The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
|
The AMA wants to make birth centers illegal, along with homebirths,
even though
Read more about the ACOG 2008 Press Release from The Big Push for Midwives and Childbirth Connections You can also educate yourself week-by-week in your pregnancy with theLamaze Weekly Pregnancy Newsletter for Parents |
Donating expired
medicines to developing countries and countries in central and eastern
Europe.
Do Medications Really
Expire By Richard Altschuler
Drug
Expiration Dates: How They Benefit the Pharmaceutical Companies - Are
Drug Expiration Dates Really Used to Indicate Danger?
Web Directory
of Medical Companies
Allegro Medical Supplies
- general supply place - they have an extensive supply of home healthcare
products, and they also carry trochanter belts!
Radiant Belly - standard
and custom home birth kits, many midwifery supplies and some organic cotton
newborn baby clothes
Midwifery Mercantile -
purveyors of supplies and equipment to midwives, doulas and homebirth families.
In His Hands - The Midwife
and Home Birth Supply Center
Everything Birth, Inc. - midwifesupplies.com
- they carry those nice single-use tubes of erythromycin eye ointment!!!
Twins and More, Inc. offers
birth kits.
Spirit Led Childbirth
- Birthing and Parenting Supplies (1-888-683-2678)
Precious Arrows - Midwifery
and Birth Supplies
Birth With Love Midwifery Supplies - The Complete Source for all Your Health Care Supplies, including the FREEBIE LIST - 1-800-434-4915
Birth With Love still carries the Hesseltine
Metal Cord Clamps-Stainless Steel.
BIRTHwaves supplies
- A Canadian supplier
Cascade HealthCare Products - Cascade seems to be the biggest midwifery supply house. Customer service: 1-503-595-1720 (9am-5pm Pacific Time/ Orders: 1-800-443-9942, same hours. They have three main subdivisions:
ICEA: BOOKMARKS: 1-800-624-4934 : an excellent source of books and educational
programs for childbirth educators and doulas.
Moore Medical Corp. . 1-800-234-1464
Arista Surgical Supply Co., Inc. 1-800-223-1984 - Discount Catalog Arista Surgical Supply in New York City - They carry American pattern (pelican?) umbilical scissors for $3.50 (American made) or $21 (German made). These are much better than Cascade! Email: aristasurgical@juno.com
Henry Schein Med. Supply
1-800-772-4346 (8am-9pm Eastern time)
Nature Path
1-800-542-4784
Childbirth Graphics
1-800-299-3366 ext 287
Labor of Love Support & Services for Childbearing Families Ft. Sill
OK 405-250-0993 services & products for childbearing families...herbal
remedies...hemp products...more
You can get Baldrin from a healthfood store or from a friendly chiropractor.
The company is, Vitaminerals, Inc., Glendale, Ca 91201.
Green Scrubs - great selection, used to carry hemp scrubs.
Uniform Store - Internet discounts - 800-542-1732
Sassy Scrubs - has maternity
scrubs
NOTE - Many of these free samples are intended for health care providers
to hand out to their clients. They are often not available directly
to consumers.
There's a FREEBIE
LIST at Birth With Love Midwifery
Supplies
Avent offers samples of their products to lactation consultants, nurses, midwives, childbirth educators, and others in the medical community in an effort to aid women in breastfeeding longer.
Here's their offer:
Avent Naturally Feeding System
Members of the Medical Community: you are welcome to fax us, on company letterhead, your sample request. The fax should explain your role in the medical community and list the product(s) you are interested in obtaining for demonstration to your clients and patients. Should you have any questions, please call us at 1-800-54-AVENT.
I would appreciate your help in this matter. If you have any additional
questions or concerns, please feel free to contact me at ext. 118 using
the number above. Thank you for your time.
Free Samples Nursing Pads
Johnson and Johnson
Consumer Products, Inc
600 Industrial Avenue
Paramus, NJ 07652-9688
My Breast Friend Nursing Pillow
Free brochures and demonstration sample. Call 1-800-555-5522
pHisoderm Samples (For Baby brochures and samples for class.) Call 1-800-366-6077 Ext. 243.
First Moments (pink packets include magazine plus samples of Moisturel
lotion, Dove body wash, Dreft Soap)
First Moments Inc.
55 Northern Boulevard
Greenvale, N.Y. 11548
1-800-645-6306 or 1-516-484-5740
This organization offers a pink packet of samples, coupons and a magazine,
complete with a childbirth planner which can be useful for birth plans.
You can also get a packet from Carnation, I think. Their number is 1-800-628-2229.
Lamaze Parents Magazine, 1-800-832-0277
This organization offers a Parent's Magazine as well as a lending video
library for CBEs on baby care and products.
Proctor and Gamble's Pampers division. They have a set of bound charts that illustrate helpful positions during labor and birth, peel-off poster pads (8.5 x 11) of the charts, pocket folders, and samples of Pampers diapers. These can come in handy for the beginning teacher (like me), especially for providing parent folders. I believe they come in cases of 50. Interested people need to call way ahead of time, since they have only certain times during the year that they send the materials out (I have to wait until June because I called in February). the toll-free number is: 1-800-950-0078. (They also have a quarterly newsletter for teachers including tricks of the trade and journal updates.)
American Baby Basket (for magazine plus samples of Baby Magic and Huggies
diaper)
51 Battle Road
Hampton, VA 23666
Warner Lambert (for Tucks pad samples with plastic cases)
Sales and Marketing Support
4914 Lambert Road
Dublin, VA 24084
I get samples of Lansinoh, which are free. Astroglide is a lubricant
that you can a whole box of samples of for free and they have an 800 number......
lots of moms have vag dryness. I have gotten female condom samples
from the Reality people. There is a company in Washington that makes
wonderful cotton breastpads called Milk Diapers. I couldn't get free
samples but was able to buy sample pairs for about $1.20 a pair and my
moms love finding them in their packs! They come with a coupon for 10%
of if moms want to purchase more and some nice little handouts that promote
breastfeeding.
Motherwear, a company that makes attractive breastfeeding clothing,
has some nice free booklets they will send that support breastfeeding and
nice catalogs that can be tucked in.
I keep my eyes open for companies that make products that I like that could be useful to new parents, and have called to see if they make sample sizes or are willing to distribute samples that I could give to my new parents. Sometimes you can support local businesses in the same way. You might find a local chiropractor who would be willing to give a coupon with a discount for an after birth business, a massage therapist, or some such person.... this advertises that person's business and the parents get a discount or maybe even a free visit in some cases and there is no cost to the midwife. You can approach pharmacies and other local stores who may have some sample items or be willing to provide a coupon for a certain service..... same deal. This kind of networking can be beneficial to the midwife too...... As the majority of us are very small businesses, there can be some advantages to forging alliances with other small businesses. After all, in exchange, they may be willing to put cards or brochures out for you.
I also include a postpartum care booklet that I wrote and developed that my clients love. Since I wrote the booklet, and illustrated it, my only cost is photocopying and each booklet costs well under a dollar to photocopy. Lately I have been making little booties out of some left over flannel for our babies...... They take only a few minutes to make unless you get fancy (I like to embroider mine so it takes a few more minutes), and cost almost nothing except my time. Since I like to sew, and find it relaxing, making booties is no big deal to me. If I hated making them, it would be different. I also make newborn caps. They are very inexpensive. I bought a box of 4 inch diameter cotton stockinette (which comes in handy for other things too sometimes). I double a length of stockinette that I cut, tie the raw end with colorful yarn, and fold up the "brim" and voila, have a cute little elf hat for pennies. I started making these when we started doing clinic births and they were so cute that I decided they were a nifty thing to send home with parents. I also make personalize birth certificates that can be framed on my computer. When we do the newborn exam, we use a footprinter so we can take the footprints of the baby and put it on the certificate. Again, it is something the parents love to frame or to put in the baby book, and the cost is negligible.
At any rate, we can come up with many useful "free" or very low cost "gifts" for our new moms that don't compromise our principles (I do not/will not accept or give out *anything* that promotes bottle feeding. I feel very strongly about this for instance). As the hospitals, and certain companies know, providing those little goodies makes good business sense.
Ione
*************************************************************************
C. Ione Sims, CNM,ARNP
Community
Nurse Midwife/Shelton Birth and Family Center
Coordinator, WA ACNM Chapters Website: www.cnm.wa.org
"a good traveler has no fixed plans and is not intent on arriving"
Lao Tzu
***************************************************************************
Suggestions for Client's Birth Supplies
Supplies Recommended for a Home Birth
We have clients buy a custom kit that contains exactly the supplies
we find helpful from Cascade. We try pretty hard to keep evaluating what
were using in the kit and delete things if we find we never use them so
we can keep costs down for folks. It has chux, sterile gloves, "goop",
ob pads, etc. in it. We also give them a list of supplies to gather, mostly
things anyone would already have around the home or can easily obtain;
receiving blankets, placenta pan, toilet paper, cookie sheet, crock pot,
olive oil, etc.
I've pretty much got everything I need to do births - sterile & non-sterile gloves, X-Tenda gloves, instruments, suturing set, stuff to clean & wrap the instruments, flashlight, sharps container, Doppler, BP cuff, fetoscope stethoscope, infant stethoscope, baby hats, sterile bulbs, 4 x 4's, cord clamps, betadine scrub brushes, bottle of alcohol, amnihooks, cord blood tubes, sutures, catheters, syringes, meds., baby scale & sling, thermometer, cord clamp cutter.
