Re: [ozmidwifery] Re: twins birth story
Title: Re: [ozmidwifery] Re: twins birth story Hi Justine, I'll be thinking of you and wish you a wonderful birth. I hope you'll let me read your birth story. My email is [EMAIL PROTECTED] for chatting any time. How are you feeling? All the best, Yvette 8 week old twins, vaginal birth - Original Message - From: Justine Caines To: OzMid List Sent: Sunday, October 23, 2005 6:26 PM Subject: Re: [ozmidwifery] Re: twins birth story Dear YvetteYour little ones look beautiful. Oh to have 2 girls!I am sorry you had all that intervention. I truly hope to avoid all of that in the next few weeks.I may need to chat to you for post-natal coping skills!!Kind regardsJustine34 weeks (twins no idea what, but I bet theres one boy!!)
[ozmidwifery] Re: twins birth story
Hi all, Some of you may remember me going on about trying to plan a vaginal twins birth. Babies are 8 weeks old now here's the full birth story. http://bellybelly.com.au/forums/viewtopic.php?t=15647 Kind Regards, Yvette Mum of 5 http://www.babiesonline.com/babies/t/twingirlslb/
Re: [ozmidwifery] Re: twins birth story
Fantastic Yvette. I have been wondering a lot lately how you went. I wish you all the best for the future. Cheers Judy --- Lindsay Yvette [EMAIL PROTECTED] wrote: Hi all, Some of you may remember me going on about trying to plan a vaginal twins birth. Babies are 8 weeks old now here's the full birth story. http://bellybelly.com.au/forums/viewtopic.php?t=15647 Kind Regards, Yvette Mum of 5 http://www.babiesonline.com/babies/t/twingirlslb/ Do you Yahoo!? Find a local business fast with Yahoo! Local Search http://au.local.yahoo.com Do you Yahoo!? The New Yahoo! Movies: Check out the Latest Trailers, Premiere Photos and full Actor Database. 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: twins birth story
Title: Re: [ozmidwifery] Re: twins birth story Dear Yvette Your little ones look beautiful. Oh to have 2 girls! I am sorry you had all that intervention. I truly hope to avoid all of that in the next few weeks. I may need to chat to you for post-natal coping skills!! Kind regards Justine 34 weeks (twins no idea what, but I bet theres one boy!!)
Re: [ozmidwifery] Re: twins birth story
Congrats Yvette to you and your family kind regards Sally-Anne - Original Message - From: Lindsay Yvette To: ozmidwifery@acegraphics.com.au Sent: Sunday, October 23, 2005 4:59 PM Subject: [ozmidwifery] Re: twins birth story Hi all, Some of you may remember me going on about trying to plan a vaginal twins birth. Babies are 8 weeks old now here's the full birth story. http://bellybelly.com.au/forums/viewtopic.php?t=15647 Kind Regards, Yvette Mum of 5 http://www.babiesonline.com/babies/t/twingirlslb/ No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.344 / Virus Database: 267.12.4/146 - Release Date: 21/10/2005 No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.12.4/146 - Release Date: 21/10/2005
Re: [ozmidwifery] RE Twins (long)
Thankyou for the further replies received from: Justine Caines, Jesse/Jayne, Lieve Huybrechts, Lindsay Kennedy, Leanne Wynne, Ken Ward, Judy Chapman, Mary Murphy, Diane Gardner, Rachele Meredith Bernadine. Lindsay Bernadine, do you have your birth stories posted anywhere I could see them? Leanne, Judy Rachele, thanks heaps for the articles. I've read them printed them out. All 5 seem to conclude that time between twins doesn't need to be limited. Michigan one 2005 113 sets French one 2002 78 sets over 2-3 year period Midwifery Today one 1996, 199 sets, doesn't say where when or by whom ?Portuguese one 50 sets, doesn't say where, when or by whom American one 1984 115 sets 1982 1982 I tried to get into the Cochrane library but you have to pay to subscribe. I had my half hour appointment with a consultant today (the one I had to write to the head of obstetrics to get). What he said is totally at odds with these articles, but I don't get to ask how he's come to the view he has. What he told me today is as follows:- -If both babies are head down, he thinks it would be ok to not even have an epidural in. -If the first one is head down but the second one breech or transverse, then the focus is on avoiding c/section. This is where timing between babies management of second baby comes in. He's told me previously he wouldn't want more than 10 minutes between babies. He reckons contractions start up again in about 15 minutes after the first baby is born, then about 15 minutes after that the cervix starts to reform and the placenta starts to come away. He says once the cervix starts to reform, any chance of birthing the second baby vaginally is stuffed, you can't do anything and so c/section becomes an emergency situation, which we obviously don't want. He says the reason for the very high c/section rate in Victoria, which he now says is 60 to 80%, is because of doctors waiting too long for the second twin, then having no choice because it's too late to reach in. There's also the fact that even consultants often have very little or no experience in grabbing the second baby if it's breech or transverse. The 3 risks for the second baby are the cervix reforming, distress because of placenta, and cord prolapse. -He therefore thinks that if second baby is breech or transverse, I want the best chance of avoiding c/section, then what needs to happen is this: Epidural in place with at least a test dose by 4-5cm dilation, along with drip. Full block in the epidural for 2nd stage. As soon as first baby is born, Syntocinon in the drip to get contractions going asap for second baby, and ready to reach in for 2nd baby if she hasn't come down within 10 minutes. Because epidural needs to be a full block for a reach in, no chance of me being upright. -The shared placenta thing is not a factor in any of this, he doesn't know why I've been told this. (both by a registrar by Monash). -Re induction at 38 weeks, he is absolutely adamant that this is essential. He says 38 weeks for twins is like 42 weeks for singletons. I asked about ways of assessing the condition of the placenta at 38 weeks, ultrasound, non-stress test, that if it all looked good wouldn't it be better to give the babies a bit longer keep a close eye rather than subject them to the risks of induction. What risks? I mentioned the obvious ones briefly, and he said that was because of the finesse of the person administering the Syntocinon. I asked how they know about the placenta deteriorating sooner for twins, and he said because of dead babies. I asked so have they examined the placentas and found something wrong with them? Didn't get any further with this discussion, he started going on about babies in India suffering because of lack of intervention. So if both head down it looks good. If the first one is not head down it's planned c/section all new questions, I'll know after about 35 weeks how that's looking. If first one is head down and second one isn't, then I have to make decisions. And if I get to 38 weeks I have that decision to make too. Ag! I'm wondering, if I say no to the epidural, or yes to the epidural no to the Syntocinon, and we're monitoring the 2nd baby's heartbeat position, and it's been 10 minutes she's transverse, or breech still high up, to keep waiting or not, and if we do, what if the heartrate does start to drop. The doctor's argument would be it's already too late to get pain relief for a reach in so it'll be c/section. If I do allow the epidural, to serve the purpose of preventing c/section in this situation I would have to have drugs in it, meaning I'm not upright, meaning it's harder for the second baby to come down, meaning high chance of reach in. What if all that was in place but the consultant or registrar doesn't know how to reach in for a breech anyway? At the
