article
   
  Miracle mum thanks 100 
  donorsBy Paula 
  BeauchampJune 15, 2004
  http://www.news.com.au/common/story_page/0,4057,9847532%255E26462,00.html
   
   
  As per our previous thread about the rising 
  incidence of placenta accreta with the rising caesarian rateI wonder if 
  this was the case and whether her previous children were born by 
  caesarian?  
   
   
  Helen 
Cahill

[ozmidwifery] Interesting article

[Graham and Helen]

 
Miracle mum thanks 100 donorsBy Paula BeauchampJune 15, 
2004
http://www.news.com.au/common/story_page/0,4057,9847532%255E26462,00.html
 
 
As per our previous thread about the rising 
incidence of placenta accreta with the rising caesarian rateI wonder if this 
was the case and whether her previous children were born by 
caesarian?  
 
 
Helen Cahill

[ozmidwifery] interesting book

[Patricia David]

Pursuant to the fascinating discussion on midwives, obstetric nurses and the 
micropolitics of the professions vis a vis obstetricians and other doctors involved in 
childbirth I have just finished my easter read: Misconceptions by Terry McGee, an 
obstetrician and first-time author from Sydney. It's a fascinating read for the story 
alone, which is a fictional tale of a female obstetrician who is sued for negligence 
after the birth of a brain-injured child. It is a real insight into the medico-legal 
process, but also a sensitive portrayal of family life and the stresses and strains 
that obstetric practice places upon it. Particularly for a woman, I might add. It 
certainly paints a less black/white:right/wrong picture of 'defensive medicine'. I 
read the whole 462 pages in two days so the narrative was compelling, but I am 
considering offering it for summer reads to my students between semesters, along with 
Chris Bojahlian's Midwives and Gay Coultier's A Midwife's Tale, etc.

It's published by Pan 2003 if you're interested. If anyone else has read it, let me 
know what you thought.

Trish
-- 
Trish David FACM
Senior Lecturer Midwifery and Nursing
Monash University School of Nursing
Gippsland Campus
Northways Road
Churchill 3842
(03) 5122 6839
0418 994033
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[ozmidwifery] Interesting article

[Graham and Helen]

This is interesting and makes me wonder if there 
was any pattern in the sleeping arrangements of these children?? i.e. 
co-sleeping, separate bedrooms etcthis seems to be often overlooked as a 
variable in such studies.
 
http://news.ninemsn.com.au/nnhwatch/story_55760.asp
 
 
Helen Cahill

Re: [ozmidwifery] interesting

[Kathryn Simile]

Tania
 
Not sure how to contact you off list.
 
Kathryn

  - Original Message - 
  From: 
  Tania Smallwood 
  
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 23, 2004 9:54 
  PM
  Subject: Re: [ozmidwifery] 
  interesting
  
  Kathryn,
   
  We always welcome new faces, and there are already a lot of 
  students who have come along to both the HBNSA and Birth Matters groups, you 
  are very welcome!
   
  You can mail me off list if you need any further 
  details
   
  Cheers
   
  Tania
  
- Original Message - 
From: 
Kathryn Simile 
To: [EMAIL PROTECTED] 

Sent: Tuesday, March 23, 2004 7:22 
PM
Subject: Re: [ozmidwifery] 
interesting

Tania,
 
Hi, my name is Kathryn and am currently in my 
first year of bachelor of midwifery at UniSA (Adelaide). 
 
Part of our curriculum at uni is to provide 
continuity of care (as a midwifery student) to pregnant women and I 
would LOVE to have the opportunity to follow women who have chosen a home 
birth.
 

You mentioned some coffee sessions on 
homebirth and Birth Matters and wondered if it was possible for midwifery 
students to attend?
 
Look forward to reading many more of everyones 
interesting comments on pregnancy, childbirth and babies
 
kathryn

  - Original Message - 
  From: 
  Tania 
  Smallwood 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 23, 2004 4:39 
  PM
  Subject: Re: [ozmidwifery] 
  interesting
  
  Rosemary,
   
  We have a homebirth network coffee morning on the 7th 
  April in Ashton, which is at the top of Magill Rd in the hills, which 
  you'd be very welcome to attend.  Birth Matters have a coffee morning 
  on the 8th, in Eastwood, which is quite near the city, from 10-12.  
  Let me know if you'd like to come, and I'll send you more details.  
  Where are you staying by the way?
   
  Tania
   
  
- Original Message - 
From: 
Rosemary Weckert 
To: [EMAIL PROTECTED] 

Sent: Tuesday, March 23, 2004 11:03 
AM
    Subject: [ozmidwifery] 
interesting

Dear all
My kids have had a couple issues of Mr. 
Bean's amazing A-Z ( a paperback weekly product that builds into an 
encylopedia). This is what it said about birth "Birth would be trickier 
without special medical experts called midwives. They help pregnant mums 
through labour - the process of giving birth to a baby" This publication 
comes from England, nice to see babies aren't DELIVERED by 
doctors.
 
I am going to be in Adelaide from 6th - 
16th April, are there any workshops or activities to do with midwifery 
that I might attend while I'm there?
 
One more thing, I am looking to write a 
learning package for our midwives who are new to Antenatal clinics. Does 
anyone have anything so I don't have to reinvent the wheel?
It's great weather at present anyone coming 
for a visit?
Regards Rosemary 
Alice 
Springs

Re: [ozmidwifery] interesting

[Tania Smallwood]

Kathryn,
 
We always welcome new faces, and there are already a lot of 
students who have come along to both the HBNSA and Birth Matters groups, you are 
very welcome!
 
You can mail me off list if you need any further 
details
 
Cheers
 
Tania

  - Original Message - 
  From: 
  Kathryn 
  Simile 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 23, 2004 7:22 
  PM
  Subject: Re: [ozmidwifery] 
  interesting
  
  Tania,
   
  Hi, my name is Kathryn and am currently in my 
  first year of bachelor of midwifery at UniSA (Adelaide). 
   
  Part of our curriculum at uni is to provide 
  continuity of care (as a midwifery student) to pregnant women and I would 
  LOVE to have the opportunity to follow women who have chosen a home 
  birth.
   
  
  You mentioned some coffee sessions on 
  homebirth and Birth Matters and wondered if it was possible for midwifery 
  students to attend?
   
  Look forward to reading many more of everyones 
  interesting comments on pregnancy, childbirth and babies
   
  kathryn
  
- Original Message - 
From: 
Tania 
Smallwood 
To: [EMAIL PROTECTED] 

Sent: Tuesday, March 23, 2004 4:39 
PM
Subject: Re: [ozmidwifery] 
interesting

Rosemary,
 
We have a homebirth network coffee morning on the 7th 
April in Ashton, which is at the top of Magill Rd in the hills, which you'd 
be very welcome to attend.  Birth Matters have a coffee morning on the 
8th, in Eastwood, which is quite near the city, from 10-12.  Let me 
know if you'd like to come, and I'll send you more details.  Where are 
you staying by the way?
 
Tania
 

  - Original Message - 
  From: 
  Rosemary 
  Weckert 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 23, 2004 11:03 
  AM
  Subject: [ozmidwifery] 
  interesting
  
  Dear all
  My kids have had a couple issues of Mr. 
  Bean's amazing A-Z ( a paperback weekly product that builds into an 
  encylopedia). This is what it said about birth "Birth would be trickier 
  without special medical experts called midwives. They help pregnant mums 
  through labour - the process of giving birth to a baby" This publication 
  comes from England, nice to see babies aren't DELIVERED by 
  doctors.
   
  I am going to be in Adelaide from 6th - 16th 
  April, are there any workshops or activities to do with midwifery that I 
  might attend while I'm there?
   
  One more thing, I am looking to write a 
  learning package for our midwives who are new to Antenatal clinics. Does 
  anyone have anything so I don't have to reinvent the wheel?
  It's great weather at present anyone coming 
  for a visit?
  Regards Rosemary 
  Alice 
  Springs

Re: [ozmidwifery] interesting

[Kathryn Simile]

Tania,
 
Hi, my name is Kathryn and am currently in my first 
year of bachelor of midwifery at UniSA (Adelaide). 
 
Part of our curriculum at uni is to provide 
continuity of care (as a midwifery student) to pregnant women and I would 
LOVE to have the opportunity to follow women who have chosen a home 
birth.
 

You mentioned some coffee sessions on 
homebirth and Birth Matters and wondered if it was possible for midwifery 
students to attend?
 
Look forward to reading many more of everyones 
interesting comments on pregnancy, childbirth and babies
 
kathryn

  - Original Message - 
  From: 
  Tania Smallwood 
  
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 23, 2004 4:39 
  PM
  Subject: Re: [ozmidwifery] 
  interesting
  
  Rosemary,
   
  We have a homebirth network coffee morning on the 7th April 
  in Ashton, which is at the top of Magill Rd in the hills, which you'd be very 
  welcome to attend.  Birth Matters have a coffee morning on the 8th, in 
  Eastwood, which is quite near the city, from 10-12.  Let me know if you'd 
  like to come, and I'll send you more details.  Where are you staying by 
  the way?
   
  Tania
   
  
- Original Message - 
From: 
Rosemary 
Weckert 
To: [EMAIL PROTECTED] 

Sent: Tuesday, March 23, 2004 11:03 
AM
Subject: [ozmidwifery] 
interesting

Dear all
My kids have had a couple issues of Mr. Bean's 
amazing A-Z ( a paperback weekly product that builds into an encylopedia). 
This is what it said about birth "Birth would be trickier without special 
medical experts called midwives. They help pregnant mums through labour - 
the process of giving birth to a baby" This publication comes from England, 
nice to see babies aren't DELIVERED by doctors.
 
I am going to be in Adelaide from 6th - 16th 
April, are there any workshops or activities to do with midwifery that I 
might attend while I'm there?
 
One more thing, I am looking to write a 
learning package for our midwives who are new to Antenatal clinics. Does 
anyone have anything so I don't have to reinvent the wheel?
It's great weather at present anyone coming for 
a visit?
Regards Rosemary 
Alice 
Springs

Re: [ozmidwifery] interesting

[Jo & Dean Bainbridge]

Hi Katherine,
welcome to the world of birth!  CARES SA is 
also supportive and proactive in promoting the benefits of mid students to 
pregnant women. We cater to women who either have to have a cs, want one or 
those who wish to have a vbac.  Please contact me if you would like to know 
more or go to the CARES web site :
 www.cares-sa.org.au
 
cheers Jo Bainbridge
 

  - Original Message - 
  From: 
  Kathryn 
  Simile 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 23, 2004 6:52 
  PM
  Subject: Re: [ozmidwifery] 
  interesting
  
  Tania,
   
  Hi, my name is Kathryn and am currently in my 
  first year of bachelor of midwifery at UniSA (Adelaide). 
   
  Part of our curriculum at uni is to provide 
  continuity of care (as a midwifery student) to pregnant women and I would 
  LOVE to have the opportunity to follow women who have chosen a home 
  birth.
   