I only have a few homeopathics, Caulophyllum, Arnica, Pulsatilla, Chamomilla, Bellis Perennis & Arnica gel.
Herbs: St. Johnswort, Labor enhancement tincture, Motherwort, Angelica root, Skullcap, Shepherd's purse, & honey straws, Evening primrose oil, Goldenseal capsules
I also have my oxygen and ambu bag.
I try really hard not to carry anything I don't know how to use. It keeps me out of trouble. I admit, I haven't sutured yet, and haven't catheterized either.
Books: Spanish-English dictionary, a homeopathy book, a little books
that came with my maternal-newborn nursing text that gives normals, sometimes
Wise-Woman herbal.
Does anybody have experience/opinions on using washable cloth waterproof
bed pads in place of chux? I read an article written by Jeannine
Parvati Baker fairly recently...she said she'd been doing this. Is
washing (with bleach? never use it, borax maybe?) sufficient to rule out
worries about disease transmission (HIV, HepB, etc)?
perhaps cloth bed pads would help assuage my environmental conscience...and I certainly think they'd be more comfortable to lie on...and they're bigger too, and not slippery on the back so they might not slide around under moms so badly.
Comparing costs only:
Chux (from Cascade) run from 25 cents each (23"x24" economy, 17.5 cents in quantity) to $1.20 each (30"x36" super, 75 cents in quantity). Reusables (also from Cascade) run from $9.00 each (24"x36", birdseye cotton, $7.50 in quantity) to $14.50 each (36"x42", cotton/poly, $12.00 in quantity).
If your parents provide all their own birth supplies including chux,
this wouldn't save YOU any money, but if you provide the chux, it certainly
would, besides saving the environment, right? The Cascade birth kits have
between $4.25 and $9.00 worth of chux pads in them. It wouldn't be logical
to ask your parents to all buy enough reusables for their birth, but on
the other hand, it would cut $5-10 off their birth kit cost if you already
had a supply on hand.
I do, because we have a birth center, I too cringed at the disposables.
So I bought 8 of the large pads from Cascade and then I had some of my
Hutterite ladies make some smaller ones from some old materials. Like sheets,
bed pads, towels ,etc. Covered with sheets. They are about 1/2 the size
of the big ones and aren't waterproof but I put them on top of the big
one and it saves them, usually only use one or two of the big ones and
many of the small ones that we can change and keep clean. We bleach them
and toss when too soiled. We usually toss on a chux when they birth so
the big blood gets on them. They are much nicer as they are most absorbable
too.
The washable pads are great! I have used them in the hospital; but of
course they wash them in all kinds of germ killing things. I would be very
squeamish about taking anything soiled with body fluids and putting it
in my washer at home(I don't know if that is what you meant). But what
about using a combination of the disposables and cloth. Cloth is so much
nicer to sit on, AND if the parents buy them they can use them on the crib
or bed to protect the mattress from spitups and bedwetting. A lot of the
nurses in the hospital where I worked would put them under the sheet to
protect the mattress from SROM late in pregnancy.
ValEthics carries reclaimed
and DISCOUNTED washable pads.
A one to 10 solution of bleach kills HBsAg while almost anything kills HIV. The above recommendation was given to us by the CDC when I worked in Dialysis where HBV is prevalent.
By the way, I am now using Pursue brand concentrated disinfectant by
AMWAY. A concentration of 2.5 oz to a gallon of water sprayed on and left
wet for 10 minutes kills the following: Klebsiella, Pseudomones, Staph
Aureus, Salmonela (2 types), E-coli, Strep pyogenes, Strep faecalis, Shigella,
molds and fungus (athlete's foot) Herpes simplex, vaccina (pox), adenovirus
and influenza. This is great for cleaning hard surfaces (including plastic
covered mattress and pillows, tubs, some of your equipment), and I'm sure
that soaking soft stuff (bedding etc.) in the correct concentration will
do the job.
I have a couple. Very nice.. Just not sure they are worth the hassle, and the transport mess to use them often.
But it's VERY easy to do births with no disposables. A flannel backed plastic table cloth or two and a dozen bath towels; with perhaps a dozen cloth baby diapers will do for just about any birth!
Everything washes up fine with no staining . (Run through a cold water wash with no soap; then a hot/warm wash with soap. Nothing else needed). Even the table cloth is washable and reusable. Added benefit -- no transport or potential transfer of blood soaked materials.
Most births only make one load of laundry...
Lands End "Lighthouse Attache" makes a great birth bag.
The Freedom Bag is small, so
it fits into most larger main bags, but it opens up to carry SO MANY THINGS.
I found a great company that makes terrific custom bags - Wells
Cargo Co. - email: fred@alltuff.com, toll-free # is 877.866.0374
I don't think I have just the right birth bag yet, but I do like the way I have things arranged. Three things to carry:
About every 3-4 years, I change the way I carry things to births. So
there's not a "best" way for me, just new things to try. Right now I have
a canvas/nylon cheap bag that is just the right size for a large Rubbermaid
box to fit into. The bag keeps it clean in my car and easy to carry with
handles. At a birth, I take the box out and remove the lid. I scoot this
box around to wherever it's needed during the birth. In the box, I keep
stuff in gallon Zip-Loc bags, divided into categories like labor supplies,
regular birth stuff, resus stuff, newborn exam stuff, suturing stuff, etc.
I can see pretty quickly which Zip-Loc bag I need. I also have another
canvas bag with extra non-emergency supplies like chucks, gloves, 4x4s,
etc. in case it's a long birth and we use up the stuff in her birth kit.
This bag usually stays in the car until it's needed. The stuff in the mom's
birth kit is usually unpacked onto her dresser top or a table near the
birth - it's laid out so everything is visible. I have seen some of the
cloth bags on exhibit at some of the MANA conferences, but never saw one
that really looked useful to me. I do have a problem in not having duplicate
stuff for a postpartum bag, so I have to take things out of the birth bag
for postpartum visits and remember to put them back in the birth bag. Not
a great plan! But I'm working on it.
I guess I am one of those midwives who have tried different things along the way. For the longest time I used two of the bags that Moonflower sold, with all the pockets. They were good, but I hated that I couldn't see what I was looking for, and my apprentices would have to open every pouch to find things.
About 6-8 months ago I decided to try something different. My son was working in a soccer store and while visiting him I saw some soccer shoe bags by Nike that looked to be THE perfect midwife supply carrier. The dimensions of the shoe bags are about 3" deep, 16" long and 9" wide. They have an easily seen through mesh top with a zipper going the whole way. I bought a medium sized sports bag, by Umbro, and 4 of the Nike shoe bags. At the end of the sports bag are two large pockets, in one I keep all my after-birth handouts and the file of the birth I am attending, and in the other one I keep my herbal, meds. and homeopathy bags (I have small bags for each of these).
In the main compartment I carry the four see-through shoe bags. In one I keep all my resuscitation supplies, in one I keep all my instruments and everything I need for sterilizing them, in one I keep misc. birth things, and in the last bag I have everything I need for a quick birth....all I need to do is unzip it and there are gloves, 4 x 4's, oil, mirror, flashlight, K-Y, baby hat, etc. Under my four see-through bags I keep a few chux pads. I use a different soccer shoe bag that isn't see-through, but with a nice handle on the end, for the things I use at prenatals and at births....my Doppler, fetoscope, BP cuff, stethoscope, baby scales, measuring tape. I take it to the office and tuck it into my birth bag when going to a birth.
Everything neat and easy to find.
Years ago I bought my husband a camera tripod and case for Christmas.
On Christmas morning I looked at that tripod case and thought that my 02
tank (a large one, I think size E) would fit perfect in it. I tried it
out and it did. My husband never got his tripod case and I found a great
way to carry my tank. I just slip the handle over my shoulder to carry.
The top sticks out just enough to put the regulator on when I get to births.
Last week I sewed myself a bag like a jewelry or lingerie travel kit with clear vinyl pockets with zippers on fabric. Saw one in the summer that a midwife in Ontario used. It was big enough to drape over a chair, she liked it because if she was sending someone unfamiliar with where stuff was, they could see it and not have to figure out which of a variety of Tupperware etc. containers it was in.
I came home and hunted in the department stores, but found a couple little ones with a makeup bag attached.
I'm quite pleased with myself, I made it as wide as would fit into my duffel bag, and the length of the fabric (45"), it fan folds, and a friend on the weekend gave me a good suggestion to the colored twine I am using to hold it closed. It is bulky when filled and folded, but so were the various containers I had.
It has 6 pockets which are about the right length to fit an amni-hook, and 3 are deep enough to fit sterile glove packages. So I have the basics for birth in the top pocket - gloves, instruments, deLee, amni-hook, sterile ky, maybe a bulb syringe.
Next pocket has bags of nonsterile gloves, and syringes, swabs, oxytocin etc., then tinctures, anchored with 1/2" elastic, then a collection of catheters, amnihooks, amniswabs, extra deLee.
Then sutures, syringes, anesthetic, extra needles, as well as Vit K and syringes and alcohol and finally more gloves and instruments for suturing in the last pocket.
I'm not down to 1 bag yet, I have resuscitation equipment, blood tubes
and IV supplies in another bag, Oxygen tank, birthing chair plus my prenatal
bag, and don't have a really good way to carry files. But it's coming.
