We have collected data re syntocinon use in our cohort, reason for it and duration. With the NICE guidelines suggesting that women should have Synto prior to the decision to perform CS for failure to progress we believe this could be interesting- or is the uterine contractility already questionable by this time???
We have also been looking at blood loss in relation to maternal BMI at booking, and maternal age. Maybe the traditional risk factors are changing. We are using qualitative data to look at women's expectations of blood loss round delivery as well as staff reactions and experiences.
This discussion has further highlighted the confusion and debate around this contentious issue!
Annette
Annette Briley,
Consultant Midwife/Clinical Trials Manager
Maternal and Fetal Research Unit
Division of Reproduction and Endocrinology
10th Floor North Wing
St Thomas' Hospital
London SE1 7EH
________________________________________
From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of jenny hall [[log in to unmask]]
Sent: 05 November 2009 20:57
To: [log in to unmask]
Subject: Re: National PPH rates
Well of course if we go back in ‘history’ when we measured in pints a pint was seen as a PPH- then we went metric and it became 500ml when in fact a pint equalled 568ml! I have also been searching for, and can’t find, a study from a long time ago that asked midwives, obs and students who were passing to estimate blood loss that had been poured out onto some towels and sheets etc. It showed that the more blood that had been poured out that more inaccurate we become at estimating as most people estimated well under. There was also another one, or a discussion I think, way back when independent midwives were measuring loss more effectively by catching in bed pans and were estimating a ‘normal’ loss to be in the region of 750ml, which included other fluids etc. I personally think that one of the factors that could be increasing the perceived amount of loss, Mandie, may be related to the increase in induction of labour. If you go back to the discussion on cycle of intervention that as soon as an artificial hormone is introduced into the system of the woman then her own mechanism for producing oxytocin will be interfered with and therefore affect her mechanism to prevent bleeding after birth. Though we are of the giving syntocinon at the third stage I am not convinced this is as effective as a woman’s own oxytocin.
Anyway I guess you know all this and this is not what you are looking for!
Best wishes
jenny
Jennifer Hall
The Practising Midwife
For information on subscriptions, advertising and contributors guides please contact [log in to unmask]<mailto:[log in to unmask]> or www.thepractisingmidwife.com<http://www.thepractisingmidwife.com/>
________________________________
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of mandie scamell
Sent: 05 November 2009 20:41
To: [log in to unmask]
Subject: Re: National PPH rates
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]<mailto:[log in to unmask]>] On Behalf Of Patricia Burkhardt [[log in to unmask]<mailto:[log in to unmask]>]
Sent: Thursday, November 05, 2009 6:46 AM
To: [log in to unmask]<mailto:[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]<mailto:[log in to unmask]>>
Date: Wednesday, November 4, 2009 2:39 pm
Subject: Re: National PPH rates
To: [log in to unmask]<mailto:[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<http://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<http://www.birthspirit.co.nz>
>
>
> On 5/11/2009, at 1:52 AM, Mandie Scamell <[log in to unmask]<mailto:[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. If you are not the intended
recipient, any use, dissemination, disclosure, publication or copying
of information contained in this email (including attachments) is
strictly prohibited. Opinions expressed in this email may be
personal to the author and are not necessarily the opinions of the
Health Service Executive. If this email has been received by you in
error, please notify the sender and then delete the email from your
system.
No virus found in this incoming message.
Checked by AVG - www.avg.com
Version: 8.5.424 / Virus Database: 270.14.51/2482 - Release Date: 11/05/09 07:37:00
|