RE: [ozmidwifery] RE Twins (long)
Thanks for the update. Hope both bubbies are head first when the time comes. Will be thinking of you. Maureen -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lindsay Yvette Sent: Wednesday, 22 June 2005 6:14 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] RE Twins (long) Thankyou for the further replies received from: Justine Caines, Jesse/Jayne, Lieve Huybrechts, Lindsay Kennedy, Leanne Wynne, Ken Ward, Judy Chapman, Mary Murphy, Diane Gardner, Rachele Meredith Bernadine. Lindsay Bernadine, do you have your birth stories posted anywhere I could see them? Leanne, Judy Rachele, thanks heaps for the articles. I've read them printed them out. All 5 seem to conclude that time between twins doesn't need to be limited. Michigan one 2005 113 sets French one 2002 78 sets over 2-3 year period Midwifery Today one 1996, 199 sets, doesn't say where when or by whom ?Portuguese one 50 sets, doesn't say where, when or by whom American one 1984 115 sets 1982 1982 I tried to get into the Cochrane library but you have to pay to subscribe. I had my half hour appointment with a consultant today (the one I had to write to the head of obstetrics to get). What he said is totally at odds with these articles, but I don't get to ask how he's come to the view he has. What he told me today is as follows:- -If both babies are head down, he thinks it would be ok to not even have an epidural in. -If the first one is head down but the second one breech or transverse, then the focus is on avoiding c/section. This is where timing between babies management of second baby comes in. He's told me previously he wouldn't want more than 10 minutes between babies. He reckons contractions start up again in about 15 minutes after the first baby is born, then about 15 minutes after that the cervix starts to reform and the placenta starts to come away. He says once the cervix starts to reform, any chance of birthing the second baby vaginally is stuffed, you can't do anything and so c/section becomes an emergency situation, which we obviously don't want. He says the reason for the very high c/section rate in Victoria, which he now says is 60 to 80%, is because of doctors waiting too long for the second twin, then having no choice because it's too late to reach in. There's also the fact that even consultants often have very little or no experience in grabbing the second baby if it's breech or transverse. The 3 risks for the second baby are the cervix reforming, distress because of placenta, and cord prolapse. -He therefore thinks that if second baby is breech or transverse, I want the best chance of avoiding c/section, then what needs to happen is this: Epidural in place with at least a test dose by 4-5cm dilation, along with drip. Full block in the epidural for 2nd stage. As soon as first baby is born, Syntocinon in the drip to get contractions going asap for second baby, and ready to reach in for 2nd baby if she hasn't come down within 10 minutes. Because epidural needs to be a full block for a reach in, no chance of me being upright. -The shared placenta thing is not a factor in any of this, he doesn't know why I've been told this. (both by a registrar by Monash). -Re induction at 38 weeks, he is absolutely adamant that this is essential. He says 38 weeks for twins is like 42 weeks for singletons. I asked about ways of assessing the condition of the placenta at 38 weeks, ultrasound, non-stress test, that if it all looked good wouldn't it be better to give the babies a bit longer keep a close eye rather than subject them to the risks of induction. What risks? I mentioned the obvious ones briefly, and he said that was because of the finesse of the person administering the Syntocinon. I asked how they know about the placenta deteriorating sooner for twins, and he said because of dead babies. I asked so have they examined the placentas and found something wrong with them? Didn't get any further with this discussion, he started going on about babies in India suffering because of lack of intervention. So if both head down it looks good. If the first one is not head down it's planned c/section all new questions, I'll know after about 35 weeks how that's looking. If first one is head down and second one isn't, then I have to make decisions. And if I get to 38 weeks I have that decision to make too. Ag! I'm wondering, if I say no to the epidural, or yes to the epidural no to the Syntocinon, and we're monitoring the 2nd baby's heartbeat position, and it's been 10 minutes she's transverse, or breech still high up, to keep waiting or not, and if we do, what if the heartrate does start to drop. The doctor's argument would be it's already too late to get pain relief for a reach in so it'll be c/section. If I do allow the epidural, to serve the purpose of preventing c/section in this situation I
Re: [ozmidwifery] RE Twins (long)
Does the cervix reform after the birth of the first twin? Does it then start right from the beginning and have to efface and dilate all over again? What kind of time frame are we looking at? Sonja - Original Message - From: Lindsay Yvette [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Wednesday, June 22, 2005 6:13 PM Subject: Re: [ozmidwifery] RE Twins (long) Thankyou for the further replies received from: Justine Caines, Jesse/Jayne, Lieve Huybrechts, Lindsay Kennedy, Leanne Wynne, Ken Ward, Judy Chapman, Mary Murphy, Diane Gardner, Rachele Meredith Bernadine. Lindsay Bernadine, do you have your birth stories posted anywhere I could see them? Leanne, Judy Rachele, thanks heaps for the articles. I've read them printed them out. All 5 seem to conclude that time between twins doesn't need to be limited. Michigan one 2005 113 sets French one 2002 78 sets over 2-3 year period Midwifery Today one 1996, 199 sets, doesn't say where when or by whom ?Portuguese one 50 sets, doesn't say where, when or by whom American one 1984 115 sets 1982 1982 I tried to get into the Cochrane library