As all of my apprentices will attest to, I have tried MANY different
methods of getting my stuff to a birth. (And the truth is, I will probably
try MANY more) For the moment, I am happy with using 2 of the flight bags
now being sold as luggage. I use one large and one medium size bag. These
have the retractable handles and wheels. Inside each I use plastic containers
to hold the supplies. The smaller one is marked as birth kit #1 and holds
everything for a quick birth. The larger one, birth kit #2, holds all extras
including newborn exam and suture stuff. This way I can grab #1 or send
anyone to the van to get what I need. My 02 tank is the large one (E??)
that is on a carrier with wheels. This is the cargo I am least happy with
right now. Not only do I feel very uncomfortable with the possibility of
the regulator getting whacked, I also must carry my resuscitation equipment
in yet another small bag. Someone wrote about a tripod bag and said that
she puts the regulator on after arrival. I had not thought of that,(duh!!)
and would like to discuss how some of you transport your 02 tanks.
Here's how I carry my files and I like it. I use a 3-ring Note Tote
binder that velcros shut. I use those clear plastic sheet holders designed
for 3-ring binders. These are great for keeping each clients records together
(also you don't have to 3-hole punch everything). The front section of
my binder has client records. The back has extra forms, information handout
sheets, heelstick supplies and any other pieces of paper I might want to
carry. Use dividers if you want to keep things separated for easy access.
The pockets in the binder cover hold pens, gestation wheel, receipt book
etc. Important pieces of info. like dosages for assorted remedies, metric
conversion chart, pager # etc. are taped on inside of binder cover. Having
all paper stored in plastic not only keeps stuff together but protects
it from spills and messes. The other day when a young child at a prenatal
spilled water all over my notes the only thing affected were his mother's
records (and not that seriously as all that).
You can get birth balls from the
Birth Balls can be purchased from Cutting
Edge Press
Birth balls can also be purchased at health and fitness shops online,
e.g. The Gym Ball Store or
The
HealthFit Marketplace
Some people say that the 65 cm ball is too big for most moms.
I felt this way until I deflated it slightly. Now I absolutely love
this size! And in its slightly deflated state, it rolls around less
and seems more stable for the mom - there's more of a cradle for her bottom
as she's in a bit of a squatting position.
from Christine Jarc of Pacific Birth Support
I want to share with you my solution for dealing with the birth ball.
I always carry my ball deflated in a separate bag that I use only for
that purpose. I carry in it a small squeeze-type inflation pump that
can be used in the hands, or placed under a foot to pump. When I arrive
at the hospital, I always give the dad the ball and pump and let him have
at it. It takes a good while with this pump, and I've learned that
this serves a very useful purpose. Firstly, it gives dad a good way
to direct his nervous energy and work out a little physical tension as
well. It makes him feel useful at a time when the mom is settling
into the room and perhaps dealing with the staff of some initial procedures.
After he inflates the darn thing, I even have him take out into the hall
for a little Lysol spray (also in the bag), and then a towel-dry.
The dads seem relieved to have something specific to do.
Article on using
balls in birthing by Australian midwife, Joy Johnston.
Using
Your Gymnic Birthing Ball
First, determine size ball you need:
These balls can be used for exercising, physical therapy, and for exercise
with children. Here's one supplier (the cheapest):
GYMNIC 1 800 752 2255 7am to 6 pm Mountain time
45 cm 11.95
Packages are available which include ball, video guide, pump and dynaband
(?) for $34.95. You could also use an air mattress pump with the pointed
tip end to blow up.
To blow up ball: Inflate until legs are at 90-degree angle to your body,
and you have a 90-degree angle at your knees when sitting on the ball.
We order from Ball Dynamics 1-800-752-2255. If you order $100 or more,
no shipping fee.
BTW, we feel the 65 cm ball is too big for most of our clients. We mostly
stock the 55 cm ball.
E-mail Loveborn1@aol.com - ask Kim for a catalog - the birth balls she
sells are even cheaper ($19.95 + shipping).
And she sends them second day (postage runs about 4 bucks). My partners
and I bought all three of our BB's from LoveBorn.
About the birth ball covers, I made one from white flannel. Use one
big circle for the bottom, and a rectangle for the sides, and gather up
at the top with a drawstring. It took a lot of flannel, but is much softer
than the sheets, gowns, chux pads, etc. we used to cover up the birth ball
with. The rubber of the ball is just too yucky for bare faces and arms
to be touching, IMO. I used white flannel so I could wash it with hot water
and bleach after each birth. It then goes into a gallon-sized Zip-Loc and
back into my birth bag until next time. And yes, I wash my birth ball with
a bleach solution after each birth.
well, this weekend, i made a birth ball cover! yahoo! here's the thing,
i made two of them, one in a fleece, and one in a knit, and the cool thing
is, there are no buttons, velcro, snaps or nothing! it fits nice and snug
around the entire ball, and stays put by overlapping the first and last
panels! they can be scotch-guarded, and washed (but not dried in the dryer!)
to avoid stains, etc. Much handier than trying to lay a blanket/towel over
the ball, and with the cover, mom can move ball around without having to
readjust the cover!
Anyone interested in obtaining a birth ball cover can email hideout@hooked.net
I bought my Joy Chair some years ago (1998?) from an ad in Midwifery
Today.
If you practice where moms deliver on birthing beds, would you please
comment on whether you prefer the bed to remain intact or broken down into
the birthing chair configuration? ...and why you prefer it "your way"?
We have an Adele bed and I never break it down for the birth, but sometimes
do if I have a nasty repair. I use a squat bar a lot, and drop the foot
when using it, otherwise it stays flat or with the head up a bit. It has
stirrups to go with it, but I'm not sure where they are, since I have NEVER
used them. I put the mom's feet in the little pedals if I break the bed
for the repair.
As to birthing chair mode - I NEVER use that. too many tears.
In my vast experience doing hospital deliveries, (4 so far!!) Have not
even thought of using the bed. Have used lots of positions and variations
though. The birth rooms in both the hospitals where I have privileges have
a poster about the bed (sorry, never thought to look which brands) and
its various positions and uses. We did break the bed and used the stirrups
for a doc who came to repair a particularly nasty tear for one birth. I
think she could have done it quite nicely with the footrest things, but
she (the doc) didn't want to, she wanted stirrups. sigh
I've only broken the bed once, for a very large woman where it actually
seemed easier to do so, and more helpful for her to have her feet in the
foot pads. I use only the foot pads, never the stirrups. Will often drop
the foot a little, esp. if anticipating a large baby, but prefer the bed
unbroken also for that reason, in case I need to flip her over onto hands
and knees. I do break the bed for repairs, (unless it's just a very small
and quick job), as it makes it easier on my back to be able to sit directly
between the mom's legs. Again, I use the foot pads for that.
I started out at my hospital with birth room beds that were low to the
ground and did not break. I have never gotten used to the birthing beds
being so high. I have some problem with being so high off the ground when
the baby comes out. I have always wanted to do births on a pallet like
Odent.
So, on most of the beds, you have to raise the bed quite a way to turn
it into a chair. So I only use that if that position has been the most
effective pushing position. I most often deliver in the pushing position.
'
When I did births with breakable beds, I never took the end off, although
I might lower it a bit depending on the circumstances. My reason for not
"breaking the bed": very simple -- those darn babies are slippery!!!!!
For those who think I am joking, I am not. That babe comes out covered
in vernix and amniotic fluid and blood and sometimes they come out really
fast and I am not exactly known for my skilled hand-eye coordination. I
like a nice solid soft bed under that baby, not a four foot drop to a cold
hard floor. Usually I ease the babe out and lay it down on the bed for
a few seconds while I dry it a bit and take a brief look and then drop
it ever so gently onto mom's chest. Also, if you (god forbid) have to resus,
you have a handy work surface that does not require cutting the cord and
the parents can watch you work.
I rarely "break the bed" As a student, we spent time at an Air Force
base whose practice was the typical delivery room, sterile set up. There
was a whole set of hand maneuvers that we were supposed to do to "shake
hands with the baby". I never got the hang of it, though I never dropped
the baby. So, to get to attend births in a bed that has a gillion options
for me and the woman is a treat. I put the baby on her tummy, I can hurry
it to the warmer if we have troubles. But best of all, I think that the
woman who is birthing can do just about anything she wants at the time
she wants it. We break the bed for vacuums and for expected large babies,
but that is usually with one of the MD's standing by and I think they are
more comfortable with that because it is what they are used to.
About the book How to Buy Almost Any Drug Legally Without a Prescription:
According to WWW.Amazon.Com this book is difficult to find but they
can get you a used copy in 2 to 6 months...it is WORTH ITS WEIGHT IN GOLD!
and for $5.00 how can you go wrong??
Author: James Johnson
Remember that if your client acquires her own meds and self administers
you have a better chance of not falling out on the wrong side of federal
laws.
Selecting a Sphygmomanometer or Blood Pressure
Monitor
LITTMANN STETHOSCOPES - An
Overview and a Stethoscopes
Comparison Guide
Anemia
Detection Methods in Low-Resource Settings - different types of hemoglobinometer
technologies.
I'd like recommendations on hemoglobinometers. Cascade carries one using
"the Oxyhemoglobin method." But, what I thought I was looking for
was definitely different than what they picture in their catalog.
