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Re: : : Ob: Trial of ForcepsFrom: Kathi Wilson, BHSc, RM (wilsonk@gtn.net)Sat Oct 9 09:13:51 1999
At Fri, 8 Oct 1999, Garry E. Siegel, M.D. wrote: > >In Atlanta, the world headquarters of Coca-Cola, you take a walk and >drink and diet *coke*! However, this woman was on 24 milliunits of pit, >and had been pushing for 1 hour 45 minutes (epidural) with excellent >effort, and the fetal heart tones were acting up a bit, and she had a >temp of 101 degrees that just started. I felt that delivery, not >expectant management, was warranted. If she didn't have the temp, and >had a normal tracing, I would have acted at 2 hours anyway, or maybe >gone a bit longer (the walk and diet coke, or read the newspaper). I'm interested to know if, at your institution, you have women begin pushing at full dilation w/ an epidural in place. The practice at my primary hospital is to let a woman w/ epidural sit for an hour or two at full dilation, then begin pushing. This allows for rotation and descent from uterine action alone, so that pushing efforts and the woman's energy can be optimized. It seems to work nicely (and has been, I believe, researched, although I don't know the ref). I had to get my metric calculator out (101 F means nada to me), but our action line for pyrexia is 38.5 on two occasions an hour apart (which is 101.3, according to my trusty calculator). We would bolus some fluid w/ a rising temp, of course, but I believe that this was done in an effort to separate out those women whose temp eventually rises due to epidural. Did your woman have antibx? Where our consultants perform forceps depends on the perceived difficulty of the lift-out. Ones that are anticipated to be difficult, or possibly result in C/S are done in a caseroom w/ C/S capability. However, we have had some done in the birthing room, as well, those less strenuous outlet sorts that our guys do very nicely without episiotomy.
-- Kathi Wilson BHSc RM Thames Valley Midwives London, Ontario, Canada http://tvm.on.ca mailto:wilsonk@gtn.net
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