but you have to pay to subscribe. I had my half hour appointment with a consultant today (the one I had to write to the head of obstetrics to get). What he said is totally at odds with these articles, but I don't get to ask how he's come to the view he has. What he told me today is as follows:- -If both babies are head down, he thinks it would be ok to not even have an epidural in. -If the first one is head down but the second one breech or transverse, then the focus is on avoiding c/section. This is where timing between babies management of second baby comes in. He's told me previously he wouldn't want more than 10 minutes between babies. He reckons contractions start up again in about 15 minutes after the first baby is born, then about 15 minutes after that the cervix starts to reform and the placenta starts to come away. He says once the cervix starts to reform, any chance of birthing the second baby vaginally is stuffed, you can't do anything and so c/section becomes an emergency situation, which we obviously don't want. He says the reason for the very high c/section rate in Victoria, which he now says is 60 to 80%, is because of doctors waiting too long for the second twin, then having no choice because it's too late to reach in. There's also the fact that even consultants often have very little or no experience in grabbing the second baby if it's breech or transverse. The 3 risks for the second baby are the cervix reforming, distress because of placenta, and cord prolapse. -He therefore thinks that if second baby is breech or transverse, I want the best chance of avoiding c/section, then what needs to happen is this: Epidural in place with at least a test dose by 4-5cm dilation, along with drip. Full block in the epidural for 2nd stage. As soon as first baby is born, Syntocinon in the drip to get contractions going asap for second baby, and ready to reach in for 2nd baby if she hasn't come down within 10 minutes. Because epidural needs to be a full block for a reach in, no chance of me being upright. -The shared placenta thing is not a factor in any of this, he doesn't know why I've been told this. (both by a registrar by Monash). -Re induction at 38 weeks, he is absolutely adamant that this is essential. He says 38 weeks for twins is like 42 weeks for singletons. I asked about ways of assessing the condition of the placenta at 38 weeks, ultrasound, non-stress test, that if it all looked good wouldn't it be better to give the babies a bit longer keep a close eye rather than subject them to the risks of induction. What risks? I mentioned the obvious ones briefly, and he said that was because of the finesse of the person administering the Syntocinon. I asked how they know about the placenta deteriorating sooner for twins, and he said because of dead babies. I asked so have they examined the placentas and found something wrong with them? Didn't get any further with this discussion, he started going on about babies in India suffering because of lack of intervention. So if both head down it looks good. If the first one is not head down it's planned c/section all new questions, I'll know after about 35 weeks how that's looking. If first one is head down and second one isn't, then I have to make decisions. And if I get to 38 weeks I have that decision to make too. Ag! I'm wondering, if I say no to the epidural, or yes to the epidural no to the Syntocinon, and we're monitoring the 2nd baby's heartbeat position, and it's been 10 minutes she's transverse, or breech still high up, to keep waiting or not, and if we do, what if the heartrate does start to drop. The doctor's argument would be it's already too late to get pain relief
Re: [ozmidwifery] RE Twins
spontaneous. No cesarean deliveries were performed. The Apgar assessment scores of the newborns, at both 1 and 5 minutes after birth, were identical at the two units. The proportions of second twins transferred to the neonatal intensive care unit were also similar at both units, at 18-19 percent. Equivalent outcomes After reviewing these and many other indicators of health, the researchers conclude: The neonatal results were similar in both groups, even though both the rate of obstetric maneuvers and the interbirth interval differed significantly. The two methods therefore appear to be equivalent when judged by the second twin's neonatal indicators. They call for further research to verify whether an active approach helps to avoid or reduce the risk of cesarean delivery. The researchers finish by making an important observation about a risk associated with the expectant approach that could not be quantified in the study: This risk is the unfamiliarity or loss of clinical experience with the obstetric maneuvers involved in version by intra-uterine manipulations and total extraction, and thus to be unequipped to perform them on the day they are indispensable. They therefore suggest that tertiary maternity units promote the active approach to second-twin delivery, to ensure adequate training of interns, residents and student midwives. From: Lindsay Yvette [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] RE Twins Date: Thu, 2 Jun 2005 10:54:38 +1000 Thanks for your reply Lieve. What state are you in? I'm certainly not keen to let them induce if I get to 38 weeks. They say there is no way of telling the condition of the placenta, and that there's evidence or studies to show significant increase in worse outcomes after 38 weeks or something like that, but I don't know yet what studies/evidence they're relying on re this. I will be asking for details as soon as they let me see someone. I see with the second one you described there was 1/2 hour between babies for monochorionic diamniotic twins. I'm not convinced about the 10 minute thing either, and they'll have to give me details of what evidence they're relying on if they want me to consider this seriously as well. I'm starting to think I should place the onus more on them to prove to me why I should adhere to their recommendations rather than the other way around. If they can let me see the info myself I can consider it, but I don't think I should just take their word for it. I met another pregnant mum yesterday, same type of twins as me and in a public hospital in Melbourne too. She's having the same issues as me. She doesn't want an epidural and has been told she has to have one. She waits up to 2 hours for a rushed 10 minute appointment with an Ob, then doesn't get to ask any questions. We'll be staying in touch; she's due a few weeks before me. Yvette (pg with monochorionic diamniotic twins due 5th Sept). Hello Yvette, I just want to tell you my excperience. I accompagned two twin births this year in the hospital. We have there very good supporting obs, that are very confident with breech and twin births. Lieve -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] RE Twins/placenta