What I have seen before was a one step process with the blood drop going
into a disposable clear plastic thing-a-ma-jig and filling in the circle
area. Then, (this is the one step part), the clear plastic thing is set
into a small drawer and the drawer is closed. The hemoglobin value is then
digitally displayed. Does anyone know from this description what this machine
is and/or who distributes it and how to contact them?
Maybe someone could tell me the plus and minuses of the one from Cascade.
Or, do you have other recommendations for consideration?
You are talking about a Hemocue. The difference in the two mainly is
that the Hemocue is internally quality controlled which is a CLIA regulation
for exempt laboratory status. The hemoglobinometer sold by Cascade depends
on the clinician doing all the steps right to get a good result.
Thanks for the name of HEMOCUE. I immediately searched the web, and
found the following:
HemoCue(TM) Blood Hemoglobin system for the screening of the donors
with laboratory accuracy and precision. The system consists of a purpose
designed photometer and unbreakable plastic microcuvettes. The cuvettes
serve as pipette, test tube and measuring vessel all in one. The HemoCue(TM)
system reduces the exposures to blood screening the donors.
Glad the name Hemocue helped you in your search. We had one at the Birth
Center where I worked. I don't remember the model number but it was the
Hemocue Hemoglobin System. We used it for checking hemoglobin at 28 weeks,
36 weeks and 6 weeks postpartum. (The first visit lab work included CBC
so we didn't need to use it then.) It was very easy to use. I have no idea
about the price but I'd guess several hundred dollars. The pipettes are
on the expensive side (don't remember the exact price but I think about
$100 for 150). That's still a lot cheaper than an outside lab plus faster
and a lot more convenient.
I have used the treated paper method (you put a drop of blood on the
paper and eyeball-compare it to a chart. Seems pretty reliable. When we
compare the numbers we get with a recent lab test, they are usually quite
close.
I use the Tallquist book too for doing repeat hgb.......not the initial
ones. The book certainly is cheap, costs $5.00 from Cascade.
Me Too - I always used the Tallquist Book at a cost of $6.00 as opposed
to a hemoglobinometer - complete unit cost $200.00. When I compared results,
they were close enough so that I could treat a woman for anemia or borderline
anemia, if necessary.
How to take a capillary
sample
Lancets and
Lancing Devices - a review from children
with DIABETES
5 yrs age to 4'11" 45 cm - 18 inches
5'0" to 5' 7" 55 cm - 21.5 inches
5'8" to 6'2" 65 cm - 25 inches
6'3" to 6'9" 75 cm - 29.5 inches
55 cm 13.95
65 cm 16.95
75 cm 21.95
Add S&H costs, no sales tax if you're outside Colorado.
Birth Ball Covers
Cleaning Birth Balls
I use a solution of 1 to 10 bleach. This is what hospitals use and it does
the job on ANYTHING!! They even use it in the labs. Also on rubber and
vinyl. It doesn't break down the rubber or vinyl like alcohol will. Just
a thought. If you can't stand the bleach smell - like me - you can then
wash the ball after about 15 minutes with plain warm water.
Birth Stools
Hospital Beds
Getting Prescription Medications
Published by AVON in Nov. 1990
ISBN 2 are listed:
0380760339
9993548863
Source of OB meds:
Durr Medical (TX)214-243-1551,
Henry Schein (NY)800-356-5788
Sphygmomanometers or Blood Pressure Monitors
and Stethoscopes
Hemoglobinometers/Lancets/Tenderletts
HemoCue, Inc.
23263 Madero #A
Mission Viejo, CA 92691
Ms. Yvonne Martenson
Marketing Manager
Telephone: (714)-859-2630 Fax: (714)-859-3066
Lancets and Tenderletts
The Tenderlett lancet
is a self-contained, single-use lancing device. Rather than using a sharpened
shaft that pokes the finger like traditional
lancets, the Tenderlett uses a tiny knife blade that slices the finger.
In the words of the maker, "Tenderlett devices make a surgical incision
instead of a guillotine puncture wound so that tissue damage and pain are
virtually eliminated." Our tester said the Tenderlett Toddler was much
less painful than a traditional (and recommended) lancet.
Three Tenderletts are available, with varying incision depths:
Tenderlett (1.75 mm)
Tenderlett Jr. (1.25 mm)
Tenderlett Toddler (0.85 mm)
The AtLast System
from Amira Medical is the first blood glucose system designed to eliminate
painful fingersticks.
We have been using pulse oximeters on babies who have poor muscle tone
or are a strange color- or who are tachypnic-- or any baby we work
on to resuscitate so besides getting a pulse it tells you how well oxygenated
the kido is -- actually has gotten rid of some stress and guess work.
Can you tell us more about this? Is there a special type for newborns, or is it just a different sensor? Do you feel it's reliable? I took in a baby with a heart problem, and the sensor they used didn't want to stay on the baby, and they had readings all over the place.
Are the sensors reusable, or do you need a new one for each baby? Where did you buy it? I've seen them on E-Bay but would not really know what kind to buy or where to buy supplies.
I've wished I had one just a couple of times.
I've got one, and I do feel that it has saved a few transports for urgent evaluation of a marginal newborn. You do need to have one that is designed for neonatal use.
I've had mine for about six years, and it's been very reliable.
I got my Fingerprint Pulse Oximeter from Moore Medical:
[NOTE - Moore Medical often has substantial discounts - up to 10% - tell them you're a new customer and ask what kinds of discounts they have.]
I like the fact that this has a little built-in printer for documenting my findings, but they've got a good selection of other models.
Here are the manufacturer's pages, and you can see they've got some newer devices and here are the sensors, including neonatal.
Although they say the neonate sensor is disposable, it really can be re-used, and you could improvise with the tape that holds it in place.
I found the Fingerprint Pulse Oximeter on sale for $625 at:
http:
or even for $605 (a sizzling summer sale!) at:
http:
More shopping might yield better prices:
http:
It's a pricey instrument, but you can claim insurance reimbursement
for it:
94760 Single Noninvasive O2 sat
$28
I've only used mine 6-7 times that I can recall, but it's saved a lot
of gray hair and sleepless nights!!!
And . . . if you get the "Sleep" version, you can use it on your friends
and family to diagnose sleep apnea! What a bonus!
P.S. A close-knit midwife community could have one that is available
for loan as needed, similar to a portable EFM device. It's the kind of
device that you rarely need URGENTLY, i.e. you can safely stay and personally
observe the baby and be ready to resuscitate if needed while someone else
(an apprentice or assistant or even a family member) goes to pick it up
from a central location.
Tired of worrying about when to send your assistant to the oven to retrieve
the warming baby blankets? Want to have a nice warm blanket to offer
mom after the birth?
Those new insulated "cooler" bags are terrific for this; obviously,
if they are insulated to keep stuff cool, you can use them to warm blankets
up if you wrap the blankets around a warm/hot heating pad. You need
to get a bag with a reasonable capacity, typically measured in "cans",
as in how many soda cans it will contain. Anything above 40-cans
is likely to be OK, but I think the larger, flatter ones are easier to
use because they conform better to the shape of the heating pad.
California
Innovations makes some really nice bags that have various straps and
outer bags and pouches, which can be nice if you want to carry additional
stuff in the bag. I got a mine (40-can or 26 quart/24.6 liter capacity)
for around $15 at Costco. I called them at their toll-free number,
888-413-2665, and they said they're available at many department and hardware
stores, such as BJ's wholesale club, Costco, Sports Authority, Loew's,
Target, Walgreen's, and Kmart. They also make one that has a capacity
of 72 cans - 18x13x13 - this would be my first choice if I could find it
easily at a good price.
I also saw one that was the ideal shape at Wal-Mart; it was longer and
not as deep, had fewer pockets and less fancy straps, for around $18.
To load the "warmer" bag:
According to Cascade: "Res-Q-Vac. Enthusiastically recommended to us
by several practicing professionals, the Res-Q-Vac safely removes meconium
from the baby's airway with virtually no risk of cross contamination. Easy
to use, nonelectric & portable, Res-Q-vac fits into a birth bag. Complete
set includes reusable handle/ pump, pediatric single use canister and two
catheters. Replacement units include canister and one 14", 10 fr catheters."
Complete set $ 58.00 Replacement units $8.95 Case of 10 $ 89.50.
As one who has gotten a mouthful of mec using a De Lee (yuck) and feeling
that I need more suction than I get with one I am interested in the Res-Q-Vac.
But is it really any better?
During our NRP class, the instructor brought a variety of suction devices,
Bac-Shield DeLee, regular DeLee, Res-Q-Vac, and I don't remember what else.
She then made up a thick instant pudding and had us try to suck it up.
It was possible, but nearly pulled your sinuses out with a regular DeLee,
impossible with the Bac-Shield, and very easy with the Res-Q-Vac.
I've used a standard DeLee once, and Res-Q-Vac once. The only advantage
I see with a regular DeLee, is that you have two hands free to guide the
catheter and you need one hand to pump with the Res-Q-Vac. I've seen the
Res-Q-Vac work well on very thick mucus (like rubber cement).
I was convinced enough to buy one.
Undergarments for Relief of Back Pain and Vulvar
Varicosities
I really like the numerous options available from
The Medical Supply House
carries a diverse product line, including medical compression stockings,
back supports, stomach binders.
