RE: [ozmidwifery] re epidural top ups and iv cannulation
Do they really need iv ab's, or are we over treating as usual? The vast majority of these babies are fine. Maybe we should only be treating those women with prom, not those in active labour, especially those with intact membranes. Another reason for leaving membranes intact i.e. no arm's. as we all carry GBS can it be pathologic? -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Monday, 23 May 2005 10:34 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I guess not if they need IV antibiotics. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Sally Westbury [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, May 22, 2005 3:30 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation 30% of women are not normal Gosh. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Sunday, May 22, 2005 1:27 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation GBS is not normal. What is the cut-off point for midwifery care scope of Px? Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 5:06 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Why involve an obs for GBS? As long as correct procedure is followed, there is little chance of transmission. We give oral abs if prom iv in labour. We don't induce for 48hrs, rather just keep an eye on the woman's temp and ctg at 18hrs and and 24hrs following. We have never had a problem. Our drs rx the abs, antenatally when the woman is diagnosed at 37/40. A lot of our women elect not to be swabbed, and again no probs. All babies are monitored temp etc for 24hrs and parents aware of what to watch for. Lets keep drs away from normal women having nice pregnancies and babies -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Saturday, 21 May 2005 12:39 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 7:43 AM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's
Re: [ozmidwifery] re epidural top ups and iv cannulation
What your describing is the risk based protocol vs the culture based one. UNfortunately the recent evidence shows more babies were missed using the risk based protocol that the culture based one. This is all covered on the web sites posted. Whenever you practice prophylactic treatments you are going to be treating some people unnecessarily it's the nature of the beast!! We don't have the test(tests) to positively identify those mthers who have a 100% chance of their babies becoming septic with GBS. And yes it does become a pathogen again we don't know all the triggers that make it change from being normal flora. Of course women refuse the antibiotics and I personally have never known anyone who has had a baby become ill or die from GBS disease. And I have attended births at home and in hospital with women who have refused the antibiotics(after testing positive) or who birthed before the iv could be set up and we simply watched the baby closely especially taking temp's 4/24 for 48 hours and regularly for the first week. However, if you read the web sites you must become aware that thinking you can pick who will have a sick baby from health status of the mother can be risky and erroneous. Though I have to say I would think babies in the one-to-one continuity of care model would be much safer than those with multiple providers and early discharge. marilyn - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, May 23, 2005 3:14 AM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Do they really need iv ab's, or are we over treating as usual? The vast majority of these babies are fine. Maybe we should only be treating those women with prom, not those in active labour, especially those with intact membranes. Another reason for leaving membranes intact i.e. no arm's. as we all carry GBS can it be pathologic? -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Monday, 23 May 2005 10:34 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I guess not if they need IV antibiotics. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Sally Westbury [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, May 22, 2005 3:30 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation 30% of women are not normal Gosh. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Sunday, May 22, 2005 1:27 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation GBS is not normal. What is the cut-off point for midwifery care scope of Px? Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 5:06 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Why involve an obs for GBS? As long as correct procedure is followed, there is little chance of transmission. We give oral abs if prom iv in labour. We don't induce for 48hrs, rather just keep an eye on the woman's temp and ctg at 18hrs and and 24hrs following. We have never had a problem. Our drs rx the abs, antenatally when the woman is diagnosed at 37/40. A lot of our women elect not to be swabbed, and again no probs. All babies are monitored temp etc for 24hrs and parents aware of what to watch for. Lets keep drs away from normal women having nice pregnancies and babies -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Saturday, 21 May 2005 12:39 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 7:43 AM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation From a student's perspective any discussion on what constitutes
Re: [ozmidwifery] re epidural top ups and iv cannulation