Surely the condition of the placenta can be monitored by fetal movements and growth. An unhealthy placenta is going to affect the baby quickly. Placentas do deteriorate towards the end of pregnancy, that's one reason they don't like babies to go too far past term. But then there are ways to assess fetal wellbeing that has to also reveal the placentas condition. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of jesse/jayne Sent: Thursday, 2 June 2005 12:11 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] RE Twins/placenta And, can the condition of twins placenta/s be expected to deteriorate earlier than a singleton's?? Jayne - Original Message - From: Justine Caines [EMAIL PROTECTED] To: OzMid List ozmidwifery@acegraphics.com.au Sent: Thursday, June 02, 2005 11:28 AM Subject: Re: [ozmidwifery] RE Twins They say there is no way of telling the condition of the placenta, Hello Midwives out there Is the above true?? Is it specific to twins? I thought an ultrasound could certainly show the condition of the placenta JC -- 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. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] RE Twins
twin's delivery very difficult, if not impossible, the researchers note. The active approach aims to limit the duration of the interval between the two births. After the birth of twin A, the artificial rupture of the membranes must be followed by twin B's birth, either spontaneously or assisted by obstetric maneuvers. At the Port-Royal, the average time between the two births was 5 minutes, and 43 percent of twin B births involved substantial intra-uterine manipulations to assist vaginal delivery. Only 27 percent of the deliveries were spontaneous. No cesarean deliveries were performed. The Apgar assessment scores of the newborns, at both 1 and 5 minutes after birth, were identical at the two units. The proportions of second twins transferred to the neonatal intensive care unit were also similar at both units, at 18-19 percent. Equivalent outcomes After reviewing these and many other indicators of health, the researchers conclude: The neonatal results were similar in both groups, even though both the rate of obstetric maneuvers and the interbirth interval differed significantly. The two methods therefore appear to be equivalent when judged by the second twin's neonatal indicators. They call for further research to verify whether an active approach helps to avoid or reduce the risk of cesarean delivery. The researchers finish by making an important observation about a risk associated with the expectant approach that could not be quantified in the study: This risk is the unfamiliarity or loss of clinical experience with the obstetric maneuvers involved in version by intra-uterine manipulations and total extraction, and thus to be unequipped to perform them on the day they are indispensable. They therefore suggest that tertiary maternity units promote the active approach to second-twin delivery, to ensure adequate training of interns, residents and student midwives. From: Lindsay Yvette [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] RE Twins Date: Thu, 2 Jun 2005 10:54:38 +1000 Thanks for your reply Lieve. What state are you in? I'm certainly not keen to let them induce if I get to 38 weeks. They say there is no way of telling the condition of the placenta, and that there's evidence or studies to show significant increase in worse outcomes after 38 weeks or something like that, but I don't know yet what studies/evidence they're relying on re this. I will be asking for details as soon as they let me see someone. I see with the second one you described there was 1/2 hour between babies for monochorionic diamniotic twins. I'm not convinced about the 10 minute thing either, and they'll have to give me details of what evidence they're relying on if they want me to consider this seriously as well. I'm starting to think I should place the onus more on them to prove to me why I should adhere to their recommendations rather than the other way around. If they can let me see the info myself I can consider it, but I don't think I should just take their word for it. I met another pregnant mum yesterday, same type of twins as me and in a public hospital in Melbourne too. She's having the same issues as me. She doesn't want an epidural and has been told she has to have one. She waits up to 2 hours for a rushed 10 minute appointment with an Ob, then doesn't get to ask any questions. We'll be staying in touch; she's due a few weeks before me. Yvette (pg with monochorionic diamniotic twins due 5th Sept). Hello Yvette, I just want to tell you my excperience. I accompagned two twin births this year in the hospital. We have there very good supporting obs, that are very confident with breech and twin births. Lieve -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Send instant messages to your online friends http://au.messenger.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] RE Twins/placenta
There is research that says placentas go on making new cells, even at the 'end' of the gestation period. (no I don't have the reference, just something I skimmed over one time)Also,some placentas can malfunction even at 28 weeks and others don't at 42 + weeks, so it is not necessarily a time thing . MM growth. An unhealthy placenta is going to affect the baby quickly. Placentas do deteriorate towards the end of pregnancy, that's one reason they don't like babies to go too far past term. But then there are ways to assess fetal wellbeing that has to also reveal the placentas condition. And, can the condition of twins placenta/s be expected to deteriorate earlier than a singleton's?? Jayne Subject: Re: [ozmidwifery] RE Twins They say there is no way of telling the condition of the placenta, Hello Midwives out there Is the above true?? Is it specific to twins? I thought an ultrasound could certainly show the condition of the placenta JC -- 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. -- 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 Twins