Jobst has a Store
Locator
Comfy Cradle
Maternity Support, #3090 without insert - this belly support also has
a top strap that might do what the Asian binders do . . . encourage baby
into the pelvis on the early side.
The Gabrialla® Maternity
Collection, including Maternity Elastic Support Belt, Maternity Support
Girdle, Maternity Graduated Compression Elastic Support Pantyhose, Postpartum
Support Girdle, Abdominal Support Girdle, Elastic Abdominal Binder, Nursing
Bra, Graduated Compression Elastic Support Hosiery, Pantyhose, and Thigh
Highs.
Maternity
support garments from Allegro
Medical
Elastic
Abdominal Binders - for use postpartum, not during pregnancy
Pre-Natal "Loving Lift/Action
Lift" maternity supporter - a simple, comfortable belly supporter hanging
off the shoulders. Can be ordered from Moore Products, P.O. Box 647,
Belmont, CA 94002, 1-800-457-1567 [patent No. 4005715]
Graduated Compression
Elastic Support Hosiery
I am looking for vendors names, addresses, and phone #s who make belly
binders for abdominal support. I am working with a multigravida who has
a significant diastasis (separation) of the rectus abdominis muscles [aka
diastasis recti] and needs to correct and maintain fetal position in the
third trimester.
Big 5 Sporting Goods makes an abdominal binder of sorts called the Body
Glove. Mostly used for support after the baby is born. Plus it is sold
as a sort of loose weight thing.
Here is one that I think is reasonably priced- the "Prenatal Cradle"
company- Tel # (517) 386-6038- they are $40- - they also have a vulvar
varicosities support, as well as a more advanced belly binder.
Check different pharmacies. I had to call in a Rx for a really good
one for my multip with twins. Her husband was the one who did the searching.
Also saw one in Midwifery Today ad - 412 694-5283 Trennaventions 131
Hill St, Derry, PA, 15627. Called the Baby Hugger.
I do not recommend the Prenatal Cradle. You can get a support belt for
pregnant women cheaply at Penney's--some maternity stores carry it also.
I've had it work well for clients.
I just got a Prenatal Cradle for a woman with significant vulvar varicosities
and I think it is really helping. But I also sell the Maternity Belt as
I work with Hutterites and they really think they are necessary for almost
all. They sell for $17.50 , hence much cheaper and just as good if you
just need abdominal support.
I just use a piece of long cloth to wrap around the belly for a binder,
and either tie or pin it. This can be used starting when the belly starts
to feel heavy for anyone who's p and during pp. It can be great during
moon time, too.
The Berkley digital electronic hanging scale can be ordered from Bass
Pro Shops at 1-800-227-7776. As of 9/97, the cost is $24.88 The scale appears
to display weight in pounds and fractions of a pound, rather than pounds
and ounces - not sure. The accuracy of a FS-1 weighs in 1/10 of a pound,
up to 50 pounds.
Bass Pro Shops (1-800-227-7776) also carries a couple of Normark digital
electronic scale that display weight in pounds and ounces. One weight up
to 15 pounds ($24.94) and the other up to 50 pounds ($39.94). These are
accurate within 2 ounces and have a special tare weight feature.
I have the Normark Weigh-In Scale. It goes up to 50 lbs, though I don't
need that much of course. I really do like it......I hook up the empty
sling, and turn it on, and it will zero out. Then leaving it turned on
I put baby in the sling and hook it up.
I have an old cotillion brass type, purchased 20+ years ago. I take
it to the local grocery 1x mo to check the weight by weighing fruit (since
those scales are checked by weights and measures folks from the state at
least 1x year and are certified accurate.
I have used several digital hanging scales and have yet to be happy
with them. Even with the great accuracy rating they have I have not found
them to be accurate. At one birth I was at, no one believed how big the
baby was so my partner weighed her again (without taking her out of the
sling or anything) moments after the first event...and got a 5 once difference
from the original reading. I had another similar experience at a birth
just a few weeks ago.
The thing supposedly zeros itself out every time you hit the power button
but I am not so sure.
I am relying on my good old brass scale.
You should be able to find the scale at any fishing store. I got mine
for 24.95 on sale, regularly about 30$. I then made the sling. Fabric at
28x45 inches. Hem the raw edges. For added safety, use six inches of elastic
and stretch and sew it on the center of both hemmed sides opening. Get
2 - 2 inch D rings (had to find them at a tack store, like saddles and
stuff). Pleat the edge in two inch pleats, then wrap them through the D
rings and hand stitch shut. (mine was too thick for my machine. Cascade
has them for about ten dollars, but they are ugly. I got great flannel
that is really cute.
I ironed the raw edge in 1/4 of an inch, placed the elastic on it and
then ironed and hemmed it an additional 3/8 of an inch. I zig zaged 1/4
inch elastic.
You can get sturdy, black plastic 2" D-rings from The
Rain Shed Inc., a supply house for outdoor gear. Call 541-753-8900
or fax 541-757-1887 or write to them at 707 NW 11th, Corvallis, OR 97330.
The cost is 40 cents per D-ring, plus $2.25 shipping and handling for
8 or fewer D-rings. Or just send them your credit card number and they'll
figure it out.
They also sell metal D-rings, but I always worry that they might fall
and hit the baby.
American size 6 or 7 needles
New Umbilical Clamp And Cutter Invention (Veridien
1997)
$6.00 Stanley wire stripper or off-brand wire stripper-$3.75
1-800-JEFFERS
Nexaband wound closure "SuperGlue" cyanoacrylate
Livestock/equine shoulder-length OB gloves (for waterbirth)
There's a $5 service charge for orders under $50. If you order for a
group of midwives, you can order 2 boxes of gloves and 4 tubes of Nexaband
for just over $50, to avoid the service charge.
KV vet supply. 100 shoulder-length gloves for $9.00 - shipping is typically
free.
They also have Nexaband SC for wound closure, and they have good prices
on suture material and BD syringes and needles. Also
The number to get a catalog is 800-269-0093. Ask for the Pet catalog.
Homebirth Options Midwifery IndependencE (H.O.M.E.) has tee shirts and
bumper stickers. The tee shirts have a small 3X3 inch design in the left
corner of the shirt.(above the breast) The design is the outline of a pregnant
belly and the mother's hand on her belly. Another hand comes in from the
right side(the midwife's hand). Underneath it says, "MIDWIFERY Preserve
the Art" They are great tee-shirts; the best quality 100% heavy duty white
cotton (no way to see through these) with a black ink design. Folks love
them, nothing overstated, just right...classy. All sizes are available.
$20.00 (half of the fee goes as a donation to the organization which promotes
pro-active legal action for homebirth)
The bumper stickers are also fun. They have white lettering and design
with a black background. The same logo design, but they say, "There's no
place like HOME...birth!" (HOME has received calls from across the coast,
requesting these bumper stickers-no kidding!) They are only $2.00, and
while the group doesn't make any $$ on the bumper stickers, they certainly
get the word out about homebirth.
To request either of these items (it's not too early to order for your
favorite midwife or friend for the holidays!) please contact HOME or
New Latex
Allergy Test Discerns Relevant Allergens [Mescape registration is free.]
Latex Allergy Links
is a comprehensive, up-to-date listing of latex allergy-related sites on
the Internet. It also includes articles and practical information about
latex allergy.
Hygiene
of the Skin: When Is Clean Too Clean? [Medscape registration
is free]
"[F]requent handwashing is not only potentially damaging to skin, it
is also time-consuming and expensive[68]. Finnish investigators demonstrated
that after frequent washing the hands of patient-care providers became
damaged and posed greater risk to themselves and patients than if they
had washed less often."
You can get a selection of glove samples from Master
Products - 1-800-826-2242
OSHA's
page on Latex Allergy [Revision Date: 03 October 2000]
OSHA issues latex
allergy warning amid intense storm of accusations - Technical bulletin
alerts field inspectors to risks for health care workers [June, 1999]
Latex Allergy Fact Sheet
from the National Institute for Occupational Safety and Health (July,
1997)
American
Nurses Association: Selected Testimony
A.L.E.R.T., Inc. (American
Latex Allergy Association) is a non-profit, tax exempt organization which
provides information about latex allergy and supports natural rubber latex
(NRL) allergic individuals.
Delaware Valley Latex Allergy Support
Network
Just as a precaution, realize that wearing latex gloves can lead to
latex sensitization and an allergy that will pull the rug out from under
your chosen line of work. I know this as I have a latex allergy after doing
4 1/2 yrs in L&D. I can no longer pursue my clinical interest in childbirth
(some blessings come in obscure disguises!!) If you use gloves routinely
in your doula work, I might suggest speaking with the infection control
administrator at the hospital you are familiar with and ask her/him about
the latest in latex-free gloves that offer the same protection as latex.
I personally use a glove called NITRILE. It is a blue glove and has similar
elasticity, is not powdered and works well for routine use. One drawback
is that the gloves are MUCH more expensive than latex gloves. The comparison
is a box of 100 latex exam gloves will cost around $4-$5 and a box of 50
NITRILE gloves will run around $18.00 A huge expense? Yes. Is it worth
it? I think if you love your work, it is. Read the latest in the Journals
of Immunology, Allergy, etc.......
There is also a lot of information on the web relating to Latex allergy.
