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#41
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home birth
Cathy Weeks wrote: -L. wrote: Cathy Weeks wrote: I don't believe any of it - you (generic) can make stats say what you want. I did it for years. Here's something for you ... http://www.cnn.com/2006/HEALTH/12/19....ap/index.html That germ is particularly notorious for running rampant through nursing homes. Horrible that it's hit a NICU. While I was glad my daughter was receiving stellar care when in NICU, I lived in constant fear that she'd acquire some opportunistic infection. Fortunately I knew that hospital's infection control team well, which calmed my fears a bit. In any case, that bacterium in particular is not likely to harm a healthy mother or child, at least not significantly. Its greatest morbidity and mortality is in immunocompromised patients. For that reason, I'm not sure it's the *best* example to illustrate your point, if I get your point correctly. Something like C.difficile, which commonly infects healthy people - and is very common in C-sections - may be a more apt example. Staph aureus is another good one. |
#42
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Anne Rogers wrote:
Mine missed the onset of my preeclampsia altogether, and I had to catch the symptoms myself. By the time I transfered, I was *really* sick, with a pressure of 220/116 and well into kidney and liver failure. Granted, not all women with a rise of 40/20 and trace proteinuria are going to develop severe preeclampsia, but she scheduled my next appointment two weeks out and sent me on my merry way. It has convinced me that some midwives do not spot that particular sort of trouble very well. hang on, you had a rise of 40/20 and trace protein? and she took no further action? I realise that rise could still put you in normal blood pressure zone, say 140/80, from 100/60 but isn't that why they take bp each time. Formally the criteria say that you have to hit 140/90 and that women with a rise of over 30/15 should be watched carefully. I was at 130/80 from my baseline of 90/60. Shouldn't trace protein always be investigated, I don't think that vaginal discharge causes a positive on that, in the same way it does on white cells, so the only explaination other than there actually is protein there is amniotic fluid. UTIs can also cause you to spill protein, and trace protein doesn't really seem to worry anyone. +1 does, though. Maybe she was right to not do anything that day, but just a regular appointment 2 weeks later seems incredibly lax, I don't know whether the bp was taken at an office visit or not, but the very least I'd expect would be a 2nd bp reading a day later and if possible doing it at home in case of white coat hypertension, and education about what signs to watch out for and when to call etc. Did you follow up afterwards what the course of action should have been with the changes you mentioned? The OB to whom I transferred care called her, I believe while he was debating whether or not to send me to ICU and was trying to get a better feel for my history, and told me he'd informed her that all protein merited a 24-hour catch and that I should have been scheduled for followup more promptly. Wish I'd been a fly on the wall for that conversation! On the topic of midwives who are lax about PE symptoms "because a bit of elevated bp and a touch of protein are normal in late pregnancy" see this link at the Preeclampsia Foundation forums from last week: http://www.preeclampsia.org/forum/to...TOPIC_ID=20142 I hope most midwives *are* aware that a bit of elevated bp and a touch of protein mean the pregnancy has turned very high risk indeed, that they are officially out of their league, and that a MFM needs to be involved in oversight of the rest of the pregnancy. It is not under any circumstances tenable to be going into multiple organ failure during pregnancy with only midwife oversight, and since it happens in one of twenty pregnancies I'd expect the vast majority of midwives know this perfectly well. But the ones who don't scare me. -- C |
#43
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Banty wrote:
In article . com, says... Granted, not all women with a rise of 40/20 and trace proteinuria are going to develop severe preeclampsia, but she scheduled my next appointment two weeks out and sent me on my merry way. It has convinced me that some midwives do not spot that particular sort of trouble very well. Wow - those were pretty much exactly my symptoms (as well as general malaise), and, as soon as my BP was taken, the nurse turned me to my left side and ran for my O.B. Sensible of her. :-) -- C |
#44
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home birth
In article . com,
"-L." wrote: I think it's silly and incidental enough not to make a fuss whether or not you can have one. I mean, seriously. If that's all you have to worry about, you've got it easy. "Oh woe is me! I can't birth at home! Whaaaa!!!!!" Please - spare me. Well, you have a baby now. Why are you still whingeing about infertility? "Oh woe is me! I can't have a baby myself! Whaaaa!!!!!" Please - spare me. Think about it. -- Chookie -- Sydney, Australia (Replace "foulspambegone" with "optushome" to reply) "Parenthood is like the modern stone washing process for denim jeans. You may start out crisp, neat and tough, but you end up pale, limp and wrinkled." Kerry Cue |
