Re: [ozmidwifery] trials

[suzi and brett]

Title: Message



I worked with women as a mid student who were 
recruited into this trial - while oral seems more appealing than gels at first - 
 I found waking up / disturbing women 2 hrly for the next oral dose was not 
conducive for the rest and relaxation required the night before birthing 
(and some of them were getting placebos anyway poor things).
 
The skinny dividable hospital bed, no partner to 
snuggle up to, no food etc etc.(common to all methods)...is not exactly the 
best way to prepare for a birth either. No wonder IOL have such a big failure 
rate. Although most failed IOL are recorded as FTP (blame the woman) or foetal 
distress so Enkin et al... says that IOL does not increase chance of 
c/s... When I queried the documentation of failed IOL - The CMC - with 
doctor concurring - said to me if she has 'some' contractions its not a failed 
IOL...hmmm.  Suzi

  - Original Message - 
  From: 
  Dean 
  & Jo 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, March 04, 2006 8:25 
  PM
  Subject: RE: [ozmidwifery] trials
  
  vaginal birth not achieved in 24 hours 
  
  misoprostol 46.0%
  v 
  dinoprostone 41.2%
   
  okay so 
  if 46% did not birth vaginally and 22.7% had cs what happened to the 
  other  23.3% that didn't birth 
  vaginally
   
  Also, are 
  women going to be told that they have almost a 50% chance of needing a cs 
  with an induction?   That inductions fail almost 
  half the timegee I know, lets do what the prominent OB 
  from Adelaide is suggesting and induce all women at 39 weeks and almost 
  double our cs rate!  
   
  caesarean section 
  22.7%
  v 
  26.6%
   
  and we 
  wonder why we have a national cs rate of over 25%!!!
   
   caesarean section for fetal distress 
  
  8.8%
   v 
  9.3% 
   
  uterine hyper stimulation with changes in fetal 
  heart rate 
  0.8% 
  v 
  1.6% 
  and yet 
  the risk of rupture being an estimated 0.3% is too high to offer vbac as an 
  optionlets give these women a drug that can hyper stimulate their uteri 
  and increase the chance of serious morbidity or mortality and potentially 
  leave them with a ruptured uterus despite not having a previous 
  scar.
   
  *sigh* I 
  seriously wonder sometimes how these academics get funded! Oh sorry, this was 
  a drug company who will benefit from this study...not 
  women.
   
  I have a 
  suggestion: why doesn't someone get funding to do a trial into 
  spontaneous non-interventative (minus the actual medical need)birth vs. 
  active management and compare the outcomes?  Lets actually see if natural 
  noninvasive supported and educated birth is fraught with the dangers that we 
  get thrown at us.  grr grr grr
  Jo
   
  
  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] On Behalf Of Mary 
  MurphySent: Saturday, March 04, 2006 7:08 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] 
  trials
  

At least they 
asked the women’s preference. Guess what they chose?  MM
Oral 
misoprostol for induction of labour at term: randomised controlled 
trial - BMJ , vol 
332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther CA; Robinson 
JS - (2006) OBJECTIVE: To 
compare oral misoprostol solution with vaginal prostaglandin gel 
(dinoprostone) for induction of labour at term to determine whether 
misoprostol is superior. DESIGN: Randomized double blind placebo controlled 
trial. SETTING: Maternity departments in three hospitals in 
Australia.Population Pregnant women with a singleton cephalic presentation 
at >/=36+6 weeks' gestation, with an indication for prostaglandin 
induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at 
two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at 
six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: 
Vaginal birth within 24 hours; uterine hyperstimulation with associated 
changes in fetal heart rate; caesarean section (all); and caesarean section 
for fetal distress. RESULTS: 741 women were randomised, 365 to the 
misoprostol group and 376 to the vaginal dinoprostone group. There were no 
significant differences between the two treatment groups in the primary 
outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 
(46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence 
interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 
(26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress 
(32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine 
hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 
(1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the 
process of labour induction, there were no significant differences in 
adverse maternal or neon

Re: [ozmidwifery] trials

[Mike & Lindsay Kennedy]

On 3/4/06, Dean & Jo <[EMAIL PROTECTED]> wrote:
cs what happened to the
> other  23.3% that didn't birth vaginally

What the research said was that 23.3% did not deliver within 24hours.
So they either failed to be inducded at all or took longer than
24hours to birth their babies.