If anyone who uses latex gloves routinely when providing prenatal care,
labor support, midwifery, or postpartum care experiences ANY redness, itching,
swelling, cracked skin, a rash that appears after wearing gloves for ANY
length of time that ends at the wrist or watery, itchy, swollen eyes, difficulty
with breathing or persistent upset stomach while in a clinical setting,
or a sensitivity to certain foods such as milk, bananas, kiwi, some nuts
like chestnuts, avocados...... GET MEDICAL ATTENTION!!!! First, you will
need a RAST test. Not very reliable, yet can give you some info. Skin testing
is the most conclusive, yet can cause a light syst. reaction.
Don't try to rationalize out of it. This is serious and there have been
deaths attributed to latex allergy. I have to carry epi-pens at all times
and have stopped breathing in the dentist's chair 3 times.
I agree!! I have a neg blood test for latex allergy, but break out in
hives something horrible when wearing latex gloves! I have used Sensicare,
but also break out in hives from the powder in them. I am also severely
allergic to bananas ( a relative of latex) and must carry two epi pens
just in case!
I did forget to mention that a hospital's SPD (Supply and Purchasing
Dept.) should have catalogues of different companies. If they have a Latex-free
crash cart.. (TOTALLY ESSENTIAL THESE DAYS) they should stock them. Call
that dept. and they might be able to point you in the right direction.
The foods I mentioned do have similar protein structures as latex which
is why they will also bother you. A lactose intolerance is not uncommon
in adults, yet it can be another signal that your body is building up allergens
to the latex. The powder in the gloves only makes it worse. The bad part
is that the uninformed person may suggest that you wash your hands more
often and use lotion to relieve the dryness. This only makes the problem
worse!!
The lotion just helps the latex proteins get deeper into your system.
The whole thing is really rotten because it seems that as soon as Universal
Precautions went into force in (I think) it was 1987, the glove manufacturers
knew that the demand would be up and larger contracts would be a premium.
In order to underbid the competitor and get the large accounts, they eliminated
several of the purification steps to cut costs. This kept many of the allergy
causing particles (proteins) in the rubber and then....... sensitization
and ALLERGY! Sadly, many health care professionals have had to let go of
their life-long careers and passions due to Capitalism at its worst.
Just a footnote..........Be alert to the possibility that those you
are attending may have this allergy and if you are wearing latex gloves
you may create a reaction for them, too. In the hospital where I work we
have a LATEX-FREE cart of supplies to use for these special situations.
I, myself have no problems with latex. However, I never use latex because
of the risk to the women I work with who might have an allergy.
Thanks for mentioning the possibility of patients/clients having the
allergy. I know recently it is becoming more prevalent, evidenced by hospitals
having latex-free crash carts and supplies.
I hope with this early warning you can avoid future exposure to latex
products and preserve your career.
For those who think they may suffer from latex allergy or have clients
with this condition, please subscribe to the following list. It is an informative
list much like the one you subscribe to now and can give you many sources
of support, encouragement and latest info in this area of medicine. When
you write to the address below, you may have to request info on how to
subscribe properly.
RUBBER@postal.tamu.edu
Is there ever a concern that we will then, as a species, develop vinyl
allergies?
Chemistry was never my strong point, but the way it was explained to
me is that because latex is a natural product (i.e. arising in nature),
it has proteins in it, and it's the proteins that trigger allergies.
Vinyl is a synthetic manufactured product and doesn't contain proteins.
Is anyone out there using a Leff fetoscope during labor? Are you able
to use it exclusively, i.e. without needing a Doppler? Can you use it to
listen to heart tones throughout a contraction, or just in between?
I have always used a Leff, was trained on one, before we used Dopplers.
Can almost always get heart tones. All the midwives in our practice use
them. However, i LOVE my Doppler, which is politically incorrect in some
circles. I love that the moms can hear it so clearly, that it is so easy
to use, that moms don't have to lie down to get heart tones, that you can
get really early heart tones, that everyone at the birth can hear what's
going on if there is a problem. --sorry, that is more than you asked! You
can listen with the Leff, through contractions, and you could do it without
a Doppler.
I used to use one when a labor and delivery nurse along many years ago.
I liked them. We used them during the delivery and could hear before, during
if she was not pushing, and after.
I use a Leff fetoscope for all clients who do not want Doppler. I've
occasionally had to ask a woman's permission to use the Doppler when for
some strange reason, I can't hear - probably positional, or if I am hearing
a lot of decels or bradycardia and want more confirmation. I like the Leff
better than other types of fetoscope because the woman can listen with
it as well and it is more flexible for different positions and it works
underwater!!
I used a Leff fetoscope during the early 1980s, before I had a Doppler.
My experience was that I was able to get heart tones well throughout labor
and most of second stage (though not with the crisp tones of the Doppler).
FHTs were often difficult for me to get in late second stage/crowning,
however--had to rely on scalp color and intuition. I do prefer the Doppler
but use my Leff-Sklar during prenatals and early labor when I have clients
who are concerned about ultrasound exposure. I do explain to them, however,
that I'll need to use the Doppler during late labor/second stage. So far
everyone's been okay with that. I prefer the Leff to the Allen, but the
weighted bell is always cold, has to be warmed if this bothers your clients.
It can be held under very warm water for about 20-30 secs and then gets
nice and warm. It can also be set on the edge of a wood stove to warm,
or kept between a heating pad with the receiving blankets. Under a lamp
light bulb would work, too, if it was close enough (gooseneck). Or
you can use a wash cloth dipped in hot H20 and wrung out to wrap the head
in to keep it warm between auscultations.
There is a difference in the sound with the Leff. I use
both a Leff and an Allen fetoscope and a doppler and find that I can hear
earlier with an Allen, sometimes 15 wks, but with the Leff, I can often
hear through second stage as well as on H&N's. Also, once you warm
the bell, you can keep it at a comfortable temp by sticking it in the pocket
of your jeans, very convenient for those labors where the Mom is wandering
from room to room.
The Leff stethoscope "For auscultation of the fetal heart, with 9" weighted
bell, chrome plated, black latex tubing, "Y" connector, binaural, eartips".
I bought one, and it is nice. The bell connects with a tapered metal
piece on the tubing that stays connected by friction to the bell (kind
of like a ground-glass perfume stopper) instead of the bayonet mount I
have seen one other stethoscopes of this type. I've used it once, and it
is really different. I know midwives who love these.
I have an old address label for the amnicators if anyone is interested.
The address is Medical Wire & Equipment Co., Corsham, Wiltshire, England
SN13 9RT Telephone is (0225) 810361. Fax is (0225) 810153
The oxygen tanks, aka
Self-Contained Breathing Apparatus (SCBA)
There is also information about Explosions
and Fires in Aluminum Oxygen Regulators and Safe Practices for Handling
and Operating Oxygen Equipment
Air is air, but oxygen is not all the same oxygen, and oxygen is not
air. It's your prerogative to not believe it, but I wanted to add
to the other replies here, because there are a LOT of students and future
midwives here, and I don't want them to think that medical grade oxygen
is not necessary. I'm not sure how many sources and which kind of
sources could help you to believe it, so right now, I'm speaking to the
students here. In some areas, they would have no problem acquiring
welding oxygen, but they may not be able to acquire medical oxygen, and
if they come away from here believing they're the same, there could be
trouble for a client or baby someday. Medical grade is purified and
must be so for human use. So all you students, please keep that in
mind.
The medical grade has been purified, gone through an extra step to clear
out the contaminants. If I'm pushing oxygen through a baby who as
apneic, I want it to be as pure as I can control.
Air is 21% oxygen and 79% nitrogen (approximately). What comes
out of an oxygen tank should be 100% oxygen. The purpose of using
100% oxygen, of course, is for a person who is compromised for some reason
and would be assisted with the higher percentage of inhaled oxygen i.e.
to get mom's blood to a higher percentage of oxygenation so that a baby
with a squished cord will thus benefit from this higher blood percentage.
Normal blood oxygen percentage would be 95% - 100% so you see that if mom
is normal at these percentages but baby is sinking into the 60 - 70% because
of a cord cut-off or partial placental abruption and we put an O2 mask
on mom which delivers 100% O2 - we thus boost mom's percentage up to maybe
200% - then baby benefits from the higher available supply.
You need an Rx for oxygen because because if oxygen at greater than
50% is administered continuously for more than 24-48 hours - it can cause
"oxygen toxicity" and lung damage (all oxygen and little nitrogen upsets
the lung and alveoli can collapse).
PS - you need a "nonrebreather" mask to deliver 100% O2 to mom (mask
has a one-way valve so that when a person breathes out it opens but stays
closed so that when a person breathes in - they are only getting the oxygen
from the tank. Potential problem with this mask is that if O2 in
tank runs out, person can suffocate.) A regular "simple" face mask
will deliver about 40 - 60% O2 and is usually best for midwives to use
.
in discussing with my dh-(emergency room doc)welding grade oxygen can
have contaminants, like lead, mercury, other gasses-it doesn't have to
go through testing such as flame spectrophotometry to prove that
it is pure oxygen without contaminants.he feels strongly that it is risky
to use on newborns-it could be contaminated with something as dangerous
as cyanide-the regulations are very loose and it is not necessary to study
the purity factor as it is not intended for use on humans. Simply to say
one has never had a problem and/or because a person working in the welding
business is willing to fill an oxygen unit- it does not make this appropriate
medical protocol.