  
  You mentioned some coffee sessions on 
  homebirth and Birth Matters and wondered if it was possible for midwifery 
  students to attend?
   
  Look forward to reading many more of everyones 
  interesting comments on pregnancy, childbirth and babies
   
  kathryn
  
- Original Message - 
From: 
Tania 
Smallwood 
To: [EMAIL PROTECTED] 

Sent: Tuesday, March 23, 2004 4:39 
PM
Subject: Re: [ozmidwifery] 
interesting

Rosemary,
 
We have a homebirth network coffee morning on the 7th 
April in Ashton, which is at the top of Magill Rd in the hills, which you'd 
be very welcome to attend.  Birth Matters have a coffee morning on the 
8th, in Eastwood, which is quite near the city, from 10-12.  Let me 
know if you'd like to come, and I'll send you more details.  Where are 
you staying by the way?
 
Tania
 

  - Original Message - 
  From: 
  Rosemary 
  Weckert 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 23, 2004 11:03 
  AM
  Subject: [ozmidwifery] 
  interesting
  
  Dear all
  My kids have had a couple issues of Mr. 
  Bean's amazing A-Z ( a paperback weekly product that builds into an 
  encylopedia). This is what it said about birth "Birth would be trickier 
  without special medical experts called midwives. They help pregnant mums 
  through labour - the process of giving birth to a baby" This publication 
  comes from England, nice to see babies aren't DELIVERED by 
  doctors.
   
  I am going to be in Adelaide from 6th - 16th 
  April, are there any workshops or activities to do with midwifery that I 
  might attend while I'm there?
   
  One more thing, I am looking to write a 
  learning package for our midwives who are new to Antenatal clinics. Does 
  anyone have anything so I don't have to reinvent the wheel?
  It's great weather at present anyone coming 
  for a visit?
  Regards Rosemary 
  Alice 
  Springs

Re: [ozmidwifery] interesting

[Tania Smallwood]

Rosemary,
 
We have a homebirth network coffee morning on the 7th April in 
Ashton, which is at the top of Magill Rd in the hills, which you'd be very 
welcome to attend.  Birth Matters have a coffee morning on the 8th, in 
Eastwood, which is quite near the city, from 10-12.  Let me know if you'd 
like to come, and I'll send you more details.  Where are you staying by the 
way?
 
Tania
 

  - Original Message - 
  From: 
  Rosemary 
  Weckert 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 23, 2004 11:03 
  AM
  Subject: [ozmidwifery] interesting
  
  Dear all
  My kids have had a couple issues of Mr. Bean's 
  amazing A-Z ( a paperback weekly product that builds into an encylopedia). 
  This is what it said about birth "Birth would be trickier without special 
  medical experts called midwives. They help pregnant mums through labour - the 
  process of giving birth to a baby" This publication comes from England, nice 
  to see babies aren't DELIVERED by doctors.
   
  I am going to be in Adelaide from 6th - 16th 
  April, are there any workshops or activities to do with midwifery that I might 
  attend while I'm there?
   
  One more thing, I am looking to write a learning 
  package for our midwives who are new to Antenatal clinics. Does anyone have 
  anything so I don't have to reinvent the wheel?
  It's great weather at present anyone coming for a 
  visit?
  Regards Rosemary 
  Alice 
Springs

[ozmidwifery] interesting

[Rosemary Weckert]

Dear all
My kids have had a couple issues of Mr. Bean's 
amazing A-Z ( a paperback weekly product that builds into an encylopedia). This 
is what it said about birth "Birth would be trickier without special medical 
experts called midwives. They help pregnant mums through labour - the process of 
giving birth to a baby" This publication comes from England, nice to see babies 
aren't DELIVERED by doctors.
 
I am going to be in Adelaide from 6th - 16th April, 
are there any workshops or activities to do with midwifery that I might attend 
while I'm there?
 
One more thing, I am looking to write a learning 
package for our midwives who are new to Antenatal clinics. Does anyone have 
anything so I don't have to reinvent the wheel?
It's great weather at present anyone coming for a 
visit?
Regards Rosemary 
Alice Springs

[ozmidwifery] Interesting article

[Graham and Helen]

This article reminds me of our previous 
discussions on post-traumatic stress syndrome following caesarian 
childbirth
 
 
http://entertainment.news.com.au/common/story_page/0,4459,9018028%255E10431%255E%255Enbv,00.html
 
Helen Cahill

Re: [ozmidwifery] interesting article

[Lynda]

Hi MM,
 
there's nothig in the body of your 
message!
 
Lynda

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] ; list 
  Sent: Saturday, February 14, 2004 10:50 
  AM
  Subject: [ozmidwifery] interesting 
  article
  
   

[ozmidwifery] interesting article

[Mary Murphy]

Re: [ozmidwifery] Interesting

[Andrea Robertson]

Hi Deniose,

Not yet, but we are working on it - it is very new and supplies have to 
come from the UK. If anyone is interested in getting a copy, send me an 
email off list and I will let you know when it comes if and the price.

Cheers

Andrea

[EMAIL PROTECTED]

At 01:30 PM 1/02/2004, Denise Hynd wrote:
Does Andrea stock the Book??
Denise
- Original Message -
From: <mailto:[EMAIL PROTECTED]>Mary Murphy
To: <mailto:[EMAIL PROTECTED]>[EMAIL PROTECTED]
Sent: Saturday, January 31, 2004 6:30 PM
Subject: Re: [ozmidwifery] Interesting
NO, MM
- Original Message -
From MIDIRS abstract: Has anyone read this?  Is it as useful as they say 
and where could one obtain it?
20040126-32*# The labour ward handbook - London: Royal Society of Medicine 
Press , January 2004. 200 pages Edozien L - (2004)
  Going beyond the theoretical framework, this practical guide provides 
advice on what the clinician should do, and when. All aspects of care and 
communication and risk management, are addressed and are consistent with 
NICE guidance on induction of labour and fetal monitoring; Cochrane 
reviews; CNST standards for Maternity; The RCOG guidelines. This book is 
recommended to senior house officers, registrars, consultants, midwives, 
labour ward managers and professionals working in related fields, 
including risk management. (Publisher)


-
Andrea Robertson
Birth International * ACE Graphics * Associates in Childbirth Education
e-mail: [EMAIL PROTECTED]
web: www.birthinternational.com
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Re: [ozmidwifery] Interesting

[Denise Hynd]

Does Andrea stock the Book??Denise

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Saturday, January 31, 2004 6:30 
  PM
  Subject: Re: [ozmidwifery] 
  Interesting
  
  NO, MM
  
- Original Message - 
From: 
Denise Hynd 
To: [EMAIL PROTECTED] 

Sent: Saturday, January 31, 2004 11:34 
AM
Subject: Re: [ozmidwifery] 
Interesting

Is there a more thorough article about it in 
MIDRIS or their web site??Denise

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: list 
  Sent: Friday, January 30, 2004 7:16 
  PM
  Subject: [ozmidwifery] 
  Interesting
  
  From MIDIRS abstract: Has anyone read this?  Is it as useful as 
  they say and where could one obtain it?  
  


  20040126-32*# The labour ward 
handbook - London: Royal Society of Medicine Press , January 
2004. 200 pages Edozien 
L - (2004)

   
  Going beyond the theoretical framework, this 
practical guide provides advice on what the clinician should do, and 
when. All aspects of care and communication and risk management, are 
addressed and are consistent with NICE guidance on induction of 
labour and fetal monitoring; Cochrane reviews; CNST standards for 
Maternity; The RCOG guidelines. This book is recommended to senior 
house officers, registrars, consultants, midwives, labour ward 
managers and professionals working in related fields, including risk 
management. 
  (Publisher)

Re: [ozmidwifery] Interesting

[Mary Murphy]

NO, MM

  - Original Message - 
  From: 
  Denise Hynd 
  To: [EMAIL PROTECTED] 
  
  Sent: Saturday, January 31, 2004 11:34 
  AM
  Subject: Re: [ozmidwifery] 
  Interesting
  
  Is there a more thorough article about it in 
  MIDRIS or their web site??Denise
  
- Original Message - 
From: 
Mary 
Murphy 
To: list 
Sent: Friday, January 30, 2004 7:16 
PM
Subject: [ozmidwifery] 
Interesting

From MIDIRS abstract: Has anyone read this?  Is it as useful as 
they say and where could one obtain it?  

  
  
20040126-32*# The labour ward 
  handbook - London: Royal Society of Medicine Press , January 
  2004. 200 pages Edozien L - (2004)
  
 
Going beyond the theoretical framework, this 
  practical guide provides advice on what the clinician should do, and 
  when. All aspects of care and communication and risk management, are 
  addressed and are consistent with NICE guidance on induction of labour 
  and fetal monitoring; Cochrane reviews; CNST standards for Maternity; 
  The RCOG guidelines. This book is recommended to senior house 
  officers, registrars, consultants, midwives, labour ward managers and 
  professionals working in related fields, including risk management. 
  (Publisher)

Re: [ozmidwifery] Interesting

[Denise Hynd]

Is there a more thorough article about it in MIDRIS 
or their web site??Denise

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: list 
  Sent: Friday, January 30, 2004 7:16 
  PM
  Subject: [ozmidwifery] Interesting
  
  From MIDIRS abstract: Has anyone read this?  Is it as useful as they 
  say and where could one obtain it?  
  


  20040126-32*# The labour ward 
handbook - London: Royal Society of Medicine Press , January 2004. 
200 pages Edozien L - (2004)

   
  Going beyond the theoretical framework, this 
practical guide provides advice on what the clinician should do, and 
when. All aspects of care and communication and risk management, are 
addressed and are consistent with NICE guidance on induction of labour 
and fetal monitoring; Cochrane reviews; CNST standards for Maternity; 
The RCOG guidelines. This book is recommended to senior house officers, 
registrars, consultants, midwives, labour ward managers and 
professionals working in related fields, including risk management. 
(Publisher)

[ozmidwifery] Interesting

[Mary Murphy]

From MIDIRS abstract: Has anyone read this?  Is it as useful as they 
say and where could one obtain it?  

