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43% of First Time Kilkenny Mums will have a Caesarean ..

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    #92
    Hannibal Smith
    Closed Accounts Posts: 3,893 ✭✭✭Hannibal Smith


    Cat Melodeon wrote: »
    I'm wondering why there is any need to check for meconium at all. I mean, I understand the problems it can cause, but is it necessary to routinely break waters just in case it is there even if labour is going normally and baby is doing fine? Genuine question, I don't have a medical background.

    I think any situation where a baby is in distress, any mother would be happy to consent to ARM and monitoring. However those are not normal births. It is still difficult to see how at least 43% of births in Kilkenny become 'not normal'.

    I don't have any medical background either (as you can tell :D) But one site said, if the meconium has been passed during labour there are risks of meconium aspiration syndrome afterbirth (which seems to be when chunks of it get stuck in the baby's respiratory system), it also seems to be an indicator of fetal distress, and then obviously the risk of infection.

    I suppose, how do you know if the baby is in distress or not? Can they judge from the heart monitors? Or is it only with the scalp clips?

    Oops sorry, i didn't mean to wink at you...don't know how I did that :D


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    #93
    SanFran07
    Registered Users Posts: 230 ✭✭SanFran07


    http://www.nice.org.uk/nicemedia/live/11837/36280/36280.pdf

    These are the UK maternity guidelines. There is no Irish equivalent. Each hospital determines its own policies.

    I think page 27 covers routine amniotomy.

    The least invasive way to check how baby is doing is to check the baby's heart rate intermittently for all low risk Mothers. Routine amniotomy comes with tradeoffs that all Mums need to be aware of so they can give informed consent before the procedure is begun. The Cochrane review recommends no routine amniotomy. Its a case of leaving well enough alone unless there is a compelling reason to interrupt labour.


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    #94
    GoerGirl
    Registered Users Posts: 94 ✭✭GoerGirl


    Hannibal Smith wrote: »

    I suppose, how do you know if the baby is in distress or not? Can they judge from the heart monitors? Or is it only with the scalp clips?

    The best way to assess if a baby is in distress is by intermittent monitoring - the baby's heart rate is the best indication of fetal distress.

    Research has shown us that continuous monitoring (CTG belt) and fetal scalp monitoring when used as routine have been shown to increase risk of intervention. Continuous monitoring and fetal scalp monitoring when used as routine have also shown no benefit in infant outcome; ie routine use does not provide a decrease in infant death. Many units in Ireland use routine practice of continuous monitoring and/or fetal scalp monitoring for women who fit into certain "risk" groups regardless of how their labour is going. For example, some units policy requires all VBAC mothers to have these method of monitoring, despite research and despite how her labour is going.

    Best practice recommends use of intermittent monitoring through out labour unless medically indicated.

    meconium aspiration syndrome is quite rare - it does not happen with all babies in which meconium is present.


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    #95
    Hannibal Smith
    Closed Accounts Posts: 3,893 ✭✭✭Hannibal Smith


    GoerGirl wrote: »
    The best way to assess if a baby is in distress is by intermittent monitoring - the baby's heart rate is the best indication of fetal distress.

    Research has shown us that continuous monitoring (CTG belt) and fetal scalp monitoring when used as routine have been shown to increase risk of intervention. Continuous monitoring and fetal scalp monitoring when used as routine have also shown no benefit in infant outcome; ie routine use does not provide a decrease in infant death. Many units in Ireland use routine practice of continuous monitoring and/or fetal scalp monitoring for women who fit into certain "risk" groups regardless of how their labour is going. For example, some units policy requires all VBAC mothers to have these method of monitoring, despite research and despite how her labour is going.

    Best practice recommends use of intermittent monitoring through out labour unless medically indicated.

    meconium aspiration syndrome is quite rare - it does not happen with all babies in which meconium is present.

    Are the scalp monitors used as routine? As far as I remember, I had the heart monitor in the delivery room, the readings from which they weren't happy with and so they used the scalp clip...and when the readings from that weren't conclusive, or when they weren't happy with the readings (not sure which) they did something with big long rods, I presume that was to take a blood test from the baby? And then they finally diagnosed fetal distress. I'm all for the scalp clips I have to say, it was necessary in my case and I'm glad they used it.

