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