  
  
20040126-32*# The labour ward 
  handbook - London: 
  Royal Society of Medicine Press , January 2004. 200 
  pages Edozien L - (2004)
  
 
Going beyond the theoretical framework, this 
  practical guide provides advice on what the clinician should do, and when. 
  All aspects of care and communication and risk management, are addressed 
  and are consistent with NICE guidance on induction of labour and fetal 
  monitoring; Cochrane reviews; CNST standards for Maternity; The RCOG 
  guidelines. This book is recommended to senior house officers, registrars, 
  consultants, midwives, labour ward managers and professionals working in 
  related fields, including risk management. 
(Publisher)

[ozmidwifery] Interesting

[Mary Murphy]

  
  
1. 
20040119-14* Midwifery care: development of 
  an instrument to measure quality based on the World Health Organization's 
  classification of care in normal birth - Journal 
  of Clinical Nursing , vol 13, no 1, January 2004, pp 
  75-83 Sandin Bojo AK; Hall-Lord ML; Axelsson O; et 
  al - (2004)
  
 
AIMS AND OBJECTIVES: The aim of the study was to 
  develop an instrument to measure midwifery care in relation to World 
  Health Organization's classification of care in normal birth and to test 
  the instrument for content validity and inter-rater reliability. METHODS: 
  The Delphi method was used for development of the instrument and to elicit 
  evidence of content validity. Six experts from three different 
  geographical regions in Sweden, representing clinically working midwives, 
  lecturers in midwifery and obstetricians, participated in the first part 
  of the study. The instrument was tested for inter-rater reliability in an 
  exploratory study by two midwives and one of the authors. Data were 
  analysed using percentage of agreement level and the Kappa coefficient. 
  RESULTS: Five expert rounds were needed to reach consensus for content 
  validity. The inter-rater reliability test showed high agreement levels 
  (95.9, 94.2 and 95.7%) and good to very good Kappa coefficients 
  (0.74-1.0). The final instrument consisted of 78 items divided into five 
  sections: background (five items); practices which are demonstrably useful 
  and should be encouraged (55 items); practices which are clearly harmful 
  or ineffective and should be eliminated (five items); practices for which 
  insufficient evidence exists to support a clear recommendation and which 
  should be used with caution while further research clarifies the issue 
  (four items); and finally practices which are frequently used 
  inappropriately (nine items). CONCLUSIONS AND RELEVANCE TO CLINICAL 
  PRACTICE: The instrument can be used at a labour ward to measure 
  documented care and quality of midwifery care. The results can be used to 
  identify areas for improvements, to develop guidelines towards 
  evidence-based care and to improve documentation. However, the present 
  study should be regarded as an exploratory study and the feasibility of 
  the instrument remains to be tested in empirical studies. 
(Author)

[ozmidwifery] Interesting law suit

[Diane Gardner]

Title: Message




  This one is interesting also. Doesn't make you 
  wonder how much control over our bodies we REALLY DO have.
   
  Diane
   
  - Original Message - 
  From: Mickey Mongan  
  Sent: Monday, January 19, 2004 12:53 PM
  Subject: RE: judge gave hospital permission to force woman to 
  deliver baby via Caesarean against her will.
  
  I 
  think the second article that spoke of the Reproductive Rights people 
  getting involved said the baby was over 11 lbs.  I don't remember how 
  many ounces over.  But really, talk to your grandmothers--and ask them 
  how many pounds their siblings weighed.  Women were having babies at home 
  and with no fuss.  Those babies over were near 11 1/2 lbs. and sometimes 
  more. I can't get over the collective determination of that woman and her 
  husband to get  hustled at two hopsitals and still head for the 
  third.  
   
  The 
  thing that is scary is that the court declared the hospital as the guardian of 
  a a preborn baby in a woman's womb.  Do you remember the issue 
  of a barely pregnant woman who was in a coma because of a serious 
  accident and a court appointed a group of six strangers to be HER guardian and 
  her baby's guardian?  The the doctors said that she had a good chance of 
  living, if they aborted the fetus, and her husband directed that they do 
  that.  This incident was in New York. The stranger read about her 
  condition and went to the Court for guardianship.  Husband had to go to 
  extreme lengths to get "possession" of his wife back.  The strangers 
  were in charge.  Yeah, I'm going to go back and read Michael Ellner's 
  statement again.  There was also the case of the early pregnant black 
  woman in D.C. who literally was incarcerated in the hospital because she 
  refused to be admitted when she wanted to return home to her other children 
  who were alone. They "suspected" that she was going to miscarry if she didn't 
  stay at the hospital.  This also was a court ordered 
  "incarceration".  They felt they were the"better 
  judges." 
   
  How 
  come women can choose to have the elective, surgical extraction, but cannot 
  choose to use her natural physical ability?  Too many people want to get 
  involved to others' lives. This isn't quite vigilante justice, because they do 
  wait for the judge to find in their favor before they take action against a 
  person.
   
  Mickey   

[ozmidwifery] Interesting law suit

[Diane Gardner]

  I found this post on our practitioners site very interesting and hope it
will have a great outcome if successful

  Diane


  - Original Message - 
  From: "Mickey Mongan
  Sent: Monday, January 19, 2004 8:53 AM
  Subject: {RMA} Here's the latest!! Lawsuit is going to take place.>
  >
  > Subject: Here's the latest!! Lawsuit is going to take place.
  >
  >
  > http://www.timesleader.com/mld/timesleader/7730516.htm
  >
  > Posted on Sun, Jan. 18, 2004Hospital faces fight in birth dispute
  > A now-moot Luzerne County court order for a Caesarian section will see a
  > challenge.
  > By TERRIE MORGAN-BESECKER
  >
  > WILKES-BARRE - Concerned his case could impact other pregnant women, a
  > Plymouth man said Friday he's working with a national reproductive
rights
  > group to challenge a court order that sought to force his wife to
undergo a
  > Caesarean section against her will.
  > John Marlowe said he's pressing on with the case - even though the order
is
  > moot since his wife already gave birth to an 11 pound, 9 ounce baby -
  > because he doesn't want other couples to endure the stress they did as
they
  > battled hospital officials regarding their decision.
  > "It's more than my wife. What happens to the next lady that goes in
there?"
  > Marlowe said. "If they get away with this, what it's telling people
across
  > the country is a hospital has a right to do what it wants, and the woman
has
  > no rights."
  > Marlowe's wife, Amber, checked out against medical advice from
Wilkes-Barre
  > General Hospital on Wednesday morning after physicians there insisted
she
  > have a Caesarean section because of concerns about the fetus' weight,
which
  > was estimated at 13 pounds. She later gave birth vaginally at Moses
Taylor
  > Hospital in Scranton.
  > Unbeknownst to the Marlowes, after they left General Hospital, attorneys
for
  > Wyoming Valley Healthcare System sought a court order to gain
guardianship
  > of the fetus in case the Marlowes returned to their hospital. The order,
  > granted without the Marlowes' knowledge, forbade them from refusing a
  > Caesarean section if doctors there deemed it medically necessary.
  > Kevin McDonald, spokesman for the health-care system, said Friday the
  > hospital stands by its decision to seek the order. "These were really
unique
  > circumstances. We did what we believed was in the best interest of the
  > patient."
  > McDonald said as far as the health system is concerned the legal dispute
is
  > over.
  > "The injunction was only effective if she came to our hospital and we
had to
  > do a Caesarean section. Since that didn't happen, the order is moot," he
  > said.
  > But Lynn Paltrow, an attorney specializing in women's reproductive
rights,
  > said the issue goes far deeper than the Marlowes.
  > "This is not a conflict between a pregnant woman and a fetus. It is a
  > conflict between a pregnant woman and her fetus against the raw power of
the
  > state to impose an unnecessary surgical procedure on a woman's own
body."
  > Paltrow, of the National Advocates for Pregnant Women in New York City,
said
  > she's working with the Marlowes to find a Pennsylvania attorney to fight
  > Conahan's order. She said she believes the couple might also have a
civil
  > case against the hospital for violating their rights.
  > Marlowe said he and his wife are still considering their options and
might
  > file suit seeking monetary damages. But he said money is not the key
factor
  > motivating him.
  > "We're talking civil liberties issues, not suing for money," he said.
"Right
  > now you have a judge saying a hospital has the right to claim
guardianship
  > of an unborn fetus and guardianship after it is born. That's
unacceptable.
  > We need to set a precedent that a hospital cannot have higher rights
than
  > the parents."



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[ozmidwifery] Interesting article

[Graham and Helen]

 
Dear List
 
Just stumbled across this very interesting article 
whilst searching online. 
 
Midwives among the machines: Recreating midwifery in the late 20th Century 
 
http://users.gsat.net.au/stubbs/Midwives_machines.html
 
Helen Cahill
 
 

[ozmidwifery] Interesting website

[Graham and Helen]

Just wanted to bring your attention to a new 
website.  It is called PLoS which stands for Public Library of 
Science.  It is available free on the web to anyone and should be 
interesting for medical issues.  Have a look for yourself but I just came 
upon it by accident.  They have just printed their inaugural issue online 
on the 13th October 2003.
 
Helen Cahill
 
 

FW: [ozmidwifery] Interesting stats on doctors quitting

[Barbara Vernon]

Somewhat belatedly, The ACMI put out a release in response to the
RANZCOG report and we did get a few media interviews in Vic and ACT.

For info...

Barb Vernon.

MEDIA RELEASE   Friday, 22 August 2003

MIDWIVES: SOLUTION TO QUITTING DOCTORS

'Midwives, as specialists in normal birth, are well placed to fill the gap
expected to be created by private obstetricians quitting practice in the
next few years' said Vanessa Owen, President of the Australian College of
Midwives.

Ms Owen was commenting on a survey released today by the Royal Australian
and New Zealand College of Obstetricians and Gynaecologists, reporting that
as many as 150 of Australia's 300 privately practicing obstetricians plan to
leave obstetrics in the next 5 years.

'Women often choose a private obstetrician because it's been the only way to
have certainty about who will be there at the birth', Ms Owen said.  'But as
every woman knows who's ever been cared for by her own midwife throughout
pregnancy, labour and birth, having your own midwife is a fantastic
alternative'.

'Research has proven that continuity of midwifery care is safe, cost
effective, and delivers better outcomes for mothers and babies' said
Associate Professor Sally Tracy, at the University of Technology in Sydney.
'Women have less need of obstetric procedures, higher satisfaction with
their birth, and less vulnerability to post-natal depression'.

Indeed research published in the British Medical Journal shows that healthy
women with normal pregnancies who use a private obstetrician are twice as
likely to have interventions such as induction, vacuum extraction or
caesarean section than women without their own private doctor.

Current shortages of midwives across Australia can be readily addressed if
the federal government would fund places for would be students.  In 2003,
more than 1,500 people applied for places in Bachelor of Midwifery courses,
for 120 places.

'The federal government should take urgent steps now to fund Bachelor of
Midwifery student places, as a positive strategy to minimizing the impact on
women of private doctors quitting obstetrics in the next few years' Ms Owen
said.

'Midwives have a crucial role to play in providing care to the healthy
majority of women and in collaborating with obstetricians to care for the
minority of women who really need medical care during labour and birth.'

MEDIA CONTACT:  Dr Barbara Vernon, Executive Officer02 6230 73330438 
8555
529


--
From: "pauline" <[EMAIL PROTECTED]>
Reply-To: [EMAIL PROTECTED]
Date: Sat, 23 Aug 2003 09:41:38 +1000
To: <[EMAIL PROTECTED]>
Subject: Re: [ozmidwifery] Interesting stats on doctors quitting

There is a very similar article in today's Melbourne Herald-sun( page
17 - Mums-to-be face crisis)  "what are all these women going to do with no
doctors to deliver their babies"..