>
> Also, are women going to be told that they have almost a 50% chance of
> needing a cs with an induction?

Obviously only 22.5% actually required a CS (Yes too high still
acording to WHO guidlines) but where did you get 50% risk from?

That inductions fail almost half the
> time

Once again where does this percentage come from.


You raise really valid issues but this trial seemed to me to be
offering birthing women a better option for induction than the very
invasive Vaginal option.

Yes we do too many IOL'S and way too many C/S's. But many women don't
know, don't care or don't have any choice and this particular peice of
research might just give them one more option that is less invasive.

As for the VBAC situation - women can choose a vbac, many choose
elective C/S too.


> At least they asked the women's preference. Guess what they chose?  MM
>
> Oral misoprostol for induction of labour at term: randomised controlled
> trial - BMJ , vol 332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther
> CA; Robinson JS - (2006) OBJECTIVE: To compare oral misoprostol solution
> with vaginal prostaglandin gel (dinoprostone) for induction of labour at
> term to determine whether misoprostol is superior. DESIGN: Randomized double
> blind placebo controlled trial. SETTING: Maternity departments in three
> hospitals in Australia.Population Pregnant women with a singleton cephalic
> presentation at >/=36+6 weeks' gestation, with an indication for
> prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol
> solution at two hourly intervals and placebo vaginal gel or vaginal
> dinoprostone gel at six hourly intervals and placebo oral solution. MAIN
> OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation
> with associated changes in fetal heart rate; caesarean section (all); and
> caesarean section for fetal distress. RESULTS: 741 women were randomised,
> 365 to the misoprostol group and 376 to the vaginal dinoprostone group.
> There were no significant differences between the two treatment groups in
> the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol
> 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95%
> confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365
> (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section
> for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44;
> P=0.679), or uterine hyperstimulation with changes in fetal heart rate
> (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there
> were differences in the process of labour induction, there were no
> significant differences in adverse maternal or neonatal outcomes.
> CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior
> to vaginal dinoprostone for induction of labour. However, it does not lead
> to poorer health outcomes for women or their infants, and oral treatment is
> preferred by women. Trial registration National Health and Medical Research
> Council, Perinatal Trials, PT0361. (11 references) (Author)
>
>
>
> --
> No virus found in this incoming message.
> Checked by AVG Free Edition.
> Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
>
>
>
> --
>  No virus found in this outgoing message.
>  Checked by AVG Free Edition.
>  Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
>


--
My photos online @ http://community.webshots.com/user/mike1962nz
My Group online @ http://groups.yahoo.com/group/PSP_for_Photographers
New Photo site@
Mike - http://mikelinz.dotphoto.com
Lindsay - Http://likeminz.dotphoto.com

"Life is a sexually transmitted condition with 100% mortality and birth is
as safe as it gets." Unknown
--
This mailing list is sponsored by ACE Graphics.
Visit  to subscribe or unsubscribe.

RE: [ozmidwifery] trials

[Dean & Jo]

Title: Message



the 
sad thing is that she works at a teaching hospital where they have only one 
thing they are familiar with -managed birth...so they are perpetuating the 
status quo.  it is sad Mary.