#45
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home birth
wrote in message ups.com... Anne Rogers wrote: Mine missed the onset of my preeclampsia altogether, and I had to catch the symptoms myself. By the time I transfered, I was *really* sick, with a pressure of 220/116 and well into kidney and liver failure. Granted, not all women with a rise of 40/20 and trace proteinuria are going to develop severe preeclampsia, but she scheduled my next appointment two weeks out and sent me on my merry way. It has convinced me that some midwives do not spot that particular sort of trouble very well. hang on, you had a rise of 40/20 and trace protein? and she took no further action? I realise that rise could still put you in normal blood pressure zone, say 140/80, from 100/60 but isn't that why they take bp each time. Formally the criteria say that you have to hit 140/90 and that women with a rise of over 30/15 should be watched carefully. I was at 130/80 from my baseline of 90/60. Shouldn't trace protein always be investigated, I don't think that vaginal discharge causes a positive on that, in the same way it does on white cells, so the only explaination other than there actually is protein there is amniotic fluid. UTIs can also cause you to spill protein, and trace protein doesn't really seem to worry anyone. +1 does, though. Maybe she was right to not do anything that day, but just a regular appointment 2 weeks later seems incredibly lax, I don't know whether the bp was taken at an office visit or not, but the very least I'd expect would be a 2nd bp reading a day later and if possible doing it at home in case of white coat hypertension, and education about what signs to watch out for and when to call etc. Did you follow up afterwards what the course of action should have been with the changes you mentioned? The OB to whom I transferred care called her, I believe while he was debating whether or not to send me to ICU and was trying to get a better feel for my history, and told me he'd informed her that all protein merited a 24-hour catch and that I should have been scheduled for followup more promptly. Wish I'd been a fly on the wall for that conversation! On the topic of midwives who are lax about PE symptoms "because a bit of elevated bp and a touch of protein are normal in late pregnancy" see this link at the Preeclampsia Foundation forums from last week: http://www.preeclampsia.org/forum/to...TOPIC_ID=20142 I hope most midwives *are* aware that a bit of elevated bp and a touch of protein mean the pregnancy has turned very high risk indeed, that they are officially out of their league, and that a MFM needs to be involved in oversight of the rest of the pregnancy. It is not under any circumstances tenable to be going into multiple organ failure during pregnancy with only midwife oversight, and since it happens in one of twenty pregnancies I'd expect the vast majority of midwives know this perfectly well. But the ones who don't scare me. Still, it happens with OB care too. I have a friend who went through almost two months of pregnancy with HELLP symptoms. Her BP would go up, she'd go in the hospital, it would go down, they'd send her home. Never did any bloodwork to notice the hemolysis and liver enzyme levels. The only reason it got caught, and her daughter delivered, was because her OB wasn't available one night and the OB on call caught it. I also have heard of another HELLP patient who had her HELLP ignored entirely in late pregnancy-the result being that her liver ruptured, and she's still in critical condition, while her baby is at home with her husband and older daughter. Her OB said that the borderline PE wasn't anything to worry about since she was in late pregnancy-unfortunately, it seems that HELLP is about as often missed as it is caught. In my case, I had a rise of 30/15, but it was before 20 weeks of pregnancy, and I'd never seen the same OB twice in a row, so it wasn't caught. At 22 weeks, I was in severe PE and Class I HELLP. I have to believe that having one continuous caregiver, as I had in my second pregnancy, would have made a difference. In my 2nd pregnancy, my BP rise was noticed, trace protein was monitored, and by 22 weeks I was on bedrest, on medication, and being very closely monitored indeed-which, I feel, made all the difference. |
#46
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cjra wrote: In any case, that bacterium in particular is not likely to harm a healthy mother or child, at least not significantly. Its greatest morbidity and mortality is in immunocompromised patients. For that reason, I'm not sure it's the *best* example to illustrate your point, LOL you are probably right. However, I saw the news piece - and my sorrow goes out to the parents - but the timing was right to use it here. Even if the bug that killed those babies in the NICU isn't one that is likely to harm a full-term healthy infant, it's still something to consider - that babies can and do get sick in hospitals, and that hospitals ARE NOT perfectly safe. Yes, they are best places to give birth if you are high risk. And they MIGHT be the best places to give birth even if you aren't. (Just feeling safer and more comfortable at the hospital is a plenty good reason, in my opinion). But people ought to know the risks so they can make an informed decision - thereby taking responsibility for their own actions. Cathy Weeks |