If you are a student midwife -- or a midwife who does only a few births
=- and are having difficulty finding medical grade O2... I would strongly
suggest going without it rather than buying welding O2. Rely on what WORKS
-- your ambubag or m-to-m -- and wait the couple minutes for the folks
to show up with medical grade O2 rather than using a controversial and
possibly contaminated substitute.
Oxygen cylinder sizes: Size C = 250 Liters Size D = 455
Liters Size E = 680 Liters
Oxygen - We get our oxygen refilled at a welding supply house and the
guys there are always friendly and never ask any questions. Other midwives
get prescriptions from friendly docs or CNM's to have their tanks filled
at more standard medical supply houses.
So, anyone who knows whether or not O2 should be kept upright and whether
or not keeping it in my hot car is safe, please respond.
I sure hope keeping it in a hot car is safe, because there really is
not any alternative when you have someone due soon. You have to keep everything
with you when you run errands, and so on.
My brother, who transports welding gasses, says that the important thing
is to make sure the stem on the tank will not bang against anything. That's
why I really like my hard case (toolbox). I've heard of the stem being
banged, and the banging causing a blast of oxygen. Aluminum oxygen tanks
are a softer metal than the steel tanks, so the threads the stem screws
into can leak if the stem gets banged around.
I have an old article that came from "The Farm", maybe Birth Gazette?
that states that oxygen should be carried upright, and in a case that will
protect the regulator as well as the tank from damage. I don't know about
this "upright" part, since fire trucks etc., that carry many oxygen tanks
have them all stored on their sides. Also, a lot of the bags, etc., that
you can buy to carry the O2 are made to have the tank lying down.
In the book "Practical Skills Guide for Midwifery", under Oxygen Set-up,
it states "...take care not to leave the free-standing cylinder in the
upright position unattended. Make sure the cylinder top is not pointed
toward anyone."
ARM'S REACH: Bedside Co-Sleeper
- A 3-sided crib that fits next to mommy's (and daddy's!) bed. it converts
into a changing table AND a playpen as well! you can fold it up with a
carrying case too, so you can take it where ever you go!
OK - I've often dreamed about having a portable ultrasound machine that
I could whip out to make a positive diagnosis of posterior or asynclitic
head positions, in addition to ruling out breech. Well, you can get
the SonoSite 180Plus for only $20,000
or so. Maybe someday . . . Or, you can get the MySono
201 ObGyn for only $13,750, or, if you can live without the transvaginal
probe, you can get the MySono
201 General for only $8950. Personally, I'm going to wait a couple
of years and see if the price comes down!
ES-101EX-2 EchoSounder™
Fetal Doppler - can hear fetal heart at six weeks???
BE WARNED!
Oils can damage the soft rubber (or elastomer) faces of ultrasound
probes. Hard faced probes are not usually damaged by the use of vegetable
or mineral oils but the cables to your probes will become brittle with
time and crack exposing bare wires. In time, the oil will work its way
down to the probe head, the transducer will start to corrode and eventually
your probe will stop working.
Don't forget that you may also be exposing your patient to hazardous
voltages etc while carrying out your routine examination.
KY-jelly is safe to use.
A rep. from Imex/Nicolet
sent me this copy: " Imex / Nicolet is one of the leading manufacturer
of fetal Dopplers in
I don't know if any of you have used the "Sonicaid" hand held Doppler,
but it is what I am ordering. It is a one hand Doppler, very sensitive,
speaker can be on or off, with a volume control, and digital readout that
calculates for you and helps determine good variability, and it is available
waterproof, or non waterproof. I have used it in the tub, shower and elsewhere
out of water at one of the birth centers I go to and love its compact size,
one hand operation, ease of use, sensitivity and waterproof features. It
goes for around 599.00 for non waterproof, and 699.00 for waterproof, I
THINK BUT DON'T QUOTE ME ON THAT AS I HAVEN'T ORDERED IT YET. Available
from:
Oxford Instruments
I just called the company that has the Sonicaid Doppler, I posted about
earlier, and they have a special Midwifery price of 599.00 for waterproof,
and 499.00 for non-waterproof.
My current favorite is the Oxford, one piece, waterproof, built in speaker
and fetal calc. Costs about $750. Sonicaid 121 -- $495 for waterproof version
The midwife we hired yesterday used aloe gel...what are you folks using?
I hadn't seen this before, though it was nice.
I've been using olive/almond oil for some time. i think the sounds are
MUCH clearer than with the Doppler gel, less staticky, and the oil rubs
into moms tummy (doesn't stiffen up and get sticky like the gel does).
Was worried at first that it might somehow harm the Doppler, but no problem
at all -- the head looks superb!
I used to use olive oil and it looked ok but the Doppler started to
have problems and I found out that the oil had seeped into the head and
ruined it. So I would say don't use oil.
any viscous substance will work. The midwife I apprenticed with
used the herbal massage oil - but then we were told by the Doppler company
that the oil can seep into the Doppler head & do multiple damage. So
now, I use a hand cream - it is still thick enough not to seep & it
rubs nicely into mom's belly when done. I even received samples from someplace
(don't remember where) of hand lotion in a small bottle that fits nicely
in my Doppler case - I can just leave it behind with that mom when I leave
after her birth. So much nicer than Doppler goop.
I've been using arnica gel. Then we can just rub it into the mom's belly.
What kind of hand cream do you use? I would just rather use this that
the Doppler gel. You always have to wipe it off and sometimes you smear
it. Plus in labor when listening to FHT's often it would be nice to leave
it on and not have the mom put her hand there and get it all over her.
No particular brand - just find one that has a thicker consistency to
it
I usually use Doppler gel, but as far as I can tell, it's just K-Y with
blue coloring. Anyone know what's actually in the stuff? Aloe gel sounds
nice, but it would be more expensive. I would avoid oils or oil-containing
lotions (i.e. the vast majority of hand lotions), as they can ruin your
Doppler head, as someone mentioned earlier. If you have a Doppler with
a hard plastic probe like Imex, it's probably not as important, but if
you have the kind that has that thin plastic membrane on the probe head
like Parks, and I think most Medasonics, stay away from anything with any
oils in it. They're very expensive to replace.
I think the Doppler gel is different. One of the midwives I work with
was out of Doppler gel, so filled up the bottle with K-Y, and at every
birth we have a plugged nozzle on the bottle. The KY is also a lot more
runny, dries up into little balls all over everything etc.
I HATE using KY on the Doppler.
I'm really sorry to hear that the lotion might not be such a good idea.
I was really liking the sound of that!
My fiance, the industrial ultrasound engineer, says that most ultrasonic
gels are solutions of cellulose and water. He says the main difference
between the industrial and medical gels is the dye color used.
I would not use k-y on the Dopplers with the plastic cover on the transducer
either. My preceptor (13 years ago) ruined her medasonics with k-y because
it was so drying. It dries and flakes and will crack the plastic.
Several messages have been posted about gels for sonography. Here's
my .02 worth.
In the 1970's mineral oil was the standard until manufacturers came
out with delicate 1/4 wave matching layers on the front to the transducer
to improve the noise to signal ratio (better pictures), which the oil destroyed.
Then the water soluble, non staining gels were developed. They are similar
than K-Y, but I'm not sure they are exactly the same, but probably are.
We often use sterile surgilube when called for, particularly with endovaginal
transducers since there have been a very few reports of yeast infections
following sonography (may have been coincidental, and not caused by, who
knows). We did have infection control test some gel and they were able
to grow cultures from it. The problem is many labs refill gel bottles,
this is an accepted procedure. They also keep them warm, this is humanitarian.
However, the warmth may promote bug growth. I have never personally seen
any identifiable problems from this in 22+ years of experience, but the
potential is there.
Of course, any liquid can be used as an air-tight coupling. Water is
advised for endovaginal in fertility laboratories because the gels retard
sperm motility. However, for transabdominal scanning, water won't stay
where you put it, and is cool due to evaporation.
Now about Aloe gels, they seem nice and work well. The only objection
to them is when they dry they leave a residue, sort of like dried mucus.
Not particularly attractive. However if you clean your equipment properly,
this is not a problem.
Hand lotions can also be used. However, some contain alcohol or other
solvents that might be damaging to transducer parts. At a $2000.00+ per
transducer you probably want to be sure the manufacturer approves the lotion
you use. The safest is to use gels designed specifically for this purpose.
Other wise your transducer may dry up and drop off.
Modern transducers use thin layers of material (1/4 wave matching layers)
that have a rubbery consistency. The exact material is usually proprietary
and manufacturers won't tell what it is, but they all claim theirs is best.
Mineral oil, alcohol, and other solvents will be absorbed, or will dissolve
this layer. Many liquids will also penetrate into the crevices of the transducers
and loosen the glue that adheres the back-damping material to the back
of the crystal elements. It is a good practice to look at the image (dry
transducer) in the air and observe the "ring-down" in the Fresnel zone
(near-field). Then press with your hand on the front and observe how much
the ring-down is reduced or not. Good transducers will not have much ring-down
and pressing will reduce it only slightly more. If it doesn't reduce it
or makes it worse, then the transducer is probably cracked or the back-damping
material is loose.