- Original Message -----
From: "Andrea Robertson" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Saturday, August 23, 2003 8:09 AM
Subject: [ozmidwifery] Interesting stats on doctors quitting


> This article appears in today's (Saturday) Sydney Morning Herald. What is
> interesting (amongst other things) is the assumption that the public
system
> won't cope with the extra numbers of women who are not using the private
> hospitals. These numbers are not high, in the overall scheme of 250,000
> babies born each year in Australia. When you think how much these few
women
> cost the taxpayer from over-servicing (i.e. unnecessary interventions) by
> obstetricians, we might all be better off if they just use our excellent
> public hospitals!
>
> Andrea
>
> --
>
> Pressure to deliver - the private crisis
>
> By Ruth Pollard, Health Writer
> August 23, 2003
>
> Almost half the country's obstetricians are planning to abandon private
> practice in the next five years, affecting the delivery of up to 17,000
> babies by 2008.
>
> Some will enter the public hospital system and others will practise
> gynaecology and related specialties.
>
> But it was not just medical indemnity that was driving the doctors away,
it
> was the constant pressures of practice and its impact on family life, a
> survey by the Royal Australian and New Zealand College of Obstetricians
and
> Gynaecologists found.
>
> The college's president, Andrew Child, said the drift from private
practice
> illustrated a cultural change within the profession.
>
> "It is that commitment in private obstetrics to being available 24 hours a
> day, seven days a week
> for your patients, particularly for solo practitioners, that affects
> people," Dr Child said.
>
> "It is possibly a g

Re: [ozmidwifery] Interesting stats on doctors quitting

[Ann green]

Dear Rhonda,
A private hospital is not the answer though as my
worst birth was in a private hospital and yet I had
good experiences in apublic hospital!Ann --- Rhonda
<[EMAIL PROTECTED]> wrote: > 
> , "we might all be better off if they just use our
> excellent
> > public hospitals!"
>  -  If only the public Hospital System was not such
> a cattle yard of crap
> then it would be good - I could not call it
> excellent - it failed me twice!
> Rhonda. 


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Re: [ozmidwifery] Interesting stats on doctors quitting

[Tom, Tania and Sam Smallwood]

And also in The Australian magazine, I think I feel a letter coming on

Tania


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Re: [ozmidwifery] Interesting stats on doctors quitting

[Rhonda]

   
  , "we might all be better off if they just use our excellent> 
  public hospitals!"
   -  If only the public Hospital System was not such a cattle 
  yard of crap then it would be good - I could not call it excellent - it 
  failed me twice!
  Rhonda.
   





	
	
	
	
	
	
	




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Re: [ozmidwifery] Interesting stats on doctors quitting

[pauline]

There is a very similar article in today's Melbourne Herald-sun( page
17 - Mums-to-be face crisis)  "what are all these women going to do with no
doctors to deliver their babies"..
- Original Message - 
From: "Andrea Robertson" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Saturday, August 23, 2003 8:09 AM
Subject: [ozmidwifery] Interesting stats on doctors quitting


> This article appears in today's (Saturday) Sydney Morning Herald. What is
> interesting (amongst other things) is the assumption that the public
system
> won't cope with the extra numbers of women who are not using the private
> hospitals. These numbers are not high, in the overall scheme of 250,000
> babies born each year in Australia. When you think how much these few
women
> cost the taxpayer from over-servicing (i.e. unnecessary interventions) by
> obstetricians, we might all be better off if they just use our excellent
> public hospitals!
>
> Andrea
>
> --
>
> Pressure to deliver - the private crisis
>
> By Ruth Pollard, Health Writer
> August 23, 2003
>
> Almost half the country's obstetricians are planning to abandon private
> practice in the next five years, affecting the delivery of up to 17,000
> babies by 2008.
>
> Some will enter the public hospital system and others will practise
> gynaecology and related specialties.
>
> But it was not just medical indemnity that was driving the doctors away,
it
> was the constant pressures of practice and its impact on family life, a
> survey by the Royal Australian and New Zealand College of Obstetricians
and
> Gynaecologists found.
>
> The college's president, Andrew Child, said the drift from private
practice
> illustrated a cultural change within the profession.
>
> "It is that commitment in private obstetrics to being available 24 hours a
> day, seven days a week
> for your patients, particularly for solo practitioners, that affects
> people," Dr Child said.
>
> "It is possibly a generational thing: the concept of being on call 168
> hours per week is something  that the younger generation just
> won't consider."
>  >
>
> When obstetrician Amanda Dennis and her husband decided to have a family,
> she knew she could not balance her family life with private practice
> on-call work. She quit private obstetrcs on July 1 and now practises in
the
> public system.
>
> "I could not . . . be on call 24 hours a day and be pregnant or have a
> young child, even with a nanny even if my husband was prepared not to
work.
>
> "My life was chaos most of the time . . . now I go home after work and
> that's it, unless I am on call, which is about three days per month."
>
> Medical indemnity was also a consideration; for Dr Dennis, it was her
> largest practice expense. In 2002 her premium was about $100,000 and in
> that year she delivered 200 babies. On top of that, she had to buy $50,000
> in tail cover for any future claims when she retired from private
practice.
> "Ultimately you have to put it on the bill to the patients," she said.
>
> Doctors are also warning that the public hospital system will be
> increasingly struggling to meet the demand created by the exodus of
private
> obstetricians.
>
> "If we get another 16,800 babies in the public hospital system, which is
> the amount of births we
> would expect to handle in the next few years, there will be strain," Dr
> Child said.
>
> Specialist obstetricians are also quitting public hospitals. The survey
> found 100 intended to quit the system in the next five years.
>
> Of the 1162 specialists practising obstetrics and gynaecology around the
> country, less than half practise obstetrics and only 300 are in private
> practice only.
>
> Already, 150 specialists have quit private practice in the past three
> years, and 55 said they
> intended to stop private practice in 2003, the survey found. Over the next
> five years, another 150 will cease practice.
>
> While medical indemnity was not nominated as the main reason for leaving
> the profession, 10 per cent of those surveyed reported paying premiums of
> more than $98,000 in 2001-02.
>
> "One issue is the affordability, but there is also the ogre of this
hanging
> around in the background, whatever you do," Dr Child said. Ultimately, it
> meant it was increasingly difficult to get a private practitioner, with
> rural areas suffering most, he said.
> 
>
>
>
> -
> Andrea Robertson
> Birth International * ACE Graphics * Associates in Childbirth Education
>
> e-mail: [EMAIL PROTECTED]
> web: www.birthinternational.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 subscribe or unsubscribe.

[ozmidwifery] Interesting stats on doctors quitting

[Andrea Robertson]

This article appears in today's (Saturday) Sydney Morning Herald. What is 
interesting (amongst other things) is the assumption that the public system 
won't cope with the extra numbers of women who are not using the private 
hospitals. These numbers are not high, in the overall scheme of 250,000 
babies born each year in Australia. When you think how much these few women 
cost the taxpayer from over-servicing (i.e. unnecessary interventions) by 
obstetricians, we might all be better off if they just use our excellent 
public hospitals!

Andrea

--

Pressure to deliver - the private crisis

By Ruth Pollard, Health Writer
August 23, 2003
Almost half the country's obstetricians are planning to abandon private 
practice in the next five years, affecting the delivery of up to 17,000 
babies by 2008.

Some will enter the public hospital system and others will practise 
gynaecology and related specialties.

But it was not just medical indemnity that was driving the doctors away, it 
was the constant pressures of practice and its impact on family life, a 
survey by the Royal Australian and New Zealand College of Obstetricians and 
Gynaecologists found.

The college's president, Andrew Child, said the drift from private practice 
illustrated a cultural change within the profession.

"It is that commitment in private obstetrics to being available 24 hours a 
day, seven days a week
for your patients, particularly for solo practitioners, that affects 
people," Dr Child said.

"It is possibly a generational thing: the concept of being on call 168 
hours per week is something  that the younger generation just 
won't consider."
>

When obstetrician Amanda Dennis and her husband decided to have a family, 
she knew she could not balance her family life with private practice 
on-call work. She quit private obstetrcs on July 1 and now practises in the 
public system.

"I could not . . . be on call 24 hours a day and be pregnant or have a 
young child, even with a nanny even if my husband was prepared not to work.

"My life was chaos most of the time . . . now I go home after work and 
that's it, unless I am on call, which is about three days per month."

Medical indemnity was also a consideration; for Dr Dennis, it was her 
largest practice expense. In 2002 her premium was about $100,000 and in 
that year she delivered 200 babies. On top of that, she had to buy $50,000 
in tail cover for any future claims when she retired from private practice. 
"Ultimately you have to put it on the bill to the patients," she said.

Doctors are also warning that the public hospital system will be 
increasingly struggling to meet the demand created by the exodus of private 
obstetricians.

"If we get another 16,800 babies in the public hospital system, which is 
the amount of births we
would expect to handle in the next few years, there will be strain," Dr 
Child said.

Specialist obstetricians are also quitting public hospitals. The survey 
found 100 intended to quit the system in the next five years.

Of the 1162 specialists practising obstetrics and gynaecology around the 
country, less than half practise obstetrics and only 300 are in private 
practice only.

Already, 150 specialists have quit private practice in the past three 
years, and 55 said they
intended to stop private practice in 2003, the survey found. Over the next 
five years, another 150 will cease practice.

While medical indemnity was not nominated as the main reason for leaving 
the profession, 10 per cent of those surveyed reported paying premiums of 
more than $98,000 in 2001-02.

"One issue is the affordability, but there is also the ogre of this hanging 
around in the background, whatever you do," Dr Child said. Ultimately, it 
meant it was increasingly difficult to get a private practitioner, with 
rural areas suffering most, he said.




-
Andrea Robertson
Birth International * ACE Graphics * Associates in Childbirth Education
e-mail: [EMAIL PROTECTED]
web: www.birthinternational.com
--
This mailing list is sponsored by ACE Graphics.
Visit  to subscribe or unsubscribe.