Thanks for your reply Lieve. What state are you in? I'm certainly not keen to let them induce if I get to 38 weeks. They say there is no way of telling the condition of the placenta, and that there's evidence or studies to show significant increase in worse outcomes after 38 weeks or something like that, but I don't know yet what studies/evidence they're relying on re this. I will be asking for details as soon as they let me see someone. I see with the second one you described there was 1/2 hour between babies for monochorionic diamniotic twins. I'm not convinced about the 10 minute thing either, and they'll have to give me details of what evidence they're relying on if they want me to consider this seriously as well. I'm starting to think I should place the onus more on them to prove to me why I should adhere to their recommendations rather than the other way around. If they can let me see the info myself I can consider it, but I don't think I should just take their word for it. I met another pregnant mum yesterday, same type of twins as me and in a public hospital in Melbourne too. She's having the same issues as me. She doesn't want an epidural and has been told she has to have one. She waits up to 2 hours for a rushed 10 minute appointment with an Ob, then doesn't get to ask any questions. We'll be staying in touch; she's due a few weeks before me. Yvette (pg with monochorionic diamniotic twins due 5th Sept). Hello Yvette, I just want to tell you my excperience. I accompagned two twin births this year in the hospital. We have there very good supporting obs, that are very confident with breech and twin births. Lieve -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] RE Twins
They say there is no way of telling the condition of the placenta, Hello Midwives out there Is the above true?? Is it specific to twins? I thought an ultrasound could certainly show the condition of the placenta JC -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] RE Twins/placenta
And, can the condition of twins placenta/s be expected to deteriorate earlier than a singleton's?? Jayne - Original Message - From: Justine Caines [EMAIL PROTECTED] To: OzMid List ozmidwifery@acegraphics.com.au Sent: Thursday, June 02, 2005 11:28 AM Subject: Re: [ozmidwifery] RE Twins They say there is no way of telling the condition of the placenta, Hello Midwives out there Is the above true?? Is it specific to twins? I thought an ultrasound could certainly show the condition of the placenta JC -- 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 Twins
Hello Yvette, I live in Belgium, Europe. The best way to interprete the condition of your placenta are the signs your twins and your body will give you. Feel for changes in the movements. When the baby's feel like in a playgarden there is nothing wrong with your placenta. When the baby's become quiet then you have to be alert. It is a myth that baby's stop moving so much at the end of the pregnancy. So feel what they tell you and feel also your body for signs of fear of tension. Also your body will tell you if something is going wrong. When the placenta's condition is not so well, your bloodpression will rise and your will have swollen feet and hands. Also other signs of unwellness are important. But even then you have to consider the risks of inducion against waiting and respect the signs by giving your body the rest and relaxation it needs. Organise already the last weeks help in your housekeeping and make your life as pleasant as you can. Read those books you ever wanted to read, go for small walks and enjoy your life. I will not answer mails now till Tuesday. I am leaving for Finland in an hour. Greetings Lieve -Oorspronkelijk bericht- Van: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Namens Lindsay Yvette Verzonden: donderdag 2 juni 2005 2:55 Aan: ozmidwifery@acegraphics.com.au Onderwerp: Re: [ozmidwifery] RE Twins Thanks for your reply Lieve. What state are you in? I'm certainly not keen to let them induce if I get to 38 weeks. They say there is no way of telling the condition of the placenta, and that there's evidence or studies to show significant increase in worse outcomes after 38 weeks or something like that, but I don't know yet what studies/evidence they're relying on re this. I will be asking for details as soon as they let me see someone. I see with the second one you described there was 1/2 hour between babies for monochorionic diamniotic twins. I'm not convinced about the 10 minute thing either, and they'll have to give me details of what evidence they're relying on if they want me to consider this seriously as well. I'm starting to think I should place the onus more on them to prove to me why I should adhere to their recommendations rather than the other way around. If they can let me see the info myself I can consider it, but I don't think I should just take their word for it. I met another pregnant mum yesterday, same type of twins as me and in a public hospital in Melbourne too. She's having the same issues as me. She doesn't want an epidural and has been told she has to have one. She waits up to 2 hours for a rushed 10 minute appointment with an Ob, then doesn't get to ask any questions. We'll be staying in touch; she's due a few weeks before me. Yvette (pg with monochorionic diamniotic twins due 5th Sept). Hello Yvette, I just want to tell you my excperience. I accompagned two twin births this year in the hospital. We have there very good supporting obs, that are very confident with breech and twin births. Lieve -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.3.3 - Release Date: 31/05/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.3.3 - Release Date: 31/05/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] RE Twins
There is a study currently being done to assess induction/caesarean section at 38 weeks for twins. Apparently there is suggestions of deterioration in outcomes after that. Having said that I had twins at 40 weeks (by induction in the end) and they were 30 minutes apart with no apparent problems. Lindsay -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lieve Huybrechts Sent: Thursday, 2 June 2005 2:19 PM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] RE Twins Hello Yvette, I live in Belgium, Europe. The best way to interprete the condition of your placenta are the signs your twins and your body will give you. Feel for changes in the movements. When the baby's feel like in a playgarden there is nothing wrong with your placenta. When the baby's become quiet then you have to be alert. It is a myth that baby's stop moving so much at the end of the pregnancy. So feel what they tell you and feel also your body for signs of fear of tension. Also your body will tell you if something is going wrong. When the placenta's condition is not so well, your bloodpression will rise and your will have swollen feet and hands. Also other signs of unwellness are important. But even then you have to consider the risks of inducion against waiting and respect the signs by giving your body the rest and relaxation it needs. Organise already the last weeks help in your housekeeping and make your life as pleasant as you can. Read those books you ever wanted to read, go for small walks and enjoy your life. I will not answer mails now till Tuesday. I am leaving for Finland in an hour. Greetings Lieve -Oorspronkelijk bericht- Van: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Namens Lindsay Yvette Verzonden: donderdag 2 juni 2005 2:55 Aan: ozmidwifery@acegraphics.com.au Onderwerp: Re: [ozmidwifery] RE Twins Thanks for your reply Lieve. What state are you in? I'm certainly not keen to let