    The CTG belts are a pain, whenever they came near me with the machine junior was always sleeping and after they break your waters, you try and lie down for 15 minutes with that bloomin belt! :D If they do away with them, I'd be quite happy :D

    I've read that about the meconium...if it's mixed up with the amniotic fluid apparently there's no risk of aspiration syndrom, but if it's in clumps, that's when there's a risk. But how are you to know whether the meconium is there or not, or whether it's clumpy or not, unless you break the waters?


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    #96
    trippingjimi
    Closed Accounts Posts: 24 ✭trippingjimi


    Nearly fainted here, reading all this...:o


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    #97
    GoerGirl
    Registered Users Posts: 94 ✭✭GoerGirl


    Hannibal Smith wrote: »
    Are the scalp monitors used as routine?


    I've read that about the meconium...if it's mixed up with the amniotic fluid apparently there's no risk of aspiration syndrom, but if it's in clumps, that's when there's a risk. But how are you to know whether the meconium is there or not, or whether it's clumpy or not, unless you break the waters?

    The fetal scalp monitoring is routine for some mothers in some units - VBAC mothers for example. But not in all units - so check with your midwife or doctor at your next appointment.

    Its impossible to know if meconium is present or not but the presence of meconium alone is not an "emergency" so to speak. Its common to have low grades of meconium in labours which progress normally; particularly if post dates. The only time meconium is a problem is if the baby is not tolerating it well. The best indicator of this is through fetal heart rate monitoring.

    If meconium is present and the baby tolerates it fine then its a non-issue.

    If the baby is having problems, care providers will investigate factors which could be contributing - such as breaking waters to see if mec is an issue.

    Breaking the waters as routine - regardless of how mum and baby are tolerating the labour - does more harm than good.

    And I agree - CTGs are horrible!


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    #98
    Ayla
    Registered Users Posts: 1,508 ✭✭✭Ayla


    Hannibal Smith wrote: »
    The CTG belts are a pain, whenever they came near me with the machine junior was always sleeping!.. If they do away with them, I'd be quite happy :D

    Agree. When I had my first they belted me up straight away & left us there forever! My husband had to push a button on the machine when I told him the baby kicked. Needless to say, our daughter decided to go on the longest nap of her in-utereo life! I started almost exaggerating up the kicks, just so something would be reported on their little printout.

    When it looked like labour was going to be a long time in the coming they let us leave for awhile (although were surprised when we didn't come back for about 3 hours). They hooked me up again, same story. So they took me out of labour put me in the maternity ward to wait it out.

    Then, when in labour (which was very quick) they had the belt on & had to keep moving it around as the baby descended. I wasn't in the frame of mind to ask for it to come off, but it was an annoyance.


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    #99
    Hannibal Smith
    Closed Accounts Posts: 3,893 ✭✭✭Hannibal Smith


    Ayla wrote: »
    Agree. When I had my first they belted me up straight away & left us there forever! My husband had to push a button on the machine when I told him the baby kicked. Needless to say, our daughter decided to go on the longest nap of her in-utereo life! I started almost exaggerating up the kicks, just so something would be reported on their little printout.

    When it looked like labour was going to be a long time in the coming they let us leave for awhile (although were surprised when we didn't come back for about 3 hours). They hooked me up again, same story. So they took me out of labour put me in the maternity ward to wait it out.

    Then, when in labour (which was very quick) they had the belt on & had to keep moving it around as the baby descended. I wasn't in the frame of mind to ask for it to come off, but it was an annoyance.

    I'm always so afraid the midwives are going to remember because of my CTG belt tantrum :o The night they broke my waters baby's head kept moving down into the pelvis and it was creating a kind of air lock...it was so painful I had to stand up and walk around the whole night. I'm sure they thought I was such a drama queen, i wasn't even in labour, but I couldn't sit or lie because it KILLED lol

    Anyhow the next morning they wanted a reading before bringing me down for the oxytocin drip...I told the poor student midwife that I'd had enough of them and their machine, the baby never moves when it's on anyway and that belt wasn't coming near me :D:D She told me they couldn't induce with out it, so I tried it and the pain came, so I stood up...took the belt off threw the mother of all hissy fits...she went off...came back 15 minutes later and escorted me to the delivery ward...I'm full sure it was to get rid of me :o


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