I don't do US scans but do use a Doppler which is one purchased several
years ago. I used to use KY Jelly with the Doppler as gel because it was
so inexpensive rather than Doppler gel but was told by the Doppler company
that even ky is different composition than the stuff produced specifically
for use with Dopplers and could damage the probe. As my Doppler was already
beginning to sound a bit staticky (I don't know if that is truly a word
or the actual spelling but I trust you understand my meaning), I decided
to just use the gel produced for this purpose and haven't had further problems
since. However I notice that many other practitioners do use KY gel on
the Dopplers, and even the little hospital where I sometimes do births
uses KY on their FM transducer which surprised me. I also notice that the
Dopplers where practitioners use lots of KY seem to produce more static,
but maybe this is artifact as the Dopplers are older anyway.
So, I suppose my question would be is it true that using KY jelly rather
than aquasonic gel might damage the probe to Dopplers? If so, I would like
to be able to pass this on to the people I know who use KY on a regular
basis. I would never dream of using oil or lotion with my Doppler unless
it was an emergency. Too paranoid, I guess.
There's a set of vaginal weights that are used for women to increase
muscle tone. The weights are called StepFree and are available from
Timm Research Co. You can reach them at (800) 966-2796. Last
I heard they were selling for around $35 including S&H.
MILEX has vaginal cones - western div is 800-milex-12
Soon after the birth, we fill the family's washing machine with cold
water, 1 cup table salt and their regular detergent. As convenient,
we gather up the laundry with blood and/or meconium and put it in to soak,
agitating for a few minutes t work in the salt and detergent. Then,
once it's all in, we agitate a little more, let it soak for an hour and
then wash normally. This gets the blood out beautifully, but it doesn't
work very well for the meconium.
Meconium was a huge laundry problem for me for a long time - I tried
all sorts of fancy enzymatic preparations made for pet "accidents", and
they worked very well, but they tended to smell awful! Then a friend
told me that Tide has enzymes in it and should do a fine job, and indeed
it does. Now I carry my own Tide and add that to the birth laundry,
and it all comes out really clean and smelling fine. I often do a
second rinse on the laundry because a lot of it will be re-used on a new
baby's skin, and we want it to be free of detergent residue.
I use liquid ivory dish soap - the clear variety. It works on just about
anything. I soak it into the spot and roll up the item and leave it for
a couple of days. Then wash with the rest of the laundry. Rarely do I not
have success. This works as well for oil and grease splatters, blood as
long as it is not straight blood - so blood mixed with amniotic fluid,
tomato stains, fruit stains, etc. In Canada, Ivory recently changed to
"Dawn" except that the clear variety is still called Classic Ivory and
is a little hard to find.
One of my clients recommended Bac-Out
Stain & Odor Eliminator - she said it worked fine on meconium with
her first baby; it's non-toxic and environmentally safe . . . always a
plus for a newborn! It's a lot less harsh than Tide.
NOTE - This section is out-of-date, and I am no longer adding links
here.
Arms' Reach Co-Sleeper - You
and your baby derive many benefits from sleeping near each other. The Co-sleeper
makes this easier for many families. (Recommended by Dr. William
Sears and Martha Sears, RN, authors of The
Baby Book.)
Breastfeeding & Attachment Parenting Products from NursingFamilyMagazine
Source for low-toxicity baby clothes and bedding
Buchic Bamboo Clothing
for baby - bamboo is grown without pesticides and is remarkably soft,
hypoallergenic and easy to clean. I love mine!
The truly hip and environmentally conscious baby will want to be wearing
hemp diapers from hipHemp! or What's
Hempenin' Baby?
Organic Cotton Alternatives,
with a special section on the Natural
Nursery
The natural
family living shopping guide at Mothering
Magazine contains links to lots of natural and organic baby items.
The New Native Baby Carrier
- organic cotton slings
Go Organic,
Baby! offers hemp diapers. Now that's an idea whose time has
come!
The Natural Baby Company, 816 Sylvia Street, 800 B-S, Trenton, NJ 08628-3299,
(800) 388-2229
Diaper
Reviews and DIAPER
CATALOG GUIDE
Some parents are very enthusiastic about Indisposables (from Kidco).
They do look like they'd work well. They're available only through
individual distributors (or from a second-hand shop at significant
discount!). You may want to do a Web search for them, but here's
one
and another to give
you an idea of the product.
ACOG
can be a good source for patient education pamphlets aimed at good liability
defense.
Krames has an extensive list of patient
education materials, including a
Maternity section
They also maintain a
list of additional external resources that support your patient education
and health promotion goals.
The DEPEND
Disposable Protective Underwear are absolutely wonderful for postpartum
women. You use them as an outer layer to hold regular OB pads; this
does a great job of preventing any kind of leakage, so moms sleep better,
and they don't have the hassle of changing sheets or sleeping on dirty
sheets. Unfortunately, this product is so popular that I have trouble
finding it on local shelves. I've found it online at drugstore.com.
Craftsman Peter Fallon makes mahogany fetoscopes that are long enough
to reach from belly to mom's ears. domain: hotmail.com, username:
pmfallon
Harbor Scientific used to make a terrific little BirthWatch device;
it was a stopwatch that would record the 5? most recent contractions and
then could display the interval and frequency. Very handy for keeping
on top of those irregular contraction patterns. I don't know if it's
still available.
A more recent incarnation of this idea is the
BirthWatch(r) maternity timepiece - estimated availability in November
or early December, 2001!
Corometrics makes a great **large** and easy to read gestational
wheel. They used to be free, but now they're charging for them.
Name Tag Jewelry - Work in an instititutional
environment and need to wear a name tag? Here's a beautiful way to
wear it!
94761 Multiple Noninvasive O2 sats $71
Insulated Bags for Warming Baby Blankets
Res-Q-Vac
Belly Binders for Abdominal Support and Other
Support Garments
Baby Scales
Baby Scale Sling
This is the hemmed side 44"
_________________________________________________
| XXXXXXXXXXXXXXXXXX |
| |
| |
| |
| | elastic is sewn
| | where the X's
| | 28" are
| |
| |
| |
| |
| |
| XXXXXXXXXXXXXXXXXX | (these x's should
__________________________________________________ be on this line)
Pleat the 28" side, wrap it through the D rings and secure. I really like
the addition of the elastic because it seems to be more secure.
Knit Newborn Baby Hat
Cast on 30 stitches
Row 1: knit; row 2 purl; row 3 knit
Repeat these 3 rows (each set of three rows makes a ridge)
20 times for a 6-7 lb. baby
24 times for an 8-9 lb. baby
Cast off
Sew together the cast on and the cast off sides to make a tube.
Then sew around the top and pull tight to make the top of the hat.
Cord Clampers/Cutters
Sears Craftsman side cuts
Diaper pin - remove pin intact
cigar cutter - $15-20
bandage scissors
Super Glue and Shoulder-Length Gloves
item #FACU $7.65 for a 2 ml tube w/extender applicators
item #ATG2 $9.90 for a box of 100
inexpensive instruments and exam and sterile gloves.
Midwifery Tee-Shirts and Bumper Stickers
Dawn Konnerth:
PO Box 166
Walden, New York 12586
914-778-7073
She'll be happy to take your order.
Gloves/Latex Allergies
Ostar® Oat Powdered Gloves:
Ostar offers samples,
so you can try them. I thought I had a latex allergy, but it was
really the glove powder I was reacting to; I can wear these for a long
time with no problems at all. They are significantly cheaper than
nitrile, and more sensitive than vinyl.
Preventing Allergic
Reactions to Natural Rubber Latex in the Workplace from the National
Institute for Occupational Safety and Health (June, 1997)
Leff Fetoscope
Amnicators
Oxygen
Medical Grade Oxygen
Yes, medical O2 is different than for welding. For medical oxygen
any parts that are lubricated cannot be lubricated with petroleum based
products. The compression exhaust is not allowed to get into it,
etc.
This, of course, does not usually apply to midwives but makes the Rx
a pain.
Bedside Crib/Co-Sleeper
Portable Ultrasound
Dopplers
the world. We provided a broad selection of user features, including
waterproof probes, to fit every need and budget. Our 30 day demo program
allows you to try any of our products before you commit, thus optimizing
your purchasing experience. Call us and compare. You will be very pleased
with the results."
Medical Systems Division
"Sonicaid Doppler"
11526 53rd St North
Clearwater, FL 34620
Phone: 813-573-4500
Fax: 813-552-6836
Waterproof Doppler
Medisonics speakers are fairly expensive but a friend in California [who
for obvious reasons needs to remain nameless until legal] put a RADIOSHACK
speaker on hers for $40.00 [and had a spare to sell to her partner].
Doppler Gel Alternatives
Kegel Weight Sets and Exercisers
Birth Laundry
Baby Clothes and Bedding
There's also the
NATURAL BABY CENTER, sponsored by Mothering Magazine!
Patient Education
Miscellaneous
DEPEND Products
Straps for DEPEND Undergarments - DEPEND products are wonderful for birth.
The DEPEND
undergarments, which are like oversized OB pads, are wonderful for
women who want to be laboring upright with broken waters. (Really,
I encourage women to start wearing them around 6 cm even if waters aren't
broken yet; they contain the bloody show really nicely and provide women
an extra measure of confidence about being up and around when waters may
break with the next contraction.) However, if you use only 2-3 undergarments
at each labor, you run out of straps really quickly. You can buy
extra straps from the DEPEND website.
BirthWatch Products LLC, 4044-104 W. Lake Mary Blvd., PMB 328, Lake
Mary, FL 32746, 1.877.698.5668
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