Agree Marilyn. I have seen a baby develop GBS. He was a normal birth at term, good Apgars. No prolonged ROM. Became ill very quickly (within one hour of birth), profound apneas brady's, collapsed died with 24 hours of birth. A big contributing factor to his death was delay in starting him on AB's. The tricky thing with newborns is that they don't always become febrile in response to infection, even a severe one. More likely a drop in temp. This case was many years ago a baby presenting like that now would be given AB's immediately until proven otherwise. GBS has an incidence of 1:1000 and good midwifery care will detect a sick or becoming sick infant. I wonder about the issue of antibiotic resistance, although this is less likely with Penicillin than the broad spectrums. WHO have big concerns about antibiotic resistance. 30% is a lot of women and babies. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, May 24, 2005 3:09 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation What your describing is the risk based protocol vs the culture based one. UNfortunately the recent evidence shows more babies were missed using the risk based protocol that the culture based one. This is all covered on the web sites posted. Whenever you practice prophylactic treatments you are going to be treating some people unnecessarily it's the nature of the beast!! We don't have the test(tests) to positively identify those mthers who have a 100% chance of their babies becoming septic with GBS. And yes it does become a pathogen again we don't know all the triggers that make it change from being normal flora. Of course women refuse the antibiotics and I personally have never known anyone who has had a baby become ill or die from GBS disease. And I have attended births at home and in hospital with women who have refused the antibiotics(after testing positive) or who birthed before the iv could be set up and we simply watched the baby closely especially taking temp's 4/24 for 48 hours and regularly for the first week. However, if you read the web sites you must become aware that thinking you can pick who will have a sick baby from health status of the mother can be risky and erroneous. Though I have to say I would think babies in the one-to-one continuity of care model would be much safer than those with multiple providers and early discharge. marilyn - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, May 23, 2005 3:14 AM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Do they really need iv ab's, or are we over treating as usual? The vast majority of these babies are fine. Maybe we should only be treating those women with prom, not those in active labour, especially those with intact membranes. Another reason for leaving membranes intact i.e. no arm's. as we all carry GBS can it be pathologic? -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Monday, 23 May 2005 10:34 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I guess not if they need IV antibiotics. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Sally Westbury [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, May 22, 2005 3:30 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation 30% of women are not normal Gosh. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Sunday, May 22, 2005 1:27 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation GBS is not normal. What is the cut-off point for midwifery care scope of Px? Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 5:06 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Why involve an obs for GBS? As long as correct procedure is followed, there is little chance of transmission. We give oral abs if prom iv in labour. We don't induce for 48hrs, rather just keep an eye on the woman's temp and ctg at 18hrs and and 24hrs following. We have never had a problem. Our drs rx the abs, antenatally when the woman is diagnosed at 37/40. A lot of our women elect not to be swabbed, and again no probs. All babies are monitored temp etc for 24hrs and parents aware of what to watch for. Lets keep drs away from normal women having nice pregnancies and babies -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL
RE: [ozmidwifery] re epidural top ups and iv cannulation
We had a baby recently that became very unwell with GBS. I believe that the mother had PROM for quite some time. Had another case last year where a baby died. Both cases though associated with prolonged rupture of membranes. I have to say that now they are very jumpy with women with PROM. A woman the other day rang to say that she had just ruptured her membranes (term baby. She wanted to stay at home, but they insisted on her coming in for a 'check up'. Little did she know that the Syntocinon infusion and Abx were already charted. Lindsay -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Tuesday, 24 May 2005 11:38 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation Agree Marilyn. I have seen a baby develop GBS. He was a normal birth at term, good Apgars. No prolonged ROM. Became ill very quickly (within one hour of birth), profound apneas brady's, collapsed died with 24 hours of birth. A big contributing factor to his death was delay in starting him on AB's. The tricky thing with newborns is that they don't always become febrile in response to infection, even a severe one. More likely a drop in temp. This case was many years ago a baby presenting like that now would be given AB's immediately until proven otherwise. GBS has an incidence of 1:1000 and good midwifery care will detect a sick or becoming sick infant. I wonder about the issue of antibiotic resistance, although this is less likely with Penicillin than the broad spectrums. WHO have big concerns about antibiotic resistance. 30% is a lot of women and babies. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, May 24, 2005 3:09 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation What your describing is the risk based protocol vs the culture based one. UNfortunately the recent evidence shows more babies were missed using the risk based protocol that the culture based one. This is all covered on the web sites posted. Whenever you practice prophylactic treatments you are going to be treating some people unnecessarily it's the nature of the beast!! We don't have the test(tests) to positively identify those mthers who have a 100% chance of their babies becoming septic with GBS. And yes it does become a pathogen again we don't know all the triggers that make it change from being normal flora. Of course women refuse the antibiotics and I personally have never known anyone who has had a baby become ill or die from GBS disease. And I have attended births at home and in hospital with women who have refused the antibiotics(after testing positive) or who birthed before the iv could be set up and we simply watched the baby closely especially taking temp's 4/24 for 48 hours and regularly for the first week. However, if you read the web sites you must become aware that thinking you can pick who will have a sick baby from health status of the mother can be risky and erroneous. Though I have to say I would think babies in the one-to-one continuity of care model would be much safer than those with multiple providers and early discharge. marilyn - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, May 23, 2005 3:14 AM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Do they really need iv ab's, or are we over treating as usual? The vast majority of these babies are fine. Maybe we should only be treating those women with prom, not those in active labour, especially those with intact membranes. Another reason for leaving membranes intact i.e. no arm's. as we all carry GBS can it be pathologic? -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Monday, 23 May 2005 10:34 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I guess not if they need IV antibiotics. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Sally Westbury [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, May 22, 2005 3:30 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation 30% of women are not normal Gosh. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Sunday, May 22, 2005 1:27 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation GBS is not normal. What is the cut-off point for midwifery care scope of Px? Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original
Re: [ozmidwifery] re epidural top ups and iv cannulation
The USA website has a lot of info on the issue of antibiotic resistance which i think is very interesting. I actually bought a book on Streptococcus when I was in the states because I felt there was a whole lot of misinformation running around (that didn't seem to fit with my biology background)and that well intentioned people were taking risks with a potentially very dangerous organism. The book is called Streptococcal infections clinical aspects, microbiology, and molecular pathogenesis edited by Dennis L. Stevens and Edward L. Kaplan. Published by Oxford University Press in 2000. In brief my understanding on antibiotic resistance and Streptococcus agalactiae (GBS) is that it remains sensitive to beta lactam antibacterials which is penicillin, the problem can be for those allergic to penicillins because there is, as you said, resistance to the cephalosporins and erythromycins, so for those who are allergic the CDC suggests sensitivities done on the 35 to 37 week low vaginal swabs. I think unfortunately this testing is not done here (at least not in FNQ) just the m/c/s on the booking in urine. Interesting too is that the doses of antibiotics recommended on the web sites (both the USA CDC site and the Belgian one) are 2X the amount used up here!! It is always reported that women receiving the AB's have an increased incidence of vaginal thrush afterwards. This has not been supported by the evidence except that women with high colonisation of GBS vaginally also report high incidence of thrush prior to administration of abs, so when this is accounted for there is no increased incidence of thrush. The other concern regarding AB resistance is with the enterococcal organisms such as E.coli and Enterobacter which also cause sepsis in neonates: apparentally some resistance is showing up: there is a discussion on the CDC website. All in all I think this is an organism we can't become blase about, who knows why it emerged as potential neonatal pathogen in the 70's and 80's but there is no denying that antibiotic prophylaxis has made a huge impact on neonatal morbidity attributed to it. Similarly, I agree Jenny, as midwives we must not become cavalier re administering antibiotics the danger of course being anaphylactic reactions, are we prepared to respond? are we staffed accordingly? marilyn - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, May 23, 2005 6:37 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation Agree Marilyn. I have seen a baby develop GBS. He was a normal birth at term, good Apgars. No prolonged ROM. Became ill very quickly (within one hour of birth), profound apneas brady's, collapsed died with 24 hours of birth. A big contributing factor to his death was delay in starting him on AB's. The tricky thing with newborns is that they don't always become febrile in response to infection, even a severe one. More likely a drop in temp. This case was many years ago a baby presenting like that now would be given AB's immediately until proven otherwise. GBS has an incidence of 1:1000 and good midwifery care will detect a sick or becoming sick infant. I wonder about the issue of antibiotic resistance, although this is less likely with Penicillin than the broad spectrums. WHO have big concerns about antibiotic resistance. 30% is a lot of women and babies. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Marilyn Kleidon [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, May 24, 2005 3:09 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation What your describing is the risk based protocol vs the culture based one. UNfortunately the recent evidence shows more babies were missed using the risk based protocol that the culture based one. This is all covered on the web sites posted. Whenever you practice prophylactic treatments you are going to be treating some people unnecessarily it's the nature of the beast!! We don't have the test(tests) to positively identify those mthers who have a 100% chance of their babies becoming septic with GBS. And yes it does become a pathogen again we don't know all the triggers that make it change from being normal flora. Of course women refuse the antibiotics and I personally have never known anyone who has had a baby become ill or die from GBS disease. And I have attended births at home and in hospital with women who have refused the antibiotics(after testing positive) or who birthed before the iv could be set up and we simply watched the baby closely especially taking temp's 4/24 for 48 hours and regularly for the first week. However, if you read the web sites you must become aware that thinking you can pick who will have a sick baby from health status of the mother can be risky and erroneous. Though I have to say I would
RE: [ozmidwifery] re epidural top ups and iv cannulation
30% of women are not normal Gosh. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Sunday, May 22, 2005 1:27 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation GBS is not normal. What is the cut-off point for midwifery care scope of Px? Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 5:06 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Why involve an obs for GBS? As long as correct procedure is followed, there is little chance of transmission. We give oral abs if prom iv in labour. We don't induce for 48hrs, rather just keep an eye on the woman's temp and ctg at 18hrs and and 24hrs following. We have never had a problem. Our drs rx the abs, antenatally when the woman is diagnosed at 37/40. A lot of our women elect not to be swabbed, and again no probs. All babies are monitored temp etc for 24hrs and parents aware of what to watch for. Lets keep drs away from normal women having nice pregnancies and babies -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Saturday, 21 May 2005 12:39 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 7:43 AM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type
Re: [ozmidwifery] re epidural top ups and iv cannulation
I guess not if they need IV antibiotics. Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Sally Westbury [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Sunday, May 22, 2005 3:30 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation 30% of women are not normal Gosh. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Sunday, May 22, 2005 1:27 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation GBS is not normal. What is the cut-off point for midwifery care scope of Px? Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 5:06 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Why involve an obs for GBS? As long as correct procedure is followed, there is little chance of transmission. We give oral abs if prom iv in labour. We don't induce for 48hrs, rather just keep an eye on the woman's temp and ctg at 18hrs and and 24hrs following. We have never had a problem. Our drs rx the abs, antenatally when the woman is diagnosed at 37/40. A lot of our women elect not to be swabbed, and again no probs. All babies are monitored temp etc for 24hrs and parents aware of what to watch for. Lets keep drs away from normal women having nice pregnancies and babies -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Saturday, 21 May 2005 12:39 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 7:43 AM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact
RE: [ozmidwifery] re epidural top ups and iv cannulation
Why involve an obs for GBS? As long as correct procedure is followed, there is little chance of transmission. We give oral abs if prom iv in labour. We don't induce for 48hrs, rather just keep an eye on the woman's temp and ctg at 18hrs and and 24hrs following. We have never had a problem. Our drs rx the abs, antenatally when the woman is diagnosed at 37/40. A lot of our women elect not to be swabbed, and again no probs. All babies are monitored temp etc for 24hrs and parents aware of what to watch for. Lets keep drs away from normal women having nice pregnancies and babies -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Saturday, 21 May 2005 12:39 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 7:43 AM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps? marilyn - Original Message - From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just wanted to share our experience. The move away from an epidural that required top ups in labour to infusion pumps came about when the midwives refused to perform the topups or push a bolus down the epidural line manually. We insisted on the anaesthetists doing this task as they were responsible
Re: [ozmidwifery] re epidural top ups and iv cannulation
are you saying that the plus or minus 30% of women that are strep B pos all be referred to an ob, even if they are well women with no complications??? Sonja - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 12:38 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 7:43 AM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps? marilyn - Original Message - From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just wanted to share our experience. The move away from an epidural that required top ups in labour to infusion pumps came about when the midwives refused to perform the topups or push a bolus down the epidural line manually. We insisted on the anaesthetists doing this task as they were responsible for the integrity of the line and most certainly for its placement. Our anaesthetists got sick of returning again and again to do this and researched an alternative for themselves that we were happy to work with. In our setting a midwife will assist the anaesthetist with equipment required for epidural insertion, however she never ever pushes any fluids
