Re: Today was a GOOD day!
From: Meenan, Anna (annam@uic.edu)
Fri Feb 29 21:25:20 2008
Not insulted at all Louana. That was kind of my point in telling the
story, that the mom, baby, and circumstances pretty much stymied
every effort of the medical crew to intervene and did it their way,
and timed it so I could be there after all. With the hours I work
now (7-noon, weekdays only) I don't get too many deliveries anymore.
I start a lot of inductions and manage a lot of labors, but the
babies always come later in the day, and I figured this one would
too, so it was icing on the cake when he arrived at 11:06 AM.
Anna Meenan, MD
>Anna,
>
>Forgive me if I insult you, I hope this doesn't though--this is a
>perfect midwife story--the mother and baby progressed on their own
>without the c/s, induction, vacuum and etc. I love it--thanks for
>calling it a good day :)
>
>Louana
>
>-- "Meenan, Anna" <annam@uic.edu> wrote:
>
>Well, in our hospital, we don't always have a ped around, but I'm
>not real big on breaking the bag just to see if there is mec either,
>since i am NRP certified. Our nurses are real big on it, however,
>and the NICU crew complains if they get called at the last minute,
>even though they are right down the hall. OTOH, I'm not into having
>moms push with bag intact if it's bulging way out ahead of the baby,
>as eventually the resident standing in front of mom's perineum will
>get soaked, so if there is a big bulgy bag and it is time to push, I
>usually do break it. In this case, there actually was thin mec, but
>heart tones had excellent variability when the spiral was placed.
>
>I suspect the deep variables with ctx were a combination of nuchal
>cord X1 and rapid descent.
>
>I'm actually not particularly interested in what the Board would
>say, because if this girl was me, I would have expected my birth
>attendant to do exactly the same thing.
>
>Oh, BTW, apgars were 9/9.
>
>Anna Meenan, MD
>
>>Anna,
>>I was not being facetious. However, you just gave a good reason to
>>break the BOW.(To adequately monitor the fetus) You didn't tell us
>>that before. (or I missed it)
>>John,
>>Breaking the bag because you think there might be meconium is one
>>of those indications that people accept, but there is not much
>>evidence for it. What difference does it make in your management
>>??? Perhaps in smaller hospitals without Peds present down the
>>hall, it might make you call in the peds if you knew it was
>>present.(that would justify it). In our hospital where we have peds
>>residents and neonatal fellows 20 yards away, it really doesn't.
>>
>>Dan
>>
>>On Fri, Feb 29, 2008 at 12:04 PM, Dr. John Provatopoulos B.Sc.
>>M.D.C.M. F.R.S.C.
>><<mailto:johnprov@sympatico.ca>johnprov@sympatico.ca> wrote:
>>
>>At Fri, 29 Feb 2008, R. Daniel Braun wrote:
>>>
>>>And why did you break the BOW??? You already had decels earlier and now you
>>>take away the baby's protective mechanism????
>>>
>>>Yes I know everyone FEELS that breaking the bag helps things along. BUT ALL
>>>of the STUDIES show that it does NOT!!!!!!
>>>
>>>Dan
>>>
>>
>>Dan I don't see anything wrong with an arm at 9cm, I would do it to
>>check for thick mec more than anything, thick mec deccels and decreaces
>>variablity would make me call in the Pediatrician from home.
>>
>>--
>> Take care, John
>>
>>--
>>R. Daniel Braun, MD FACOG(L) ABMP CMTh
>>Professor Emeritus
>>Dept. of Obstetrics and Gynecology
>>Indiana U. School of Medicine
>>
>>R. Daniel Braun
>>
>> "Science without Religion is LAME; Religion without Science is BLIND"
>> Einstein 1941
|
|
