cnm in progress

I hardly think anyone would have even NOTICED if he had accessed all of OUR records, let alone prosecuted him. I'm confident that the celebrity status had a lot to do with it. Edited to add: Sorry geocachingRN... I just finished reading the posts after the one I quoted and saw your post that says basically the same thing about fine vs. jail... I don't know that jail is the appropriate sentence. IMHO, he should be fired, face a hefty fine (which GENERATES money for the government... as opposed to jail, which costs taxpayers money), and have a suspension on his license so that he can't practice for an appropriate period of time.

I don't quite understand the rationale for such high-dose protocols, but not because of uterine rupture issues. A 24 week uterus doesn't have many pitocin receptors, so what are we accomplishing with such a high dose? Even a full-term uterus doesn't have the ability to do anything with such a high concentration... it would definitely become tetanic, but it doesn't require such a high dose. The only rationale I can come up with is because at such an early gestation there can be issues with placental separation and it is often preferable to have the fetus, amniotic sac, and placenta deliver as 1 single unit to aid in this process. High-dose misoprostol works very nicely for this... but it can cause severe diarrhea as well.

At 24 weeks gestation, the lower uterine segment is still quite thick.

The risk of uterine rupture in a 24 week uterus is really low. Risk of rupture becomes more of an issue as the uterus is stretched to its maximum. That's why this protocol (and high dose misoprostol) are both safe in prior c/s patients.

Ditto!!

Not here either.

Congratulations! You'll love Frontier! I'm in Class 61... just 10 more births to go... I thought I was scared starting the program, but now I'm REALLY scared! Boards... Independence...

YEAH!! That sounds like an ideal setting! Where is it located? I'm at a large university teaching hospital, and we have tons of midwives, but no separate birth center (which I would love to change!!). We do have a free-standing birth center in our city that I work in, but the volume is low. By the way... you'll LOVE Frontier!!!

Interesting. I'm thinking some women are really sensitive to it... and for others it does nothing at all.

The most accurate way would be for them to sit upright or in a semi-fowler's position. You're correct that if she's on her left side and you take it in her right arm then it is slightly lowered. If she's on her left side and you take it in her left arm, then it can be significantly falsely elevated. I'll have to look through references, but I know that I read somewhere that the slightly lowered reading in the elevated arm is a minor difference, while the falsely elevated reading on the dependent arm can be more significant. I think the bottom line is... if she's truly hypertensive, the reading you get on her elevated arm is not going to all of a sudden make her look like she's normotensive, at least from my experience. One important thing to keep in mind though... you've got to compare apple to apples, not apples to oranges. If someone's been taking her BP on her elevated arm all day and she was normotensive... and now at shift change someone puts the cuff on her dependent arm and gets really high BP's... that's not an accurate assessment.

Definitely true regarding the inability to remove it after placement. As a practitioner, I know that I will pick and choose very carefully who is a good candidate for cytotec for that very reason. I've heard cytotec called cytoblast by others as well. I'm curious... what dosage/frequency do you use. We use 25 mcg q 4 hours, and I've rarely seen that happen with it. I also wonder if there's any correlation with rapid progression and Bishop score on admission? Interestingly, with as much as cytotec has been used, it's efficacy and safety are fairly well-documented. But the manufacturer will NEVER label it for use as a cervical ripening agent for several reasons: 1) There's too much liability with OB and they don't want to assume that risk. 2) It's a VERY cheap medication, so they don't stand to make much money from marketing it for OB use. The costs involved in getting it labeled for use in OB would be too prohibitive. 3) It's already being used for this purpose, so they're already making money. Why spend money to entice OB's to use their medication when it's already occurring.

I just looked at the U. of C. website. Part of their curriculum includes 900 clinical hours. Frontier only requires 675 clinical hours, yet their required numbers of births, labor managements, postpartum visits, new ob visits, etc... is double that of U. of C. For example, U. of C. only requires 20 births. I've already done 30 and need 10 more, yet I feel like I want closer to 50... I can't imagine feeling safe after just 20.

I did a little research, because I've never heard/read that Cervidil can't be repeated. I work in a very large, well-respected teaching hospital that is usually up-to-date on practice standards... and we've definitely repeated Cervidil in the past. I went to "Intrapartum Management Modules" and followed the reference given for this statement (the author references Forest Pharmaceuticals). According to the drug monograph for Cervidil: "Cervidil is used as a single dosage in a single application." It doesn't actually say that it can't be repeated at the end of the dosage/application. If the manufacturer has stated that it doesn't recommend more than one dose, it certainly isn't found within the drug monograph. I haven't found any evidence yet in the literature, but I haven't done a thorough search yet. If I find anything else I'll post a link. On a side-note: I personally think Cervidil isn't worth its high price-tag. Misoprostol works much better and costs just pennies.

I have to admit, I'm speechless... maybe I'm being naive, but why would a hospital need a waiver for a patient to use a birthing ball? Next we're going to have women signing a waiver to be allowed to ambulate after her birth, or to be allowed to wear her own shoes.

#1: requires you to have l&d nursing experience (to me that implies a certain base level of knowledge required for entrance at cincinnati) not necessarily so. i admit that i don't know enough about u. of c.'s program, but i can tell you that a base level of knowledge is definitely helpful at frontier. frontier will teach you what you need to know about l & d, but those students who came from a l & d background have a much easier time than those with no experience. frontier is a very challenging program... but with my l & d experience i had a much easier time in my intrapartum courses. that said, i know several people with doula experience who work in the er or icu who have absolutely no problem learning the material... and they have an edge over me in the primary care courses. there is a certain benefit to having no l & d experience when you are learning the midwifery model. the medical model of care prevails in most l & d units, and it can be very hard to remove all of the "what if's" from your mind and focus on normal pregnancy. #2: their program is 2 1/2 years long vs frontier's only 2 years. (to me this implies a more in-depth program: on top of the higher base level of knowledge required for entrance) frontier's program is actually 27 months if you go full-time, so it's really only a 3 month difference. i don't know about "breaks" while at u. of c., but at frontier you only get 1 week off between terms and you go year round. #3: grades lower than a 3.0 are unacceptable at cincinnati and would lead to dismissal. (again, implying a higher standard). grades lower than 80% (3.0) are considered failing at frontier as well. so, from my research, i've concluded that the more challenging, indepth program is cincinnati. at the end of the day, it is about getting the best education available. that is why i'm choosing cincinnati. frontier is the oldest operating school of midwifery in the u.s. it is ranked among the best graduate nursing programs in u.s. news & world report. it's graduates are well-respected in the ob community. i don't know that the same can be said of u. of c. preceptors who take students from various midwifery programs consistently say that they will gladly take another frontier student in the future because they are well-prepared for clinical practice. i'm not trying to sway you into choosing frontier... that's your personal decision and you have to choose what you feel best about. but just based on the reasons you've cited, you might want to take another look at frontier. also, from my reseach, it is more expensive (just as a reply to the previous poster).