them induce if I get to 38 weeks. They say there is no way of telling the condition of the placenta, and that there's evidence or studies to show significant increase in worse outcomes after 38 weeks or something like that, but I don't know yet what studies/evidence they're relying on re this. I will be asking for details as soon as they let me see someone. I see with the second one you described there was 1/2 hour between babies for monochorionic diamniotic twins. I'm not convinced about the 10 minute thing either, and they'll have to give me details of what evidence they're relying on if they want me to consider this seriously as well. I'm starting to think I should place the onus more on them to prove to me why I should adhere to their recommendations rather than the other way around. If they can let me see the info myself I can consider it, but I don't think I should just take their word for it. I met another pregnant mum yesterday, same type of twins as me and in a public hospital in Melbourne too. She's having the same issues as me. She doesn't want an epidural and has been told she has to have one. She waits up to 2 hours for a rushed 10 minute appointment with an Ob, then doesn't get to ask any questions. We'll be staying in touch; she's due a few weeks before me. Yvette (pg with monochorionic diamniotic twins due 5th Sept). Hello Yvette, I just want to tell you my excperience. I accompagned two twin births this year in the hospital. We have there very good supporting obs, that are very confident with breech and twin births. Lieve -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.3.3 - Release Date: 31/05/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.3.3 - Release Date: 31/05/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.4.0 - Release Date: 1/06/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.4.0 - Release Date: 1/06/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] RE Twins
Hello Yvette, I just want to tell you my excperience. I accompagned two twin births this year in the hospital. We have there very good supporting obs, that are very confident with breech and twin births. The first mother was due jan 13th and went in spontaneous labor jan 18th. It was her first pregnancy. First the doctor also mentioned inducing on due date (not 38 weeks) but mother negotiated and could wait until spontaneous labour. Het membranes ruptured Sunday evening without labour, Monday morning she got stimulation and went in labour at noon. Slow progression, but at midnight she was complete, but no pushing urge. We waited for 1 1/2 hours and thn she felt some pushing urge, but not enough to get to good pushing. At the end doctor tried with ventousse, gave an epidural and tried again (but no violence) and then we had to perform a c-section. First baby was so in assynclitisme that he couldn't engage deeper. Mother and babys were fine after the marathon they had and she has a very good feeling with the birth. She is always informed at every stage about possibilitys and made her own choices. I had the privilege to be her midwife and could stay with them all the time. After the c-section babys stayed with her, breastfeeding was no problem and till this moment they are exclusively breastfed. The second twin mother went in spontaneous labour at 36 weeks and gave birth on the birthing chair with only some oxytocine for second twin, born 1/2 hour after the first, they were monochorionic diamniotic. She could hold the first one for 20 minutes before pushing the second out and immediatly both babys were given to her. She also had a midwife exclusively for her. She returned home after 5 days, they request her to stay for the birth weight (2460gr and 2620 gr)and pregnancy of 36 weeks. Baby's received some cupfeeding and mother put them on the breast and pumped. On day 9 they have exclusively breastfeeding and both regained birthweight. It was her 3th pregnancy with 1 homebirth. So 38 weeks is never been an issue for the obs and also epidural was no must. Even though the first ended in c-section they had plenty of time to give her the epidural to perform the c-section. I think you are privileged to have your own midwife. I wish you a great birth and lovely children. Lieve -Oorspronkelijk bericht- Van: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Namens Lindsay Yvette Verzonden: zaterdag 28 mei 2005 11:41 Aan: ozmidwifery@acegraphics.com.au Onderwerp: Re: [ozmidwifery] RE Twins Thankyou Ken, Andrea, and Sue for your replies. Andrea we can't afford a home birth. I do have the maternitycoalition.org site bookmarked, it's great. What you said about the epidural with the test dose is interesting, and you've obviously seen happen all the things I'm fearing. I can be pretty assertive if I feel confident enough in what I believe, so I'm hoping that armed with lots of info knowing what they will try to do, I'll be able to handle it politely but firmly say no where I need to. Sue, thanks so much for that info re the 18 sets of homebirth twins.. I bet Ina May's stats are great too. It's a real worry about the time limit for the second baby. I want to find out what they're worried about so I can argue for more time if necessary. I wonder if having 3 kids before will make the second baby more likely to come down more quickly? Going past 38 weeks if it happens will be a worry too. I hope I just go at 37 weeks 6 days, lol. Waiting on my reply from the head of obstetrics. Mentioned to my GP that I'd written the letter to the hospital. She gave me the name of the head of obstetrics says he's very approachable will see me himself, if not she'll ring him for me. She thinks I'll have no trouble getting to see someone in anaesthetics too. (She's an Ob too used to work there until recently). I have a detailed birth plan I'm working on, but not putting it in til I have heaps more info. Want to make it simple enough for them to refer to easily, assertive so they get the point that nothing is to be done without my consent, clear about what I want, but friendly sounding iykwim. Will keep you posted about how it goes, glad you're interested. And any additional info gratefully received. Yvette (pg with monochorionic diamniotic twins due 5th Sept.) -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.2.0 - Release Date: 27/05/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.322 / Virus Database: 267.2.0 - Release Date: 27/05/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] RE Twins