RE: [ozmidwifery] re epidural top ups and iv cannulation
The doctor orders the antibiotics...but since when does he/she ever actually give the antibiotics? I guess that it is an interesting thing.. so the midwives could cannulate... the motivation to do this? Make it easier for the women? minimize stimulation during labour? Make it easier for the obs.. he doesn't have to get out of bed. Make it easier for the midwives.. no.. we are taking more responsibility. Is this being an obstetric handmaiden or is it being professional midwives. Is the danger here become obstetric midwives.. how far do we go as midwives in medical intervention in birth? It is very cloudy. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Barry Sonja Sent: Sunday, May 22, 2005 8:36 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation are you saying that the plus or minus 30% of women that are strep B pos all be referred to an ob, even if they are well women with no complications??? Sonja - Original Message - From: Jenny Cameron [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 12:38 PM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] re epidural top ups and iv cannulation
GBS is not normal. What is the cut-off point for midwifery care scope of Px? Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Ken WArd [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 5:06 PM Subject: RE: [ozmidwifery] re epidural top ups and iv cannulation Why involve an obs for GBS? As long as correct procedure is followed, there is little chance of transmission. We give oral abs if prom iv in labour. We don't induce for 48hrs, rather just keep an eye on the woman's temp and ctg at 18hrs and and 24hrs following. We have never had a problem. Our drs rx the abs, antenatally when the woman is diagnosed at 37/40. A lot of our women elect not to be swabbed, and again no probs. All babies are monitored temp etc for 24hrs and parents aware of what to watch for. Lets keep drs away from normal women having nice pregnancies and babies -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Jenny Cameron Sent: Saturday, 21 May 2005 12:39 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 7:43 AM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps? marilyn - Original Message - From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just
Re: [ozmidwifery] re epidural top ups and iv cannulation
From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps? marilyn - Original Message - From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just wanted to share our experience. The move away from an epidural that required top ups in labour to infusion pumps came about when the midwives refused to perform the topups or push a bolus down the epidural line manually. We insisted on the anaesthetists doing this task as they were responsible for the integrity of the line and most certainly for its placement. Our anaesthetists got sick of returning again and again to do this and researched an alternative for themselves that we were happy to work with. In our setting a midwife will assist the anaesthetist with equipment required for epidural insertion, however she never ever pushes any fluids down the line manually. Priming the line is all done by the anaesthetist, he/she connects all lines, filter and tubing to a syringe and together they check the settings on the syringe driver and turn it on. Works for us, women have the analgesia they request, midwives turn the pump off when second stage is noted and many women push their infant actively- although there is still a high number of instrumental births Cheers Alesa Alesa Koziol Clinical Midwifery Educator Melbourne Find local movie times and trailers on Yahoo! Movies. http://au.movies.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] re epidural top ups and iv cannulation
You can access a cannulation study day that is offered by an outside agency. Periodically flyers come round offering these and groups such as MIPP in Victoria organise their own. A group of students wishing to undertake it could organise their own day and the practice on each other. Andrea Quanchi On 21/05/2005, at 8:13 AM, Miriam Hannay wrote: From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps? marilyn - Original Message - From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just wanted to share our experience. The move away from an epidural that required top ups in labour to infusion pumps came about when the midwives refused to perform the topups or push a bolus down the epidural line manually. We insisted on the anaesthetists doing this task as they were responsible for the integrity of the line and most certainly for its placement. Our anaesthetists got sick of returning again and again to do this and researched an alternative for themselves that we were happy to work with. In our setting a midwife will assist the anaesthetist with equipment required for epidural insertion, however she never ever pushes any fluids down the line manually. Priming the line is all done by the anaesthetist, he/she connects all lines, filter and tubing to a syringe and together they check the settings on the syringe driver and turn it on. Works for us, women have the analgesia they request, midwives turn the pump off when second stage is noted and many women push their infant actively- although there is still a high number of instrumental births Cheers Alesa Alesa Koziol Clinical Midwifery Educator Melbourne Find local movie times and trailers on Yahoo! Movies. http://au.movies.yahoo.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.
