|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: AMOLFrom: maggiela@rochester.rr.comWed Apr 10 08:58:25 2002
At Wed, 10 Apr 2002, PELLIS45@aol.com wrote: > >So, let me get this straight..........you augment with pit when the woman is >in "active labor". If she's in "active labor", why the need for augmentation >? Just to speed up the labor ? I would never put words in his mouth but I think the poster means that he would augment a labor if there was not steady progress as SUGGESTED by the Friedman curve. In other words a multip at 6 cms whose contractions stall and doesn't progress for several hours may benefit from a small amount of pitocin being given. The labor soon picks up, the contractions become adequate and the baby gets delivered before very aggressive measures instituted. The risk of chorio (because active management does imply AROM as well) can be avoided, the use of repeated doses of antibiotics and pain medicine can be avoided and the risk to baby of a NICU stay because mom gets a temp and baby gets a 48 hour rule out and atbx can also be reduced. The Friedman curve is just that, a curve and there are labors that are slower and those that are faster. Except in the case of VBAC, the curve should be interpreted to allow for some normal variations. I would also suggest that you go back and actually look at the way the Dublin trials were done- women were actually in labor before they were actively managed- several cms dilated and really contracting, not 38 weeks and sick and tired of being pregnant and coming for elective induction. That is an entirely different kind of management and as someone else has said don't start the clock until she really is in labor. Far too often the patient gets a few hours of pit, doesn't progress and is told she has failed induction and gets a C-section. That is not active management of labor or a failed induction!! I went to a grand rounds a few years ago where Fred Frigoletto was discussing active management of labor and I know it changed my opinion of it. I do use cytotec for ripening only and never in a scarred uterus. My feeling is that for a lady with a scarred uterus, her labor needs to be spontaneous and progress normally in order to be safe. I don't even like to use pitocin for fear of rupture. As an aspiring doula is important for you to remember that we are not the enemy of pregnant or laboring women and their babies. Too many doulas believe that their job is to protect their "clients" from the evil OBs and midwives. So do your homework carefully and read read read. Read the professional literature and studies as well as the soft stuff and observe as many births as you can.
-- Maggie, CNM
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 04:51:23 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.