[ozmidwifery] Interesting conclusion

[Mary Murphy]

  
  
20010802-8* Amniotomy plus intravenous oxytocin for 
  induction of labour (Cochrane Review). (Date of most recent substantive 
  update: 25 May 2001) - In: The Cochrane 
  Library. Oxford: Update Software , issue 2, 2003 Howarth 
  GR; Botha DJ - (2003)
  
 
Background: 
  Induction of labour is a common obstetric intervention. Amniotomy alone 
  for induction of labour is reviewed separately and oxytocin alone for 
  induction of labour is being prepared for inclusion in The Cochrane 
  Library. This review will address the use of the combination of these two 
  methods for induction of labour in the third trimester. This is one of a 
  series of reviews of methods of cervical ripening and labour induction 
  using standardised methodology. Objectives: To determine, from the best 
  available evidence, the efficacy and safety of amniotomy and intravenous 
  oxytocin for third trimester induction of labour. Search strategy: The 
  Cochrane Pregnancy and Childbirth Group Trials Register, the Cochrane 
  Controlled Trials Register and reference lists of articles were searched. 
  Date of last search: May 2001. Selection criteria: The criteria for 
  inclusion included the following: (1) clinical trials comparing amniotomy 
  plus intravenous oxytocin used for third trimester cervical ripening or 
  labour induction with placebo/no treatment or other methods listed above 
  it on a predefined list of labour induction methods; (2) random allocation 
  to the treatment or control group; (3) adequate allocation concealment; 
  (4) violations of allocated management not sufficient to materially affect 
  conclusions; (5) clinically meaningful outcome measures reported; (6) data 
  available for analysis according to the random allocation; (7) missing 
  data insufficient to materially affect the conclusions. Data collection 
  and analysis: Trial quality assessment and data extraction were done by 
  both reviewers. A strategy was developed to deal with the large volume and 
  complexity of trial data relating to labour induction. This involved a 
  two-stage method of data extraction. The initial data extraction was done 
  centrally, and incorporated into a series of primary reviews arranged by 
  methods of induction of labour, following a standardised methodology. The 
  data is to be extracted from the primary reviews into a series of 
  secondary reviews, arranged by category of woman. Main results: Seventeen 
  trials involving 2566 women were included. Amniotomy and intravenous 
  oxytocin were found to result in fewer women being undelivered vaginally 
  at 24 hours than amniotomy alone (relative risk (RR) 0.03, 95% confidence 
  intervals (CI) 0.001-0.49). This finding was based on the results of a 
  single study of 100 women. As regards secondary results amniotomy and 
  intravenous oxytocin resulted in significantly fewer instrumental vaginal 
  deliveries than placebo (RR 0.18, CI 0.05-0.58). Amniotomy and intravenous 
  oxytocin resulted in more postpartum haemorrhage than vaginal 
  prostaglandins (RR 5.5, CI 1.26-24.07). Significantly more women were also 
  dissatisfied with amniotomy and intravenous oxytocin when compared with 
  vaginal prostaglandins, RR 53, CI 3.32-846.51. Reviewers' 
  conclusions: Data on the effectiveness and safety of amniotomy and 
  intravenous oxytocin are lacking. No recommendations for clinical practice 
  can be made on the basis of this review. Amniotomy and intravenous 
  oxytocin is a combination of two methods of induction of labour and both 
  methods are utilised in clinical practice. If their use is to be continued 
  it is important to compare the effectiveness and safety of these methods, 
  and to define under which clinical circumstances one may be preferable to 
  another. (Author) 
  


  Standard Search: L24 

[ozmidwifery] interesting

[Jo & Dean Bainbridge]

thought you might be interested in 
this...
A Native American Community With a 7% Cesarean Delivery Rate: 
Does Case Mix, Ethnicity, or Labor Management Explain the Low 
Rate? Cesarean delivery 
rates vary widely across populations. Studying communities with low rates may 
identify practices that can lower the cesarean rate.Ann Fam Med 1(1) 
2003
Jo Bainbridgefounding member CARES SAwww.cares-sa.org.au[EMAIL PROTECTED]phone: 08 8388 
6918birth with trust, faith & love...

RE: [ozmidwifery] Interesting..

[Wayne and Caroline McCullough]

Title: Message



Having just birthed 17 days past my due date 
I am finding this thread interesting. I did have another Caesarean after a 
feotal well-being test showed no amniotic fluid at 16 days past EDD and when he 
came out there was both old and new mec staining but they never suctioned him as 
the pediatrician was satisfied he did not aspirate any. Interestingly, he cried 
as soon as they got his head out of the pelvis so he was breathing air well 
straight away. 
 
With my first son, also born by caesarean 
but an emergency CS, he was covered in fresh mec. and he had some respitory 
distress 2 weeks after birth but I am not sure why. Could the MAS be related to 
the way the operation is handled perhaps or the level of shock an infant is 
exposed to at delivery (from drugs etc.)?
 
Reading this thread has also reassured me 
that we handled the situation with our second son's birth appropriately and made 
the right call.
 
Cheers,
 
Cas
 
ps: my new son Daniel did not have 
any signs of postmaturity at birth but cried real tears the day after he 
was born and seems older than his brother was at the same stage. He has also put 
on a whopping 1.5 kg in 3 weeks and is in some 00 clothes. Is this normal for an 
infant born at nearly 43 weeks? I just wonder if his growth rate is going to 
slow down at some stage. : )

  

Re: [ozmidwifery] Interesting..

[Anne Clarke]

Dear Mary,
 
The FLF is reabsorbed into the lung 
capillaries prior to and during labour (autonomic and hormonal response) this is 
why it can be recommended to some women who are planning a 
caesarean be given a choice to 'labour for a while' to signal to the baby 
to start absorbing lung fluid.
 
This is why, unless an underlying cause e.g. 
fetal distress is present, babies that have a caesarean birth after the mother 
has laboured do better than those babies from a 'cold' caesarean, who are more 
likely to have the malabsorpiton problem.
 
Regards,
Anne Clarke

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Saturday, May 31, 2003 11:50 
  AM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
  Re the squeeze.. If it is not the natural birth process which squeezes 
  the FLF, then why is it that many C/S, especially those who do not labour, 
  have fluid in their lungs and require extra care in Special Nursery?  
  MM
  
- Original Message - 
From: 
Gayle Rafferty 
To: [EMAIL PROTECTED] 

Sent: Friday, May 30, 2003 10:06 
PM
Subject: Re: [ozmidwifery] 
Interesting..


  
  
Thanks for your reply Marilyn.  Your apneic 
  baby could be the result of a placental insufficiency, cord 
  compression, anaemia of the mother and generally any 
  condition that will lead to a lack of oxygen to supply the baby 
  through the placenta, including true or false knots in the 
  cord. Respiration, oxygenation, nutrition, elimination occurs 
  through the exchange of gases and waste products through the 
  placenta.  The closer to delivery, the more senile and 
  non-functional the placenta becomes. Another possibility is an anemic 
  baby, whose Hering Bruer reflex is initiated in response to 
  hypoxia.  
  Worthy of note is that fetal breathing movements are just that, 
  movements - they are not breathing, per se.  I verified this 
  today with an ultrasonographer who regularly performs biophysical 
  profiles.  He stated that they do not, can not, inhale against a 
  closed glottis. Try it for yourselves.  The fetal lung fluid and 
  amniotic fluid remain separate, as Anne Clark also pointed out.  
  Must admit Anne, I was not aware that the squeeze doesn't clear the 
  FLF.  Thanks.
  Mary, I would really like to know a little more of the ante natal 
  and intrapartum details of the MSL/MSA C/S baby.  Also whether 
  any organism was cultured from the baby's aspirate (if taken).  
  Was there any ROM prior to delivery?  Was mother anaemic, 
  healthy, laboring prior to C/S? Febrile, negative GBS /other 
  culture?  
  Gayle
   
   
   
  ---Original 
  Message---
   
  
  From: [EMAIL PROTECTED]
  Date: Friday, 30 
  May 2003 10:31:34 PM
  To: [EMAIL PROTECTED]
  Subject: Re: 
  [ozmidwifery] Interesting..
   
  I thought so too Lesley, but this info 
  was making me rethink that. But I think that is what happens. Without 
  the gasp the mec liquor wont enter the lungs with normal fetal 
  breathing and I guess from the other comments, if you have periodic 
  late decels during labour and mec liquor then you have a potentially 
  apneic baby, and a potential gasp,  but you wont know unless 
  you're looking. Interesting.
   
  marilyn
  
- Original Message - 
From: 
Lesley Kuliukas 
To: [EMAIL PROTECTED] 

Sent: Thursday, May 29, 2003 
    5:50 PM
    Subject: Re: [ozmidwifery] 
Interesting..

I always believed it was secondary or 
terminal apnoea that caused the baby to gasp whether inside or 
outside of the uterus.
Lesley

  - Original Message - 
  From: 
  Mary Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Thursday, May 22, 2003 
  4:25 PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
  Marilyn wrote "Yet most babies with mec liquor 
  don't present with MAS. And some (a very few) babies with very 
  normal uncomplicated labours and births do develop MAS. Is it the 
  gasp of a baby in distress (which may happen at any time and be 
  undetected) or just a random gasp that carries the mec deep into 
  the lungs ? Just curious"
   
  I'm curious too

Re: [ozmidwifery] Interesting..

[Mary Murphy]

Re the squeeze.. If it is not the natural birth process which squeezes the 
FLF, then why is it that many C/S, especially those who do not labour, have 
fluid in their lungs and require extra care in Special Nursery?  MM

  - Original Message - 
  From: 
  Gayle Rafferty 
  To: [EMAIL PROTECTED] 
  
  Sent: Friday, May 30, 2003 10:06 PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
  

  
Thanks for your reply Marilyn.  Your apneic baby could be the 
result of a placental insufficiency, cord compression, anaemia of the 
mother and generally any condition that will lead to 
a lack of oxygen to supply the baby through the placenta, including 
true or false knots in the cord. Respiration, oxygenation, 
nutrition, elimination occurs through the exchange of gases and waste 
products through the placenta.  The closer to delivery, the more 
senile and non-functional the placenta becomes. Another possibility is 
an anemic baby, whose Hering Bruer reflex is initiated in response to 
hypoxia.  
Worthy of note is that fetal breathing movements are just that, 
movements - they are not breathing, per se.  I verified this today 
with an ultrasonographer who regularly performs biophysical 
profiles.  He stated that they do not, can not, inhale against a 
closed glottis. Try it for yourselves.  The fetal lung fluid and 
amniotic fluid remain separate, as Anne Clark also pointed out.  
Must admit Anne, I was not aware that the squeeze doesn't clear the 
FLF.  Thanks.
Mary, I would really like to know a little more of the ante natal 
and intrapartum details of the MSL/MSA C/S baby.  Also whether any 
organism was cultured from the baby's aspirate (if taken).  Was 
there any ROM prior to delivery?  Was mother anaemic, healthy, 
laboring prior to C/S? Febrile, negative GBS /other culture?  

Gayle
 
 
 
---Original 
Message---
 

From: [EMAIL PROTECTED]
Date: Friday, 30 May 
2003 10:31:34 PM
To: [EMAIL PROTECTED]
Subject: Re: 
[ozmidwifery] Interesting..
 
I thought so too Lesley, but this info was 
making me rethink that. But I think that is what happens. Without the 
gasp the mec liquor wont enter the lungs with normal fetal breathing and 
I guess from the other comments, if you have periodic late decels during 
labour and mec liquor then you have a potentially apneic baby, and a 
potential gasp,  but you wont know unless you're looking. 
Interesting.
 
marilyn

  - Original Message - 
  From: 
  Lesley 
  Kuliukas 
  To: [EMAIL PROTECTED] 
  
  Sent: Thursday, May 29, 2003 5:50 
  PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
  I always believed it was secondary or 
  terminal apnoea that caused the baby to gasp whether inside or outside 
  of the uterus.
  Lesley
  
- Original Message - 
From: 
Mary Murphy 
To: [EMAIL PROTECTED] 

Sent: Thursday, May 22, 2003 
4:25 PM
    Subject: Re: [ozmidwifery] 
Interesting..