#47
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hang on, you had a rise of 40/20 and trace protein? and she took no
further action? I realise that rise could still put you in normal blood pressure zone, say 140/80, from 100/60 but isn't that why they take bp each time. Formally the criteria say that you have to hit 140/90 and that women with a rise of over 30/15 should be watched carefully. I was at 130/80 from my baseline of 90/60. so you'd had the rise that should lead to careful watching, but often doesn't (cf Donna's first pregnancy) Shouldn't trace protein always be investigated, I don't think that vaginal discharge causes a positive on that, in the same way it does on white cells, so the only explaination other than there actually is protein there is amniotic fluid. UTIs can also cause you to spill protein, and trace protein doesn't really seem to worry anyone. +1 does, though. unless you had white cells present the chances of a UTI would be slim, in the absence of the blood pressure changes you noted above, I can see why midwives to discount trace protein, if they didn't, they'd just end up transferring too many patients unnecessarily and noone would trust them when they did transfer a patient requiring urgent attention, a bit like the boy who cried wolf, but you weren't just exhibiting trace protein. The OB to whom I transferred care called her, I believe while he was debating whether or not to send me to ICU and was trying to get a better feel for my history, and told me he'd informed her that all protein merited a 24-hour catch and that I should have been scheduled for followup more promptly. Wish I'd been a fly on the wall for that conversation! well I'm glad someone followed up with her On the topic of midwives who are lax about PE symptoms "because a bit of elevated bp and a touch of protein are normal in late pregnancy" see this link at the Preeclampsia Foundation forums from last week: http://www.preeclampsia.org/forum/to...TOPIC_ID=20142 I hope most midwives *are* aware that a bit of elevated bp and a touch of protein mean the pregnancy has turned very high risk indeed, that they are officially out of their league, and that a MFM needs to be involved in oversight of the rest of the pregnancy. It is not under any circumstances tenable to be going into multiple organ failure during pregnancy with only midwife oversight, and since it happens in one of twenty pregnancies I'd expect the vast majority of midwives know this perfectly well. But the ones who don't scare me. I think I'm going to ask some questions about this on a midwifery list I'm on, it is a tough call, but the distinction here is the gestation it's happening at, for you it was pre 34 weeks, for this lady on this board it's 35 weeks, that's not in my mind, late pregnancy, and midwifes do have to be careful with ladies who are around the 40 week mark and have any changes in bp and urine, because if they send them into the hospital, they will almost certainly be induced, rather than waiting for other tests to be ordered, then you end up with 20% or something having a c-section because the induction failed and it may all have been unnecessary, so maybe it's fair to behave differently with symptoms like yours at 41 weeks than it is at 33 weeks, at 33 weeks those symptoms probably have a much higher chance of developing into PE than at 41 weeks, simply because of the underlying rate of having such symtoms at that gestation. Cheers Anne |
#48
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Cathy Weeks wrote: -L. wrote: I think it's silly and incidental enough not to make a fuss whether or not you can have one. I mean, seriously. If that's all you have to worry about, you've got it easy. "Oh woe is me! I can't birth at home! Whaaaa!!!!!" Please - spare me. Spare you? Well, you *did* jump into the conversation. Chick asked for opinions - I gave mine. If you don't like the discussion then why did you take part? Chick askedfor opinions - I gave mine. It's an open, unmoderated forum. Just because the topic causes you pain It doesn't cause me pain - au contraire. I'll take my kidlets clean, well fed and dressed in Carter's over ****ting out a football anyday, LOL... due to your own situation, doesn't mean it should be discussed at all, or that people should strive to make their situation better. Why do you think I said it shouldn't be discussed? I merely said it's a trivial problem. I don't believe any of it - you (generic) can make stats say what you want. I did it for years. Uh, ok. Your point is what? That anyone can make the stats say whatever they want? Doesn't that work borth ways? The hospitals (and you) can make it look dangerous (even if it's not?). Or are you just not willing to accept anything