  


--
No virus found in this outgoing message.
Checked by AVG Free Edition.
Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
 

RE: [ozmidwifery] trials

[Mary Murphy]

Title: Message








I attended a birth at home early this
morning as “2nd midwife”. Primip, vaginal water birth, non -directed
second stage, physiologic 3rd stage.  Small 2nd deg. Tear,
sutured by midwife. A beautiful birth of a.3.7kg baby.   I was speaking to a
midwife who works in the birth suite of our large teaching hospital where about
5,000 women give birth.  Some high risk but most potentially normal birth.  She
was thrilled to hear about the birth.  She said she “never” sees anything like
it where she works.  How sad,.  MM 



Subject: RE:
[ozmidwifery] trials



 



vaginal birth not achieved in 24 hours 





misoprostol 46.0%





v 





dinoprostone 41.2%





 





okay so if 46% did
not birth vaginally and 22.7% had cs what happened to the other  23.3%
that didn't birth vaginally





 





Also, are women
going to be told that they have almost a 50% chance of needing a cs with
an induction?   That inductions fail almost half
the timegee I know, lets do what the prominent OB from Adelaide is suggesting and induce all women
at 39 weeks and almost double our cs rate!  





 





caesarean section 





22.7%





v 





26.6%





 





and we wonder why we
have a national cs rate of over 25%!!!





 





 caesarean section for fetal distress 





8.8%





 v 





9.3% 





 





uterine hyper stimulation with changes in fetal heart rate






0.8% 





v 





1.6% 





and yet the risk of
rupture being an estimated 0.3% is too high to offer vbac as an optionlets
give these women a drug that can hyper stimulate their uteri and increase the
chance of serious morbidity or mortality and potentially leave them with a ruptured
uterus despite not having a previous scar.





 





*sigh* I seriously
wonder sometimes how these academics get funded! Oh sorry, this was a drug
company who will benefit from this study...not women.





 





I have a suggestion:
why doesn't someone get funding to do a trial into spontaneous
non-interventative (minus the actual medical need)birth vs. active
management and compare the outcomes?  Lets actually see if natural
noninvasive supported and educated birth is fraught with the dangers that we get
thrown at us.  grr grr grr





Jo





 





-Original Message-
From: owner-ozmidwifery@acegraphics.com.au
[mailto:owner-ozmidwifery@acegraphics.com.au]
On Behalf Of Mary Murphy
Sent: Saturday, March 04, 2006
7:08 PM
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] trials





At least they asked
the women’s preference. Guess what they chose?  MM

Oral
misoprostol for induction of labour at term: randomised controlled trial - BMJ , vol
332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther CA;
Robinson JS - (2006) OBJECTIVE:
To compare oral misoprostol solution with vaginal prostaglandin gel
(dinoprostone) for induction of labour at term to determine whether misoprostol
is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING:
Maternity departments in three hospitals in Australia.Population Pregnant women
with a singleton cephalic presentation at >/=36+6 weeks' gestation, with an
indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral
misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal
dinoprostone gel at six hourly intervals and placebo oral solution. MAIN
OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with
associated changes in fetal heart rate; caesarean section (all); and caesarean
section for fetal distress. RESULTS: 741 women were randomised, 365 to the
misoprostol group and 376 to the vaginal dinoprostone group. There were no
significant differences between the two treatment groups in the primary
outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v
dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95
to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82,
0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v
35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with
changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21;
P=0.401). Although there were differences in the process of labour induction,
there were no significant differences in adverse maternal or neonatal outcomes.
CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to
vaginal dinoprostone for induction of labour. However, it does not lead to poorer
health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration
National Health and Medical Research Council, Perinatal Trials, PT0361. (11
references) (Author)

 

--
No virus found in this incoming message.
Checked by AVG Free Edition.
Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006










--
No virus found in this outgoing message.
Checked by AVG Free Edition

RE: [ozmidwifery] trials

[Dean & Jo]

Title: Message



vaginal birth not achieved in 24 hours 

misoprostol 46.0%
v 
dinoprostone 41.2%
 
okay so if 
46% did not birth vaginally and 22.7% had cs what happened to the 
other  23.3% that didn't birth vaginally
 
Also, are 
women going to be told that they have almost a 50% chance of needing a cs 
with an induction?   That inductions fail almost 
half the timegee I know, lets do what the prominent OB from 
Adelaide is suggesting and induce all women at 39 weeks and almost double 
our cs rate!  
 
caesarean section 
22.7%
v 
26.6%
 
and we 
wonder why we have a national cs rate of over 25%!!!
 
 caesarean section for fetal distress 

8.8%
 v 
9.3% 
 
uterine hyper stimulation with changes in fetal 
heart rate 
0.8% 
v 
1.6% 
and yet the 
risk of rupture being an estimated 0.3% is too high to offer vbac as an 
optionlets give these women a drug that can hyper stimulate their uteri and 
increase the chance of serious morbidity or mortality and potentially leave them 
with a ruptured uterus despite not having a previous scar.
 