Marilyn wrote "Yet most babies with mec liquor 
don't present with MAS. And some (a very few) babies with very 
normal uncomplicated labours and births do develop MAS. Is it the 
gasp of a baby in distress (which may happen at any time and be 
undetected) or just a random gasp that carries the mec deep into the 
lungs ? Just curious"
 
I'm curious too.  I haven't read any studies 
about that.  Maybe it hasn't been done yet, or can't ethically 
be done?  Does anyone know?  MM
 

  

  
  

Re: [ozmidwifery] Interesting..

[Mary Murphy]

Thanks Gayle for your very informative information.  The answer to all 
of your questions is No.  The mother was planning a normal birth.She 
was cared for  by her own midwife during pregnancy, saw an 
obstetrician several times for shared care. Problem free pregnancy. There was no 
labour. Term plus 4days.  Reported a slow down of movements during the 
day.  Attended a labour ward for monitoring in the early hours of the 
morning.  Poor CTG (don't know the details of this)  Had a C/S at 
5am.  and a very poorly baby was born.thickly covered in old, yellow, thick 
mec    Was on a ventilator for about 5 days.  I don't 
believe there was any organisms cultured altho I am sure that this major 
hospital would have covered all bases.  MM
 
Gayle wrote:

  

  
Mary, I would really like to know a little more of the ante natal 
and intrapartum details of the MSL/MSA C/S baby.  Also whether any 
organism was cultured from the baby's aspirate (if taken).  Was 
there any ROM prior to delivery?  Was mother anaemic, healthy, 
laboring prior to C/S? Febrile, negative GBS /other culture?  

Gayle
 
 
 
 
 

  

  
  

Re: [ozmidwifery] Interesting..

[Gayle Rafferty]

Thanks for your reply Marilyn.  Your apneic baby could be the result of a placental insufficiency, cord compression, anaemia of the mother and generally any condition that will lead to a lack of oxygen to supply the baby through the placenta, including true or false knots in the cord. Respiration, oxygenation, nutrition, elimination occurs through the exchange of gases and waste products through the placenta.  The closer to delivery, the more senile and non-functional the placenta becomes. Another possibility is an anemic baby, whose Hering Bruer reflex is initiated in response to hypoxia.  
Worthy of note is that fetal breathing movements are just that, movements - they are not breathing, per se.  I verified this today with an ultrasonographer who regularly performs biophysical profiles.  He stated that they do not, can not, inhale against a closed glottis. Try it for yourselves.  The fetal lung fluid and amniotic fluid remain separate, as Anne Clark also pointed out.  Must admit Anne, I was not aware that the squeeze doesn't clear the FLF.  Thanks.
Mary, I would really like to know a little more of the ante natal and intrapartum details of the MSL/MSA C/S baby.  Also whether any organism was cultured from the baby's aspirate (if taken).  Was there any ROM prior to delivery?  Was mother anaemic, healthy, laboring prior to C/S? Febrile, negative GBS /other culture?  
Gayle
 
 
 
---Original Message---
 

From: [EMAIL PROTECTED]
Date: Friday, 30 May 2003 10:31:34 PM
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery] Interesting..
 
I thought so too Lesley, but this info was making me rethink that. But I think that is what happens. Without the gasp the mec liquor wont enter the lungs with normal fetal breathing and I guess from the other comments, if you have periodic late decels during labour and mec liquor then you have a potentially apneic baby, and a potential gasp,  but you wont know unless you're looking. Interesting.
 
marilyn

- Original Message - 
From: Lesley Kuliukas 
To: [EMAIL PROTECTED] 
Sent: Thursday, May 29, 2003 5:50 PM
Subject: Re: [ozmidwifery] Interesting..

I always believed it was secondary or terminal apnoea that caused the baby to gasp whether inside or outside of the uterus.
Lesley

- Original Message - 
From: Mary Murphy 
To: [EMAIL PROTECTED] 
Sent: Thursday, May 22, 2003 4:25 PM
Subject: Re: [ozmidwifery] Interesting..

Marilyn wrote "Yet most babies with mec liquor don't present with MAS. And some (a very few) babies with very normal uncomplicated labours and births do develop MAS. Is it the gasp of a baby in distress (which may happen at any time and be undetected) or just a random gasp that carries the mec deep into the lungs ? Just curious"
 
I'm curious too.  I haven't read any studies about that.  Maybe it hasn't been done yet, or can't ethically be done?  Does anyone know?  MM
 

Re: [ozmidwifery] Interesting..

[Marilyn Kleidon]

I thought so too Lesley, but this info was making 
me rethink that. But I think that is what happens. Without the gasp the mec 
liquor wont enter the lungs with normal fetal breathing and I guess from the 
other comments, if you have periodic late decels during labour and mec liquor 
then you have a potentially apneic baby, and a potential gasp,  but you 
wont know unless you're looking. Interesting.
 
marilyn

  - Original Message - 
  From: 
  Lesley 
  Kuliukas 
  To: [EMAIL PROTECTED] 
  
  Sent: Thursday, May 29, 2003 5:50 
PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
  I always believed it was secondary or terminal 
  apnoea that caused the baby to gasp whether inside or outside of the 
  uterus.
  Lesley
  
- Original Message - 
From: 
Mary 
Murphy 
To: [EMAIL PROTECTED] 

Sent: Thursday, May 22, 2003 4:25 
PM
Subject: Re: [ozmidwifery] 
Interesting..

Marilyn wrote "Yet most babies with mec liquor don't 
present with MAS. And some (a very few) babies with very normal 
uncomplicated labours and births do develop MAS. Is it the gasp of a baby in 
distress (which may happen at any time and be undetected) or just a random 
gasp that carries the mec deep into the lungs ? Just curious"
 
I'm curious too.  I haven't read any studies about 
that.  Maybe it hasn't been done yet, or can't ethically be done?  
Does anyone know?  MM

Re: [ozmidwifery] Interesting..

[Lesley Kuliukas]

I always believed it was secondary or terminal 
apnoea that caused the baby to gasp whether inside or outside of the 
uterus.
Lesley

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Thursday, May 22, 2003 4:25 
PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
  Marilyn wrote "Yet most babies with mec liquor don't present 
  with MAS. And some (a very few) babies with very normal uncomplicated labours 
  and births do develop MAS. Is it the gasp of a baby in distress (which may 
  happen at any time and be undetected) or just a random gasp that carries the 
  mec deep into the lungs ? Just curious"
   
  I'm curious too.  I haven't read any studies about 
  that.  Maybe it hasn't been done yet, or can't ethically be done?  
  Does anyone know?  MM

RE: [ozmidwifery] Interesting..

[Janet Caulfield]

Dear Gayle,
Well answered and very clearly worded thanks 
heaps i have saved your response
Janet Caulfield

Re: [ozmidwifery] Interesting..

[Marilyn Kleidon]

Thank you Gayle, that is a great explanation. However I have 
also been told and read it is the inutero gasp. I know we need to wipe and 
suction any mec, but especially in cases where this has been well done, 
verifiably, and the baby has gone on to develop MAS, it has been suggested the 
gasp was in utero.
 
marilyn

  - Original Message - 
  From: 
  Gayle Rafferty 
  To: [EMAIL PROTECTED] 
  
  Sent: Thursday, May 29, 2003 12:53 
  AM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
  

  
 
Babies lungs are filled with a special fluid that is quite separate 
to amniotic fluid.  It is called Fetal Lung Fluid (FLF).  This 
is what is expelled as the baby is squeezed through the birth 
canal.   The baby occasionally 'spits' a little of this into 
the amniotic fluid, as a result of fetal breathing.  The FLF 
contains surfactant and lecithin/sphyngomyelin which is what is, or 
rather used to be measured when an amniocentisis is done to assess 
gestation and lung maturity.  Remember L:S Ratios?  Thank 
heavens for newer technology and the use of ultrasound scanning and 
telemetry in cases of need.  It is retained fetal lung fluid that 
is responsible for most of the respiratory distress named TTN or 
transient tachypnoea of the neonate.
Also, a baby can quite easily recover from an distressing episode 
in utero, and, as outlined above, the mec does not necessarily go into 
the lungs causing MAS at birth.  It is the first gasp in an 
extrauterine environment that may lead to inhalation of mec passed the 
originally closed glottis.
 
Gayle
 
---Original Message---
 

From: [EMAIL PROTECTED]
Date: Thursday, 29 
May 2003 2:37:49 PM
To: [EMAIL PROTECTED]
Subject: Re: 
[ozmidwifery] Interesting..
 
And just to add something more, it is 
interesting to know that it (the inutero pooing) happens so early in 
gestation.  We have also all been told (at least I have) that the 
more mature a baby is (ie post dates) then the more likely it is that 
there will be mec in the liquor. I'd like to read the whole article but 
from memory the abstract said that passing of meconium had been observed 
as early as 28 weeks. 
 
Something I've often wondered about is 
those breathing actions by the baby. When a biophysical profile is done 
that is one of the items scored so it is obviously expected in all term 
babies. Yet most babies with mec liquor don't present with MAS. And some 
(a very few) babies with very normal uncomplicated labours and births do 
develop MAS. Is it the gasp of a baby in distress (which may happen at 
any time and be undetected) or just a random gasp that carries the mec 
deep into the lungs ? Just curious.
 
I just had a really weird glimpse into the 
future of all pregnant women past 24 weeks wearing telemetry monitors 
just in case something untoward happens. Am I paranoid?? I hope 
so.  As Mary said it is all in the interpretation.
 
marilyn

  - Original Message - 
  From: 
  Mary Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, May 21, 2003 
  4:18 PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
   
  
Debbie wrote:  "It is well known that babies 'wee' in 
utero - so why not 'the other'?"
 
Deb, it is not so much that they do it, but how we interpret 
it.  We have for years been told that meconium in the liqour is 
a sign of "Fetal Distress"  There have been many unnecessary 
operative procedures carried out on women and babies because it was 
concluded that slowed Fetal Heart Rate (mostly normal head 
compression dips) and meconium stained liqour meant distressed 
baby.  Then Voila!  Apgars of 9 & 10 at birth or 
C/S.  Midwives, women and doctors too have taken the blame for 
all sorts of things that happen to babies.  (Not denying some 
negligence claims are true.)  It has been known by midwives gor 
generations that women past their "due date" frequently have 
meconioum stained liqour. If is present...panic!  Now we 
also know that the symptoms of meconium pneumonia and "meconium 
aspiration" are mostly present in the lungs before birth because 
babies do these marvelous "breathing actions" that we didn't know 
 

Re: [ozmidwifery] Interesting..

[Debbie Slater]

Yes - I suppose what I was trying to say was that it is considered normal
for babies to wee 'in utero', so why shouldn't it be normal to pass meconium.
 When Jamie had his problems and I had the polyhydramnios, I was given Indomethacine
to control Jamie's urine output and so reduce the amount of amniotic fluid.