that doesn't jibe with your pre-conceived notions? Look - it's not rocket science. You have a major complication and a widwife can't do diddly **** to help you or your baby. Hummm....Maybe - just maybe - because if something does go wrong you have a team of well-trained medical professionals seconds away and not minutes or hours away? It's not rocket science. Hmmmmm... it may not be rocket science, then why do as many babies die every year in the hospital as they do at home? (This is after controlling for high-risk pregnancies). Those teams of well-trained medical professionals cannot prevent hospital-caused infections. They cannot prevent those occasional women who have complications from anesthesia, and become paralized from the epidural, they cannot prevent the occasional epidural from not taking so that the mother can FEEL her abdomen being cut open (Just google Sophie Macgehee over at misc.kids.pregnancy about that one). No, YOU go Google Megan What's-her-name too whose baby came out DEAD at home. Hospitals aren't panaceas for birth. They do not save all babies no matter what. Well no ****, Sherlock. But if your baby has a major neurological problem, what kind of diagnostic equipment do you have at home? Is your husband a neurosurgeon or a neonatal specialist? That's just one example. I very recently met a baby whose scalp was cut so badly during his c-section birth that it required stitches. Fortunately, it was in his hair, so it will not be permanantly disfiguring. And at home he may have died in the birth canal. In the end, he'll be fine. But hospitals are NOT without risks to either mother or baby. never said they were. So your rocket science comment was just plain silly. nope. Hospitals have a ton of trained specialists to call upon should a problem arrive. You have yourself, your kiddie pool, a granola-crunching midwife who fancies herself a doctor and your husband who probably couldn't find the clitoris without a map. So you want the tax payer to fund a "whole 'nother" level of birthing "professional" which is redundant. I see. No, I don't think you do. You see, home birth is CHEAPER than hospital birth. In 2001, when I had my daughter, the cost of my home birth was $3850 (normally only $3500, but I had a non-stress test at one point). Your average hospital birth costed $7000, and considerably more for C-sections - beginning at $10,000. Midwives have a c-section rate of 10% or less, and many hospitals have c-section rates approaching 40% - the national average is now over 25%. You can do the math if you wish. It would still require funding another level of birth that is unnecessary. One of my midwives did her thesis on how homebirth saves money for the insurance industry (her practice alone had millions of dollars for the insurance industry). LOL...especially if it isn't covered. And in low-income neighborhoods, where midwives practice (and have the same good outcomes as doctors despite lack of prenatal care) they save the taxpayers lots of money too. Ditto above. So it's cheaper, often safer, and gives a better level of care. Midwives usually spot complications earlier in the process than do doctors, and give more choices. But, I guess nobody ought to have more and even better, choices. I see. I don't want to pay for your quackery. -L. |
#49
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Chookie wrote: In article . com, "-L." wrote: I think it's silly and incidental enough not to make a fuss whether or not you can have one. I mean, seriously. If that's all you have to worry about, you've got it easy. "Oh woe is me! I can't birth at home! Whaaaa!!!!!" Please - spare me. Well, you have a baby now. Why are you still whingeing about infertility? "Oh woe is me! I can't have a baby myself! Whaaaa!!!!!" Please - spare me. That's not what I said at all. I simply have little sympathy for people for whom this is a major issue in their lives. -L. |
#50
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Cathy Weeks wrote: -L. wrote: Cathy Weeks wrote: I don't believe any of it - you (generic) can make stats say what you want. I did it for years. Here's something for you ... http://www.cnn.com/2006/HEALTH/12/19....ap/index.html If you don't believe this article, then don't bother reading any further. These were very sick babies (premature) who shouldn't have been born anywhere but at the hospital - they were in the neonatal intensive care ward. Then I guess your example - and point - is moot then. And by the way, Pseudomonas aeruginosa is a gram-negative bacteria which can be controlled by a number of classes of antibiotic - but not in immunocompromised patients. It's often found in swimming pools and spas - the same swimming pools you birth-at-home types like to use. However what they died from was a virulent infection that would have been dangerous to ANY infant despite being healthy at birth. You cannot truely separate the germs and the sick from the healthy in a hospital envrironment. And you can't at home, either. You have P. aeruginosa in the soil in your plants at home, dearie. You probably have some - or did at one time - on your skin as well. -L. |
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