Re: [ozmidwifery] re epidural top ups and iv cannulation
I take everyones point about it being useful and probably essential for midwives in rural areas to be able to cannulate but don't forget the core skills of midwifery practice during labour are support and assessment of progress and the ability to recognise potential problems. I don't feel comfortable hearing that midwives are performing induction of labour cannulations etc. Or inserting bungs for IV antis for GBS for that matter, If a woman is GBS pos then she should be referred and OBs involved. Who orders the antis?? Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835 0419 528 717 - Original Message - From: Miriam Hannay [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, May 21, 2005 7:43 AM Subject: Re: [ozmidwifery] re epidural top ups and iv cannulation From a student's perspective any discussion on what constitutes a core midwifery skill really interests me. we have a template that needs to be completed and signed off by supervising midwives regarding epidural maintenance. we are supposed to witness a few and then do the top ups ourselves and also remove the catheter after the birth, document etc. This is obviously regarded as an important midwifery skill by our educators. However, I know of VERY few students who have been given the opportunity to acquire cannulation skills. In the tertiary hospital I am currently placed in the RMOs do all the cannulation. Midwives can do it but must do a course to become accredited. This course is not available to students, and as far as i am aware, you must have done a grad years in the hospital to access the course. To me this seems ridiculous! I have no intention of doing a GMP, instead intending to apprentice in private practice before setting out my own shingle. How on earth can I safely practice in the private sector if i am not confident in establishing iv access? to me this is a core midwifery skill that while hopefully rarely utilised is of critical importance when needed. It is a skill I would much prefer to develop than doing maintenance and clean up for our anaeshetists. Also, on the thread of epidurals and instrumental births...in my limited experience what Marilyn mentions is borne out. I have been involved in several births with epidural blocks and have only seen instrumental birth needed when coached pushing was utlised. In those cases where the power of the uterus was allowed to facilitate descent until we had head on view no assistance was required. The power of these women's bodies birthed their babies despite the block and it was marvellous to watch. Miriam (2nd year Bachelor of Midwifery Flinders uni of SA) --- Marilyn Kleidon [EMAIL PROTECTED] wrote: LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births. Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps? marilyn - Original Message - From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just wanted to share our experience. The move away from an epidural that required top ups in labour to infusion pumps came about when the midwives refused to perform the topups or push a bolus down the epidural line manually. We insisted on the anaesthetists doing this task as they were responsible for the integrity of the line and most certainly for its placement. Our anaesthetists got sick of returning again and again to do this and researched an alternative for themselves that we were happy to work with. In our setting a midwife will assist the anaesthetist with equipment required for epidural insertion, however she never ever pushes any fluids down the line manually. Priming the line is all done by the anaesthetist, he/she connects all lines, filter and tubing to a syringe and together they check the settings on the syringe driver and turn it on. Works for us, women have the analgesia they request, midwives turn the pump off when second stage is noted and many women push their infant actively- although there is still a high number of instrumental births Cheers Alesa Alesa Koziol Clinical Midwifery Educator Melbourne Find local movie times and trailers on Yahoo! Movies