Hi Yvette, Good luck with your twins birth - I've only attended twins at home, but I can empathise with your desire and concerns about wanting a normal birth in a hospital setting. I am currently looking at twins births through all my texts - including one called 'High Risk Pregnancy Delivery' and most of the major concerns are around the mono/mono scene where there is a higher risk of entanglement of cord/bodies etc. Your situation looks great for a good birth, and as you've been told, best if first baby is head down for everyone's peace of mind. You could really encourage this as I'm sure you're aware, by dialoguing with your babes. The time limit of ten minutes between babies seems absurd - I have records here for 18 sets of homeborn twins. The average time between babies for 16 births was 27 minutes, ranging from 7 mins to 90 minutes, with only 5 sets arriving within the 10 minute time frame. One of the other sets were 23 hours apart, and the other I don't have the time difference for. Placentas were birthed between 1 and 60 minutes after the second baby. There was one cord prolapse of a first born breech twin, who then came quickly and was fine. One of the sets of twins died in utero before labour began at 38 weeks (they shared a placenta and were possibly identical as they both has the same slight abnormality, but I can't confirm that), and all the others arrived in fine form. Their gestational ages varied from 42 days early to 14 days overdue for 15 sets, with 7 sets arriving 21-42 days early, 2 sets 7 days early and 6 sets term or overdue; 2 dates were unknown and one set I don't have that information. I am also currently waiting for statistics from The Farm where Ina May Gaskin and her team of midwives have delivered twins. I am aware of current hospital practice of rushing the second baby, usually then born by c/section, but in the last year I have heard about 2 sets born normally at our local large teaching hospital, so it does happen and there is hope, particularly if you are armed with your own midwife, and are well informed. Good luck Yvette and I hope this information helps, Sue Cookson -Original Message-[Ken Ward] *From:* [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of *Lindsay Yvette *Sent:* Thursday, 26 May 2005 3:26 PM *To:* ozmidwifery@acegraphics.com.au *Subject:* [ozmidwifery] monochorionic diamniotic twins birth in a public hospital, hopefully vaginal. Hello list. I've subscribed so I can submit details of my situation for anyone who wants to respond, and so I can keep an eye out for anything that comes up about twins births. I'm not a midwife or anything, so I hope it's ok to do this. I'm a public patient at Box Hill hospital in Melbourne, and due to have twin girls on 5th Sept, or by 38 weeks which is 22nd Aug. They are identical, sharing a placenta but each in her own amniotic sac. I want a vaginal birth without unnecessary intervention provided this is safe. I'm looking for any advice, information, studies, articles, comments etc relevant to my situation. I'm having ultrasounds every 2 weeks, and no signs of TTTS as yet, though their sizes have been varying. The baby girls have been fine and are kicking and wiggling nicely. The hospital has a 'know your midwife' thing, so I know and am happy with the midwife who will be attending me. She was with me for the birth of my 11 month old son at the same hospital. I'll also have my husband and a support person with me, and hopefully my 2 daughters, 12 8. My daughters were both born at home, and all 3 of my births so far have been vaginal with no drugs or intervention. I'm 39 and in good health, no GD, no high BP ever, no health probs. I'm 5'6 and 75 kg at 25 weeks. I've always gone 13 hours from the very first contraction, and the waters have always broken 1-3 hours before the birth, with the head never engaging until well into labour. My son turned himself from posterior a couple of hours before birth while I was lying on my side. The hospital tell me I will have one of the 11 consultants attending me, and he/she will be running it, but my midwife may get to catch the first baby. They say I must be induced if I get past 38 weeks, and they very much want me to have an epidural incase of needing to reach in for the second baby. They don't want more than 10 mins between babies. One Ob I saw said no vaginal births are done for this type of pg, one I've seen since then says it can be attempted if 1st one presents head down, but 65% of all twins in Melb are born by c/section. I've asked about having the epi in with no drugs in it, but it seems it depends on the views/wishes of whichever anaesthetist happens to be on when I get there. If I go earlier than 32-34 weeks I get
re twins
Hello Anne. Yes, it's a good story to share. Regards, Liz. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Fw: Re Twins
Dear Liz, Thank you so much for that good story. Well done!! My daughter is now 26/40, well and confident. I will keep the list posted. Regards, Joy Joy Cocks RN (Div 1) RM CBE IBCLC BRIGHT Vic 3741 email:[EMAIL PROTECTED] - Original Message - From: Liz Ekins [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Thursday, 23 May 2002 16:05 Subject: Re Twins Greetings, Joy 2days ago I visited homebirth twins I attended at the end of December and they're thriving! Mum was firmly of the opinion that she wanted them born at home, the one scan she had showed separate placentas. One baby was breech at 35 weeks. Labour started progressed quickly at 36 weeks, 2nd midwife unavailable but competent support couple were present. First little chap(2440g) came head first, pink, took in the scene then straight to the breast. 25 mins later his sister(2090g) arrived, complete breech, very pale, good heart rate, not ready to take a breath. I bagged her for perhaps 2 mins (how reassuring it was to see her chest rise with each puff) and she was soon pink but needed time to recover. However, from the expression in her eyes she was very much with us. After 2 hours she still was not interested in mum's breast so she commenced 2hrly colostrum feeds by eye dropper. 8 hrs after birth she took mum's breast in her mouth but no suck so they continued 2hrly eyedropper feeds. 14 1/2hrs after her birth she decided she really did want titty and sucked vigorously mostly on but sometimes off for the next 6 hours! She really hasn't looked back since. Thoughts..I would have preferred the 2nd midwife to be present (my first time twins at home) but trusted the mother when I expressed my small self-doubt. She felt confident in her body and babies and her support people and reiterated that she really did want to birth in the familiarity and privacy of her own home. Driving to the home and during the births I kept coming back to all those superb midwives and educators who have paved the way and stressed the importance of maintaining and practicing midwifery skills. I also thought of all the wee mites who were born and survived beautifully at home. Imagine the scenario in hospital. Possible C-section for the 2nd twin, certainly S.C.U., with heel pricks and gavage feeds ?? Separation from mum,etc. I hope your daughter and babies have an optimal birthing - best wishes! Liz -- 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.