*sigh* I 
seriously wonder sometimes how these academics get funded! Oh sorry, this was a 
drug company who will benefit from this study...not women.
 
I have a 
suggestion: why doesn't someone get funding to do a trial into spontaneous 
non-interventative (minus the actual medical need)birth vs. active 
management and compare the outcomes?  Lets actually see if natural 
noninvasive supported and educated birth is fraught with the dangers that we get 
thrown at us.  grr grr grr
Jo
 

-Original Message-From: 
[EMAIL PROTECTED] 
[mailto:[EMAIL PROTECTED] On Behalf Of Mary 
MurphySent: Saturday, March 04, 2006 7:08 PMTo: 
ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] 
trials

  
  At least they 
  asked the women’s preference. Guess what they chose?  MM
  Oral 
  misoprostol for induction of labour at term: randomised controlled 
  trial - BMJ , vol 
  332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther CA; Robinson 
  JS - (2006) OBJECTIVE: To 
  compare oral misoprostol solution with vaginal prostaglandin gel 
  (dinoprostone) for induction of labour at term to determine whether 
  misoprostol is superior. DESIGN: Randomized double blind placebo controlled 
  trial. SETTING: Maternity departments in three hospitals in 
  Australia.Population Pregnant women with a singleton cephalic presentation at 
  >/=36+6 weeks' gestation, with an indication for prostaglandin induction of 
  labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly 
  intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly 
  intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth 
  within 24 hours; uterine hyperstimulation with associated changes in fetal 
  heart rate; caesarean section (all); and caesarean section for fetal distress. 
  RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to 
  the vaginal dinoprostone group. There were no significant differences between 
  the two treatment groups in the primary outcomes: vaginal birth not achieved 
  in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); 
  relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean 
  section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), 
  caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 
  0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal 
  heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). 
  Although there were differences in the process of labour induction, there were 
  no significant differences in adverse maternal or neonatal outcomes. 
  CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to 
  vaginal dinoprostone for induction of labour. However, it does not lead to 
  poorer health outcomes for women or their infants, and oral treatment is preferred by women. 
  Trial registration National Health and Medical Research Council, Perinatal 
  Trials, PT0361. (11 references) (Author)
  --No virus found in this incoming message.Checked by 
  AVG Free Edition.Version: 7.1.375 / Virus Database: 268.1.1/273 - Release 
  Date: 3/2/2006


--
No virus found in this outgoing message.
Checked by AVG Free Edition.
Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
 

[ozmidwifery] trials

[Mary Murphy]

At least they asked
the women’s preference. Guess what they chose?  MM

Oral
misoprostol for induction of labour at term: randomised controlled trial - BMJ , vol
332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther CA;
Robinson JS - (2006) OBJECTIVE:
To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone)
for induction of labour at term to determine whether misoprostol is superior.
DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity
departments in three hospitals in Australia.Population Pregnant women with a
singleton cephalic presentation at >/=36+6 weeks' gestation, with an
indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral
misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal
dinoprostone gel at six hourly intervals and placebo oral solution. MAIN
OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with
associated changes in fetal heart rate; caesarean section (all); and caesarean
section for fetal distress. RESULTS: 741 women were randomised, 365 to the
misoprostol group and 376 to the vaginal dinoprostone group. There were no
significant differences between the two treatment groups in the primary
outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v
dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95
to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82,
0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v
35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with
changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21;
P=0.401). Although there were differences in the process of labour induction,
there were no significant differences in adverse maternal or neonatal outcomes.
CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to
vaginal dinoprostone for induction of labour. However, it does not lead to
poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial
registration National Health and Medical Research Council, Perinatal Trials,
PT0361. (11 references) (Author)