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Date: | Sat, 23 Sep 1995 01:13:46 EDT |
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Hi Rosemarie:
I haven't forgotten to send you our protocols etc, will do soon. Just had to
comment on your part about IVs in labour -------- where is that soap box????
I do not believe the line that routine IV's should be placed "just in case" in
the low risk women in labour.
First - birth is a natural event - and rarely ends with complications - your
physicians have a bad attitude.
Second - I have spent 10 years working in High Risk obstetrics - and have NEVER
not been able to get an IV in when I have had an emergency - pregnant women have
the best veins in town - even when in stress and hypotensive! I've started IVs
on massive PPHs, complete abruptions, stat c/s for fetal distress, prolapsed
cords, severe PET, sepsis, - you name it - under the worst do or die
circumstances - and have never failed to get a line - with 18 angios. Anyone
with skill can do the same.
Third - when we had HIGH RISK (patients already at risk) in labour - which St
Paul, Alberta should have transferred to Edmonton, :-) we place a saline
lock (heparin locks are no longer necessary ) - which allows mobility and that
quick access your physicians seem to crave.
Fourth - 5% dextrose is NOT a solution of choice for the labouring women. An
inadvertent bolus of this solution could contribute to hypogylcemia in the
infant after delivery. A lactated Ringers solution is often preferred if
necessary. Sugar solutions are used with diabetics - but must be carefully
titrated through a pump with an insulin infusion.
About your drugged sleepy babies:
My area of great interest - these babies sometimes take days to wake up. Moms
should be encouraged to pump on day one if no latch. Cup feeding works great -
whatever volume is pumped - usually 5 - 15 cc of collostrum - but the baby must
be awake when it eats. We don't have a set period of time - we assess each
mother/ baby and recommend pumping and cup feeding until baby is interested in
serious nursing. Frequent attempts and nuzzles a must. I am interested to
hear what other people are recommending out there. I am having breakfast with
Jack Newman and Molly Pessly tomorrow - they are speaking to my staff - I will
ask them what they do with these babies.
NOT tongue in cheek. We should loose the key to our narcotic cupboards and send
the anaesthesia deptartment on a long cruise. Put big round birthing tubs in
all the rooms - No problems with groggy sleepy babies I bet.....
Bon Chance Rosemarie,
Kim Campbell
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