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Thanks for that Mary - nice reference, it reminded me of the Sally Inch third stage material but from another perspective. I'm not sure your 450mls trick is simply anecdotal, see for example Annette Briley's JISC response from yesterday. This seems to me to be a pretty universal midwifery technique in the UK to maintain ownership over normal birth. I have certainly come across it a lot in my research. Regards Mandie Scamell CHSS University of Kent _____ From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Doyle, Mary Sent: 2009-11-05 16:50 To: [log in to unmask] Subject: Re: National PPH rates I know its old but the paper by Gill Gyte in MIDIRS 2:1 March 1992 pp. 88-92 gives an interesting critique on the significance of blood loss at delivery. It is also very soundly discussed in terms of physiology e.g. reticulocyte counts. She relates blood loss to the physiological alteration in the cardiovascular system in pregnancy and the need for the body to redress the balance post birth. Among some of the questions she poses is that of 'too little blood loss at delivery'. just to put another perspective for consideration. I am not sure where 500mls leaves us as in my experience people will often put 450mls to not record a PPH in their practice - anecdotal but true. Mary _____ From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Marianne Mead Sent: 05 November 2009 15:25 To: [log in to unmask] Subject: Re: National PPH rates Very interesting question. If by "normal", we understand the statistical norm, then I suppose that level of blood loss is normal. However, the mother's body will not react differently to 1000ml blood loss if the mother has had a vaginal delivery or a caesarean section, and so I would think that keeping to the definition of >500ml or any amount that leads to a deterioration of the maternal condition ought to stand. Just a personal opinion, really. Marianne _____ From: Pamella R. Harmon <[log in to unmask]> To: [log in to unmask] Sent: Thursday, 5 November, 2009 15:01:37 Subject: Re: National PPH rates Hi Patricia, I am a student nurse midwife and I am wondering about your statement about double standard. Do you mean that the acceptance of pph as a norm for c/s mothers vs. vaginal birth mothers? ________________________________________ From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of Patricia Burkhardt [[log in to unmask]] Sent: Thursday, November 05, 2009 6:46 AM To: [log in to unmask] Subject: Re: National PPH rates 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) ========= IMPORTANT ========= Information in this email (including attachments) may be confidential. It is intended for receipt and consideration only by the intended recipient. 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