Dawn27

UK_nurse the problem is the 18 month course post reg midwifery course is only possible if you have done adult branch. This means yu would have to do the direct entry 3 year midwifery course, I am not sure if they APL any of your child branch course and so reduce the 3 years by a small margin.

Just thought I would let you know the reccomendations in UK The Royal Collegege Of Obstericians and Gynaecologists have published guidlenes and they state : In the summary of product characteristics the licensed maximum dose is 20 milliunits per minute. If higher doses are used the maximum dose used should not exceed 32 milliunits per minute. Useful references: American College of Obstetricians and Gynecologists. Induction of labour. Washington DC: ACOG;1999. Practice Bulletin no. 10. Society of Obstetricians and Gynaecologists of Canada.Induction of Labour. Ottawa: SOGC; 1996.SOGC Policy Statement no. 5 The full guidelines can be found at http://http://www.rcog.org.uk/resources/public/pdf/rcog_induction_of_labour.pdf

Again it has been interesting reading all the arguements for and against obstetrician lead deliveries only. As a midwife in the UK I am a practioner of normal childbirth if all is well with mum and baby I care for the womwn in labour and am the professional responsible for the delivery. We are also aware of all potential problems and in these cases even if only for advice we refer to a doctor for their opinion. I know that health care systems are different here to the US but not that different that maternity care couldn't be made less medical. I think that may be the key ......... attitude, on the whole midwives are more accepting of doing nothing and allow nature to do what it does best. Doctors, on the whole, tend to prefer intervention and 'helping nature along'. Litigation also seems to be a high priority in some of the posts from the L/D nurses, I wouldn't say I practice defensivley but I do practice safely, yes the unexpected can happen but I am prepared for that and have the skills and knowledge to recognise those situations and call for medical assistance appropriately.

I know this was discussed before but I thought I'd add here too. In the UK one really popular method of pain relief is Entonox - nitrous oxide and oxygen, it seems it isn't really used at all in the US for pain relief in labour. I have used it personally and have lost count of the times I have looked after women who were using it.

The cynic in me would also like to point out that this is all party political bickering and point scoring, we are in an election year, probably May. The daily mail is tory through and through and the story is probably run to discredit any labour claims to be improving numbers of medical staff in the NHS

As far as I am aware Jayla you are correct in your assumptions if this woman has been taking regular doses of morphine the baby may well go through a period of withdrawal after birth. The same precautions and plan of action should be in place as if she were using heroin.

This is a real tricky topic, I am very much in favour of having as little intervention as possible. I think as long as there is definite progression it's ok to continue, but 3 hours is a long time to have a woman actively pushing. However there has been some research about the effect of prolonged pushing and postnatal urinary incontinence due to damage to pelvic floor muscles( I'll see if I can post the reference) and for this reason I would be wary of a very prolonged second stage.

I totally agree SmilingBlueEyes. IMO medical intervention can sometimes be the selfish action that starts a rollercoaster of intervention, which then leads to an adverse outcome. I have attended many home deliveries as a Midwife and think they have so many plus points. Machinery and technology have a place in some circumstances, but using some basic midwifery skills can sometimes tell a whole lot more than technology alone.

I have personally tried pushing with legs in stirrups and it is the most unnatural position to try to give birth to your baby. In the end I asked if I could turn on one side and deliver that way so much easier so much more comfortable.

Wow 30% home births that is impressive. Our team works in a sure start area and we are all advocates of home birth we manage a measly 8-10%

Hi I am a midwife in the UK but I'll do my best to explain. Down Syndrome is a genetic condition, it cannot be diagnosed from a scan alone it can only be diagnosed antenatally by carrying out a diagnostic procedure such as amniocentisis (there are others but i presume if they looked for markers the pregnancy is advancing). Downs syndrome is known to show 'markers' on scan these include a larger pad of fat on theback of the neck, short femur bone length, bowel that shows echo's from the scan, enlarged kidneys and cardiac problems. However these may be seen and the baby has no problems after birth at all. Amniocentisis is where a needle is pushed through Mom's abdomen into the uterus and fluid is sampled. As I said before this is really the only way to remove doubt and have an answer about Down syndrome. Your BIL's partner should discuss with her doctor the results of the scan and recommendation for further testing. I hope that helps, if you have other questions I'll try to answer them.

informed consent can be verbal, it doesn't always necessitate a signature, in the uk we do not request a signature on a consent form before amniotomy, however i would record in the woman's notes, why the procedure was thought to be appropriate and that the procedure had been discussed with the woman and she had consented for me to proceed, that's just good record keeping.

Kay I think the key to any method of induction is that point when the cervix is 'ready', no methods even the most aggressive are quite as successful if the womans body isn't ready. I work in the community and since we changed our policy, some 2 years ago, for induction in the case of post dates to do a membrane sweep somewhere between 7-12 days at home and follow up with prostin gel 2-3 days later in hospital if nothing has happened, our failed induction rates have decreased. Have anecdotal evidenceas have manymidwives of success or not, of sexual intercourse, rasberry leaf tea and aromatherapy. I am all for trying anything that has the potential to work as long as it does no harm.

All education is university based they have links with hospitals to allow for the practical experience also needed to obtain the qualification. There are two routes either 3 year direct entry midwifery course for those without a nursing qualification. The 18 month post registration course is for Registered nurses who wish to train as midwives. Both courses run at 2 academic levels, degree and diploma but the practical achievements are the same for both levels. Evidence of, observation of 10 normal deliveries, actually undertaking 40 normal deliveries under the supervision of a registered midwife and care of at least 40 women in labour. At least 100 prenatal examinations and care of at least 100 women and their babies in postnatal period including post natal examination. Again these are just snapshots of the requirements. I've added a link to the standards set out by the Nursing and Midwifery Council http://http://www.nmc-uk.org/nmc/main/publications/Standardofproficiency_v2.pdf

In the UK Midwives are the practioners of normal childbirth, some are also registered nurses but not all. Midwives are responsible for all aspects of of care of the woman and her baby from preconception through labour and delivery to the postnatal period. Women in the UK can be booked for midwife only care, which means they are not referred to an obstetrician at all. Midwives work in hospital and in the community, they provide care and deliver women and their babies in hospital and at home. I think your role is probably very similar in the care that you give to the labouring woman but a midwife in the UK would also deliver that woman if there were no deviations from normal, we wouldn't call a doctor. That isn't to say UK midwives don't care for women with complicated pregnancies or deliveries, they do, but the lead professional in these cases is always an obsterician and they organise the plan of care. That's very much a brief overview of the things we do, hope it makes sense.