"Do I have to go through a formal process to organise a FAQ...or do I just
do a Todd?"
--Ellen/Chookie, 2002
http://groups-beta.google.com/group/
misc.kids.pregnancy/msg/a45192dfb785c7ed

Ellen/Chookie,

You didn't mention birth position so - for the benefit of new readers - I
will risk doing a Todd. : )

1. Most women understandably do not wish to say to the OB or midwife:

"Your standard delivery positions - semisitting and dorsal - close the birth
canal up to 30%."

Instead, women usually say diplomatically: "I want to push in positions
which allow the birth canal to open maximally" - or words to that effect.

2. Most women also understandably do not wish to say to the OB:

"Your standard procedure is to keep the birth canal closed the "extra" up to
30% - keep women semisitting or dorsal when babies get stuck - I don't want
you to do that."

Instead, women usually say diplomatically: "If you have to pull with hands,
forceps or vacuum, please make sure I am in a position that allows my birth
canal to open maximally."

Point #2 in this Todd is rather new - I think it was inspired by Rivka.

Todd

PS One more note below######

"Chookie" wrote in message
...
I'm heading in to my delivery hospital to discuss labour management this
Friday. I'm particularly interested to hear from people who had
pre-eclampsia, ITP or a similar condition on what practices suited them or
annoyed them etc, but all comments are welcome.

I want a relaxed normal delivery with as few interventions as possible
during
labour, and to delay cord clamping until after pulsation ceases.

##### New readers. Immediate cord clamping temporarily asphyxiates the baby
and robs him/her of up to 50% of his/her blood volume. It is wise not to
explicitly call the OB or midwife's attention to this fact - but all women
should know it. Saying "delay cord clamping until after pulsation ceases"
is much more diplomatic.

DH would
like to cut the cord and say a prayer. I want to put the baby to the
breast
immediately. My idea of a Bad Time is arguing with an intervention-happy
obstetrician between contractions, and I'm planning to enlist the aid of
the
midwives to prevent this (they run the show unless something goes wrong).

So far, my enquiries include:

I expect to need more emotional support than the average second-timer,
particularly if I develop symptoms.

I think staff should have a look at the relevant section of my labour
notes
from DS's birth, so they know what went wrong last time and how fast.

Do you want me to come in fairly early in labour for blood tests or other
baseline measurements? (ASSHP suggest a repeat full blood count, serum
uric
acid, creatinine and liver function tests, together with assessment of
urinary
protein at 33-36 weeks gestation in symptomatic PE.)

Under what circumstances would induction/augmentation be considered? Or
Caesarean?

My obstetrician suggested an IV be put in "just in case". How about we
hold
off on that until I develop symptoms? I don't want to labour with a
needle
stuck in my hand.

I want CFM only at the onset of serious symptoms (ie, inability to control
blood pressure despite adequate hypertensive therapy; deteriorating liver
function; deteriorating renal function; progressive thrombocytopenia or
neurological complications or imminent eclampsia) or heavy-duty
medication.

Do you use magnesium sulphate for convulsion prophylaxis?

What cutoff should we use for BP? (ASSHP suggest 170 systolic and/or 110
diastolic, but I am not sure my numbers got that high until I actually
seized). What would you do if my BP did get too high?

Frequency of BP monitoring -- half-hourly and at delivery of placenta if
symptomatic -- how often will it be done beforehand?

Is there any point to anaesthetic assessment prior to labour if I am
asymptomatic?

Platelet count prior to epidural -- how long does it take and how much
could
my platelets fall in the intervening period?

No ergometrine/syntometrine for third stage -- use oxytocin (they probably
do
this anyway).

My ob suggested 4-hourly BP monitoring for 24 hours post-partum. I would
like
6-hourly BP monitoring for the succeeding 24 hours as well.

"Careful clinical monitoring should detect premonitory signs of
convulsions
(eclampsia) such as hyperreflexia with clonus, retinal vasospasm, visual
obscurations and persistent headaches." How do we do this in labour?

"All of the features of pre-eclampsia will resolve postpartum but
clinicians
should remain alert for new maternal complications for at least a week
after
delivery." What will this involve?

"Eclampsia is a well recognised complication of the puerperium, especially
when the guard of regular observations has been dropped. Some
abnormalities, particularly thrombocytopenia and platelet function
defects,
will often get worse during the first 2-3 days after delivery" -- how will
this possibility be handled?

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"In Melbourne there is plenty of vigour and eagerness, but there is
nothing worth being eager or vigorous about."
Francis Adams, The Australians, 1893.