Debbie

Mary Murphy wrote:

  
  
  
 
  
 
   
 
   
  
Debbie wrote:  "It is well known that babies 'wee' in utero - so
whynot 'the other'?"
   
 
   
Deb, it is not so much that they do it, but how we interpret it. 
Wehave for years been told that meconium in the liqour is a sign of "Fetal
   Distress"  There have been many unnecessary operative procedures carried
   out on women and babies because it was concluded that slowed Fetal Heart
Rate(mostly normal head compression dips) and meconium stained liqour
meantdistressed baby.  Then Voila!  Apgars of 9 & 10 at birth or
   C/S.  Midwives, women and doctors too have taken the blame for all sorts
   of things that happen to babies.  (Not denying some negligence claims
aretrue.)  It has been known by midwives gor generations that women past
   their "due date" frequently have meconioum stained liqour. If ispresent...panic!
 Now we also know that the symptoms of meconiumpneumonia and "meconium
aspiration" are mostly present in the lungs beforebirth because babies
do these marvelous "breathing actions" that we didn'tknow about before
U.S studies told us so.  It is very complicated. So, this piece of research
is a very helpful piece of the jig-saw. cheers, MM


   
 

  
 

   
 
   
  

 
   
    
. 





  


  

Re: [ozmidwifery] Interesting..

[Gayle Rafferty]

 Just found this interesting article, sorry it is so lengthy
 
DISCUSSION 
 
Meconium first appears in the fetal ileum between 10 and 16 weeks of gestation as a viscous, green liquid composed of gastrointestinal secretions, cellular debris, bile and panrcreatic fluid, mucous, blood, lanugo, and vernix. Meconium is approximately 72% to 80% water. MSAF rarely occurs before 38 weeks of gestation. The increased incidence of MSAF with advancing gestational age probably reflects the maturation of peristalsis in the fetal intestine. Intestinal parasympathetic innervention and myelination also increase throughout gestation and may play a role in the amplified passage of meconium in late gestation. Most infants with MSAF do not have lower Apgar scores, more acidosis or clinical illness than infants born with clear amniotic fluid. Perinatal morbidity is increased in newborns with abnormal fetal heart rate patterns in the intrapartum period. 
Before the late 1970’s it was thought that aspiration of amniotic fluid and meconium occurred during the first few breaths after delivery. Meconium aspiration syndrome continues to occur in those who are adequately suctioned in the delivery room indicating that in some infants, especially those with asphyxia, in-utero aspiration takes place. Clinically fetal lung fluid flows outward from the lungs into the amniotic sac. However studies with radioopaque contrast and Cr labelled erythrocytes injected into the amniotic sac demonstrated that occasionally some amniotic fluid enters the fetal lung in the non-asphyxiated  human fetus. Gasping associated with inhalation of amniotic fluid or meconium occurs in fetal lambs, rhesus monkeys, and humans in response to fetal asphyxia induced by compression of the umbilical cord or aorta. 
 
It goes on to say
PRACTICAL POINTS :

1.  Passage of meconium is physiological in breech deliveries and  postdated babies, but would be considered pathological any time if the fetal heart rate monitoring is associated with non reassuring fetal heart rate pattern. 
2.  Passage of meconium is extremely rare in preterms and its presence should consider diagnosis of listeria sepsis. 
3.  Majority of MSAF babies have  uneventful course unless complicated by abnormal fetal heart rate patterns. 
4.  Yellow meconium is usually old, while green meconium suggests a more recent insult. 
5.  The indication for intubation in MSAF babies is only for those who are depressed at birth irrespective of the consistency of meconium. 
6.  For infants requiring endotracheal suctioning, vigorous stimulation and drying maneuvers are delayed until intubation is performed to avoid initiation of respiration. After clearance of  the airway usual steps of resuscitation are performed.
7.  Bag and mask ventilation is contraindicated in MSAF babies who are depressed at birth and intubation for intra tracheal suctioning takes precedence for airway clearance. 
8.  To date there are no data verifying the efficacy of chest physiotherapy either in preventing MAS or in treating the disorder. 
9.  To date there have been no prospective randomized controlled trials assessing the potential benefits of cesarean versus vaginal delivery in preventing MAS. 
10.  Negative pressure during suctioning of airway should not exceed - 120mm of Hg. It should be applied continously and not intermittently for  optimal retrieval. 
11.  An intriguing therapy is that of dilute surfactant  lavage which has been found to be beneficial in human infants with established MAS. 
 
 All this info and more at  http://www.neoclinic.net/Artcl/msaf.htm
 
 
---Original Message---
 

From: [EMAIL PROTECTED]
Date: Thursday, 29 May 2003 7:47:21 PM
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery] Interesting..
 

Thanks for your question and the quote Mary, 
There are several different ideas within this posting.
Regardless of the mode of delivery and the intrapartum course, if there is mec.stained liquor, the baby is at risk of MAS and it's complications, regardless again of whether it is old or new meconium.  Who's to say the mec didn't get there from the first breath after emergence from the uterus at c/s.  Would love to find somewhere that perhaps quantifies how much meconium will cause MAS.  It would be interesting also to find information on how long it takes to affect the whole lung fields.  A chest Xray done soon after birth only shows the damage and effects of the inhaled mec, and a CRP on the baby is only an indicator of tissue damage or inflammation, and not all that useful.  The chemical pneumonitis caused from MAS is only one part of the cascade.
Regarding the poor CTG, as we all know, there could be any numbers of reasons for a poor one, not necessarily old meconium.  This could be the effect of an insult as oppos

Re: [ozmidwifery] Interesting..

[Gayle Rafferty]

Thanks for your question and the quote Mary, 
There are several different ideas within this posting.
Regardless of the mode of delivery and the intrapartum course, if there is mec.stained liquor, the baby is at risk of MAS and it's complications, regardless again of whether it is old or new meconium.  Who's to say the mec didn't get there from the first breath after emergence from the uterus at c/s.  Would love to find somewhere that perhaps quantifies how much meconium will cause MAS.  It would be interesting also to find information on how long it takes to affect the whole lung fields.  A chest Xray done soon after birth only shows the damage and effects of the inhaled mec, and a CRP on the baby is only an indicator of tissue damage or inflammation, and not all that useful.  The chemical pneumonitis caused from MAS is only one part of the cascade.
Regarding the poor CTG, as we all know, there could be any numbers of reasons for a poor one, not necessarily old meconium.  This could be the effect of an insult as opposed to the cause.  Would be handy to know more of the ante and intrapartum history first.
As I have already posted, the glottis is usually closed until the stimulation to gasp, be it the squeeze or perhaps environmental factors and exposure to air.  I would also be interested to hear any other explanation from others in the know.
Gayle
 
Meconium Aspiration Syndrome 
This is the commonest cause if respiratory distress.  It is a condition which may affect both preterm and term infants, particularly if delivered by caesarian section.  It is attributed to delayed clearing of the fetal lung fluid into the vessels and lymphatics after birth.  The condition is not due to surfactant deficiency and the shake test is usually positive. 
http://web.uct.ac.za/depts/ich/teaching/undergrad/6th_year/nnh/nnh_cp16.htm

Incidence and risk factors:
Meconium stained liquor occurs in 10-20% of deliveries and increases to over 30% of deliveries after 42 weeks gestation1.http://www.cs.nsw.gov.au/rpa/neonatal/html/newprot/Meconium.htm

MECONIUM ASPIRATION This is due to the inhalation of meconium during or immediately after delivery.  It usually follows on fetal distress during labour.  It is limited to mature or wasted infants since preterm infants rarely pass meconium in utero.  The inhaled meconium produces areas of emphysema and atelectasis throughout the lungs.  There is considerable risk of pneumothorax and pneumomediastinum.  A pneumonitis may be caused by chemical irritation or secondary bacterial infection.  Many infants with severe meconium aspiraton die or suffer severe lung damage. 
http://web.uct.ac.za/depts/ich/teaching/undergrad/6th_year/nnh/nnh_cp16.htm
 
 
 
 
---Original Message---
 

From: [EMAIL PROTECTED]
Date: Thursday, 29 May 2003 6:54:02 PM
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery] Interesting..
 
Thanks Gayle for your explanation.  What then causes a Term baby to have lungs with tissue choked with old meconium when birthed by elective caesarean because of poor CTG's?  MM

- Original Message - 
From: Gayle Rafferty 
To: [EMAIL PROTECTED] 
Sent: Thursday, May 29, 2003 3:53 PM
Subject: Re: [ozmidwifery] Interesting..





 
Babies lungs are filled with a special fluid that is quite separate to amniotic fluid.  It is called Fetal Lung Fluid (FLF).  This is what is expelled as the baby is squeezed through the birth canal.   The baby occasionally 'spits' a little of this into the amniotic fluid, as a result of fetal breathing.  The FLF contains surfactant and lecithin/sphyngomyelin which is what is, or rather used to be measured when an amniocentisis is done to assess gestation and lung maturity.  Remember L:S Ratios?  Thank heavens for newer technology and the use of ultrasound scanning and telemetry in cases of need.  It is retained fetal lung fluid that is responsible for most of the respiratory distress named TTN or transient tachypnoea of the neonate.
Also, a baby can quite easily recover from an distressing episode in utero, and, as outlined above, the mec does not necessarily go into the lungs causing MAS at birth.  It is the first gasp in an extrauterine environment that may lead to inhalation of mec passed the originally closed glottis.
 
Gayle
 
---Original Message---
 

From: [EMAIL PROTECTED]
Date: Thursday, 29 May 2003 2:37:49 PM
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery] Interesting..
 
And just to add something more, it is interesting to know that it (the inutero pooing) happens so early in gestation.  We have also all been told (at least I have) that the more mature a baby is (ie post dates) then the more likely it is that there will be mec in the liquor. I'd like to read the whole article but from memory the abstract said that passing of meconium had been observed as early as 28 weeks. 
 
Something I've often wondered about is those breathing actions by the baby. When a biophysical profile is done 

Re: [ozmidwifery] Interesting..

[Mary Murphy]

Thanks Gayle for your explanation.  What then causes a Term baby to 
have lungs with tissue choked with old meconium when birthed by elective 
caesarean because of poor CTG's?  MM

  - Original Message - 
  From: 
  Gayle Rafferty 
  To: [EMAIL PROTECTED] 
  
  Sent: Thursday, May 29, 2003 3:53 
PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
  

  
 
Babies lungs are filled with a special fluid that is quite separate 
to amniotic fluid.  It is called Fetal Lung Fluid (FLF).  This 
is what is expelled as the baby is squeezed through the birth 
canal.   The baby occasionally 'spits' a little of this into 
the amniotic fluid, as a result of fetal breathing.  The FLF 
contains surfactant and lecithin/sphyngomyelin which is what is, or 
rather used to be measured when an amniocentisis is done to assess 
gestation and lung maturity.  Remember L:S Ratios?  Thank 
heavens for newer technology and the use of ultrasound scanning and 
telemetry in cases of need.  It is retained fetal lung fluid that 
is responsible for most of the respiratory distress named TTN or 
transient tachypnoea of the neonate.
Also, a baby can quite easily recover from an distressing episode 
in utero, and, as outlined above, the mec does not necessarily go into 
the lungs causing MAS at birth.  It is the first gasp in an 
extrauterine environment that may lead to inhalation of mec passed the 
originally closed glottis.
 