Urgent help re twins at home statistics
Hi everyone, I have been asked to attend a 'hearing' on May 16 in support of a homebirth midwife after a twins transfer. Both babies and mother are fine - second twin was born small (1.2kg) and did require a blood transfusion at 2 weeks. It appears to me to be the typical 'you don't have the right to do this' sort of affair, and what I need is statistics on twins born at home - international statistics probably, as I have the official Homebirth Australia ones. Can anyone help please?? It may also help if I have stats on twins born in hospitals and their outcomes, incidences of intrauterine compromises in twins and anything else that may be relevant. Hoping our collective knowledge can assist in educating those who choose to sit in judgement, Sue Cookson -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Urgent help re twins born at home
Sue You might like to try this homebirth web site for info - it has loads of research on the site: http://www.homebirth.org.uk/ It''s UK biased, but may have some info of use for you. Debbie Slater CBE Perth, WA
Re: twins
Looking over some old emails I thought worthy of keeping and found this. Has anyone any idea how things are going and what model of care she was able to access? Thanks, Mary Murphy - Original Message - From: Marian Bullard To: [EMAIL PROTECTED] Sent: Wednesday, September 26, 2001 4:33 PM Subject: twins Hi Jan Your comments in regard to twins is a dilema I am faced with in a very personal way. My very precious niece had just joined our local team midwifery program and her excitement was great. Much to her delight she now finds she is having twins, unfortunately I practice in a low risk unit that excludes her from midwifery care. I am so loath to advise her to attend the mainstream clinic for fear of the fear that seems to be generated from various medical officers. I purchased a video from the multiple birth association at the acmi conference in brisbane, imagine my horror that the first birth is a c/section and the so called "normal' birth is a ventouse delivery in a private hospital with midwifery care being alluded to in a very minor way. Can you suggest any reading material or videos related to twins, to support this beautiful young couple in deciding what the best options are for them. I am really trying to give them a realistic picture of what is possible with each option. I have floated the home birth idea but would also like to think the "system' could meet their needs if they chose that option. Does anyone else have an ideas? Thanks Marian
Re: twins
Title: Re: twins Hi Marion, Have a read of the latest AIMS journal about the twin breech birth I was involved with. Manju was amazing! Leigh - Original Message - From: Jan Robinson To: Marian Bullard Cc: [EMAIL PROTECTED] Sent: Thursday, October 04, 2001 10:36 PM Subject: Re: twins Hi Jan Your comments in regard to twins is a dilema I am faced with in a very personal way. My very precious niece had just joined our local team midwifery program and her excitement was great. Much to her delight she now finds she is having twins, unfortunately I practice in a low risk unit that excludes her from midwifery care. I am so loath to advise her to attend the mainstream clinic for fear of the fear that seems to be generated from various medical officers. I purchased a video from the multiple birth association at the acmi conference in brisbane, imagine my horror that the first birth is a c/section and the so called "normal' birth is a ventouse delivery in a private hospital with midwifery care being alluded to in a very minor way. Can you suggest any reading material or videos related to twins, to support this beautiful young couple in deciding what the best options are for them. I am really trying to give them a realistic picture of what is possible with each option. I have floated the home birth idea but would also like to think the "system' could meet their needs if they chose that option. Does anyone else have an ideas? Thanks Marian Hi Marian There is a great up-to-date book (probably available through libraries if your niece does not want to purchase) called MOTHERING MULTIPLES - Breastfeeding Caring for Twins (or more!!!) by Karen Kerkhoff Gromada - La Leche Leage International Revised Edition. This is a good book to help your niece focus on her future life with twins. Provide your niece and her husband with as much information as they can digest. Current evidence will help empower them when negotiating their birth plans with any health professionals involved in their care. Make sure your niece understands the necessity for additional rest towards the third trimester and that she makes arrangements to get it! Can other family members or friends pitch in and take over some of the household chores for her after she gets to thirty weeks? She increases her chances of getting the babies to term if she can achieve a rest period every day. Establish the whereabouts of the local multiples group and give your niece the contact details. Drag out your midwifery textbooks usually and all the 'twins' articles you can find in Midwifery Today, MIDIRS current journals, etc. All the twin birth stories (thoses with great outcomes along with the not so great outcomes) should be discussed and understood. Help the couple write their birth plans and make a copy to present to the consulting obstetrician. If your niece does not want to use drugs during labour and wants to stay upright she should put it in writing and discuss this with the attending obstetrician during pregnancy. Having a written birth plan will help negotiate the type of labour and birth care she desires. She will also be better equiped to decline offers of unecessary intervention as well as accept and understand the reasons for any necessary ones. The couple will do better if they have a midwifery advocate during visits to any attending medical officers. Perhaps that person could be you and you could follow them through and be their support person during labour as well. If this does not sit well with you there must be some local midwife who you would trust to provide advocacy for them in a similar fashion. Continuity of care (apart from any others involved) will do wonders for the birth outcome. I am looking forward to hear of your niece's progress. Jan -- __Jan Robinson Phone/fax: 011+ 61+ 2+ 9546 4350Independent Midwife Practitioner e-mail: [EMAIL PROTECTED]8 Robin Crescent www: midwiferyeducation.com.auSouth Hurstville NSW 2221 National Coordinator, ASIM__
