Hi Patricia,
thanks for that!
This is an interesting point and is much the same here in the UK,
although not quite so concrete.
It is fascinating to see how the introduction of an intervention in
the birth process can operated to extend the category 'normal'. It
reminds me a bit of the extension of what is considered to be a normal
second stage time frame with the introduction of epidurals.
Weird that midwives don't seem to have the same discursive resources
to claim or shift the boundaries of what should be considered normal,
although I might be overstating my case here given that the (somewhat
covert) facilitation of midwifery led physiological third stage in
this country appears to having had a similar impact on PPH
classification, but i guess this might be in the light of the changing
C- section definitions you mention.
regards
Mandie Scamell
CHSS
University of Kent
On 5 Nov 2009, at 14:46, Patricia Burkhardt wrote:
> In the US 'normal' blood loss post cesarean surgery is 1,000, so by
> definition, all have PPH. The double standard seems acceptable here.
>
> Patricia Burkhardt, CM, DrPH
> New York University
> Adjunct Clinical Associate Professor
> 718 644-8963 (Cell)
> Fax: 718 855-9241
>
> ----- Original Message -----
> From: Maggie Banks <[log in to unmask]>
> Date: Wednesday, November 4, 2009 2:39 pm
> Subject: Re: National PPH rates
> To: [log in to unmask]
>
>> Hi Mandie. I am away from my computer so can't give you links but if
>>
>> you google search for 'MMPO report' from New Zealand you will come up
>>
>> with midwifery stats for several thousand births. If you can't find
>> this I could send you the link next week. There are also lots of
>> stats
>>
>> in the Reports on Maternity on the Ministry of Health wesite.
>>
>> PPH rates must be increasing with the increasing caesarean rates -
>> less than 500 ml loss would be very rare.
>>
>> Regards
>>
>> Maggie Banks
>>
>> check out Birthspirit Midwifery Journal at www.birthspirit.co.nz
>>
>> 15 Te Awa Road
>> RD 3
>> Hamilton
>> New Zealand
>> Ph 64 7 8564612
>> Fax 64 7 8563070
>> www.birthspirit.co.nz
>>
>>
>> On 5/11/2009, at 1:52 AM, Mandie Scamell <[log in to unmask]>
>>
>> wrote:
>>
>>> Hi,
>>> Hoping someone might be able to help me!
>>> Have come across interesting ethnographic data RE midwifery
>>> perception of
>>> PPH rates and am trying to test the perception against recorded
>>> national
>>> rates.
>>> Not with standing difficulties with definition and EBL etc. etc I am
>>
>>> looking for
>>> rough ball park figures for the last 20 yrs. While mortality rates
>>
>>> from PPH are
>>> easily available, I am having trouble locating stats on the trends
>>
>>> in over all
>>> incident rates.
>>> Any suggestions where a stats illiterate researcher should look?
>>> Thanks
>>>
>>> Mandie
>>>
>>> PS my data suggests midwives think the rate is increasing.
>>> Surprising I think
>>> given the moving gate posts where a more symptomatic approach is
>>> applied in
>>> the defining process and where an appreciation that physiological
>>> third stage
>>> management is likely to be associated with an increase in initial
>>> loss (which,
>>> incidentally, is considered to be normal)
Mandie Scamell
Centre for Health Service Studies
University of Kent
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