Gayle
 
---Original Message---
 

From: [EMAIL PROTECTED]
Date: Thursday, 29 
May 2003 2:37:49 PM
To: [EMAIL PROTECTED]
Subject: Re: 
    [ozmidwifery] Interesting..
 
And just to add something more, it is 
interesting to know that it (the inutero pooing) happens so early in 
gestation.  We have also all been told (at least I have) that the 
more mature a baby is (ie post dates) then the more likely it is that 
there will be mec in the liquor. I'd like to read the whole article but 
from memory the abstract said that passing of meconium had been observed 
as early as 28 weeks. 
 
Something I've often wondered about is 
those breathing actions by the baby. When a biophysical profile is done 
that is one of the items scored so it is obviously expected in all term 
babies. Yet most babies with mec liquor don't present with MAS. And some 
(a very few) babies with very normal uncomplicated labours and births do 
develop MAS. Is it the gasp of a baby in distress (which may happen at 
any time and be undetected) or just a random gasp that carries the mec 
deep into the lungs ? Just curious.
 
I just had a really weird glimpse into the 
future of all pregnant women past 24 weeks wearing telemetry monitors 
just in case something untoward happens. Am I paranoid?? I hope 
so.  As Mary said it is all in the interpretation.
 
marilyn

  - Original Message - 
  From: 
  Mary Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, May 21, 2003 
  4:18 PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
   
  
Debbie wrote:  "It is well known that babies 'wee' in 
utero - so why not 'the other'?"
 
Deb, it is not so much that they do it, but how we interpret 
it.  We have for years been told that meconium in the liqour is 
a sign of "Fetal Distress"  There have been many unnecessary 
operative procedures carried out on women and babies because it was 
concluded that slowed Fetal Heart Rate (mostly normal head 
compression dips) and meconium stained liqour meant distressed 
baby.  Then Voila!  Apgars of 9 & 10 at birth or 
C/S.  Midwives, women and doctors too have taken the blame for 
all sorts of things that happen to babies.  (Not denying some 
negligence claims are true.)  It has been known by midwives gor 
generations that women past their "due date" frequently have 
meconioum stained liqour. If is present...panic!  Now we 
also know that the symptoms of meconium pneumonia and "meconium 
aspiration" are mostly present in the lungs before birth because 
babies do these marvelous "breathing actions" that we didn't know 
about before U.S studies told us so.  It is very 
complicated.  So, this piece of research is a very helpful 
piece of the jig-saw.  cheers, MM

  

   
  
 

  
. 
 

  

  
  

Re: [ozmidwifery] Interesting..

[Mary Murphy]

Marilyn wrote "Yet most babies with mec liquor don't present 
with MAS. And some (a very few) babies with very normal uncomplicated labours 
and births do develop MAS. Is it the gasp of a baby in distress (which may 
happen at any time and be undetected) or just a random gasp that carries the mec 
deep into the lungs ? Just curious"
 
I'm curious too.  I haven't read any studies about 
that.  Maybe it hasn't been done yet, or can't ethically be done?  
Does anyone know?  MM

Re: [ozmidwifery] Interesting..

[Gayle Rafferty]

 
Babies lungs are filled with a special fluid that is quite separate to amniotic fluid.  It is called Fetal Lung Fluid (FLF).  This is what is expelled as the baby is squeezed through the birth canal.   The baby occasionally 'spits' a little of this into the amniotic fluid, as a result of fetal breathing.  The FLF contains surfactant and lecithin/sphyngomyelin which is what is, or rather used to be measured when an amniocentisis is done to assess gestation and lung maturity.  Remember L:S Ratios?  Thank heavens for newer technology and the use of ultrasound scanning and telemetry in cases of need.  It is retained fetal lung fluid that is responsible for most of the respiratory distress named TTN or transient tachypnoea of the neonate.
Also, a baby can quite easily recover from an distressing episode in utero, and, as outlined above, the mec does not necessarily go into the lungs causing MAS at birth.  It is the first gasp in an extrauterine environment that may lead to inhalation of mec passed the originally closed glottis.
 
Gayle
 
---Original Message---
 

From: [EMAIL PROTECTED]
Date: Thursday, 29 May 2003 2:37:49 PM
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery] Interesting..
 
And just to add something more, it is interesting to know that it (the inutero pooing) happens so early in gestation.  We have also all been told (at least I have) that the more mature a baby is (ie post dates) then the more likely it is that there will be mec in the liquor. I'd like to read the whole article but from memory the abstract said that passing of meconium had been observed as early as 28 weeks. 
 
Something I've often wondered about is those breathing actions by the baby. When a biophysical profile is done that is one of the items scored so it is obviously expected in all term babies. Yet most babies with mec liquor don't present with MAS. And some (a very few) babies with very normal uncomplicated labours and births do develop MAS. Is it the gasp of a baby in distress (which may happen at any time and be undetected) or just a random gasp that carries the mec deep into the lungs ? Just curious.
 
I just had a really weird glimpse into the future of all pregnant women past 24 weeks wearing telemetry monitors just in case something untoward happens. Am I paranoid?? I hope so.  As Mary said it is all in the interpretation.
 
marilyn

- Original Message - 
From: Mary Murphy 
To: [EMAIL PROTECTED] 
Sent: Wednesday, May 21, 2003 4:18 PM
Subject: Re: [ozmidwifery] Interesting..

 

Debbie wrote:  "It is well known that babies 'wee' in utero - so why not 'the other'?"
 
Deb, it is not so much that they do it, but how we interpret it.  We have for years been told that meconium in the liqour is a sign of "Fetal Distress"  There have been many unnecessary operative procedures carried out on women and babies because it was concluded that slowed Fetal Heart Rate (mostly normal head compression dips) and meconium stained liqour meant distressed baby.  Then Voila!  Apgars of 9 & 10 at birth or C/S.  Midwives, women and doctors too have taken the blame for all sorts of things that happen to babies.  (Not denying some negligence claims are true.)  It has been known by midwives gor generations that women past their "due date" frequently have meconioum stained liqour. If is present...panic!  Now we also know that the symptoms of meconium pneumonia and "meconium aspiration" are mostly present in the lungs before birth because babies do these marvelous "breathing actions" that we didn't know about before U.S studies told us so.  It is very complicated.  So, this piece of research is a very helpful piece of the jig-saw.  cheers, MM




 

 

  
. 
 

Re: [ozmidwifery] Interesting..

[Marilyn Kleidon]

And just to add something more, it is interesting 
to know that it (the inutero pooing) happens so early in gestation.  We 
have also all been told (at least I have) that the more mature a baby is (ie 
post dates) then the more likely it is that there will be mec in the liquor. I'd 
like to read the whole article but from memory the abstract said that passing of 
meconium had been observed as early as 28 weeks. 
 
Something I've often wondered about is those 
breathing actions by the baby. When a biophysical profile is done that is one of 
the items scored so it is obviously expected in all term babies. Yet most babies 
with mec liquor don't present with MAS. And some (a very few) babies with very 
normal uncomplicated labours and births do develop MAS. Is it the gasp of a baby 
in distress (which may happen at any time and be undetected) or just a random 
gasp that carries the mec deep into the lungs ? Just curious.
 
I just had a really weird glimpse into the future 
of all pregnant women past 24 weeks wearing telemetry monitors just in case 
something untoward happens. Am I paranoid?? I hope so.  As Mary said 
it is all in the interpretation.
 
marilyn

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Wednesday, May 21, 2003 4:18 
  PM
  Subject: Re: [ozmidwifery] 
  Interesting..
  
   
  
Debbie wrote:  "It is well known that babies 'wee' in utero - so 
why not 'the other'?"
 
Deb, it is not so much that they do it, but how we interpret it.  
We have for years been told that meconium in the liqour is a sign of "Fetal 
Distress"  There have been many unnecessary operative procedures 
carried out on women and babies because it was concluded that slowed Fetal 
Heart Rate (mostly normal head compression dips) and meconium stained liqour 
meant distressed baby.  Then Voila!  Apgars of 9 & 10 at birth 
or C/S.  Midwives, women and doctors too have taken the blame for all 
sorts of things that happen to babies.  (Not denying some negligence 
claims are true.)  It has been known by midwives gor generations that 
women past their "due date" frequently have meconioum stained 
liqour. If is present...panic!  Now we also know that the symptoms 
of meconium pneumonia and "meconium aspiration" are mostly present in the 
lungs before birth because babies do these marvelous "breathing actions" 
that we didn't know about before U.S studies told us so.  It is very 
complicated.  So, this piece of research is a very helpful piece of the 
jig-saw.  cheers, MM

  
  

   
  
 

  
. 

RE: [ozmidwifery] Interesting..

[Larry & Megan]

I 
can't believe we needed a study to show this, what was supposed to happen 
to the babies waste product.
Or am 
I just too simplistic?
Megan

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Mary 
  MurphySent: Tuesday, 27 May 2003 7:20To: 
  listSubject: [ozmidwifery] Interesting..
  
  
   American Journal of Obstets & Gynae. Vol 188. jan 2003 pgs 
  153-156
  
  Defecation in utero: A physiologic fetal function 
  C. López Ramón y Cajal MDa and R. Ocampo Martínez MDb 
  From the Unit of Prenatal Diagnosis, Service of Obstetrics and 
  Gynecology,a and the Service of Interne Medicine, Xeral 
  Hospital.b Received 30 November 2001;  revised 18 
  April 2002.  Available online 7 February 2003. 
  
  Abstract
  Objective: The objective of this study was to investigate the occurrence of 
  in utero defecation as a normal function in the human fetus. Study Design: The 
  anuses of 240 fetuses were studied sonographically between weeks 15 and 41 of 
  gestation. Fetal defecation was defined as the expulsion of rectal contents 
  through the anus into the amniotic fluid. The diameter and area of the anus 
  were measured sonographically at times of maximum anal aperture. Results: One 
  or more defecations were documented in all fetuses. The frequency of 
  defecations was highest between week 28 and 34 of gestation. Conclusion: This 
  study confirms that defecation in utero is a normal function and supports the 
  view that the evacuation of rectal contents into the amniotic fluid is no 
  departure from normal fetal physiologic behavior. (Am J Obstet Gynecol 
  2003;188:153-6.) 
  
    
  . 

RE: [ozmidwifery] Interesting..

[Judy Giesaitis]

Dear 
Mary
 
you 
have such a way with explaining things.  Sometimes your explanations clear 
up things which we have "always sort of known".  I always enjoy reading 
your posts.   Thanks and keep it up.   Judy 
Giesaitis

  -Original Message-