Ornament

The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Ornament

Supplies

Why women shouldn't fear home birth
by Mayim Bialik, Ph.D.
This short essay is humorous, honest, insightful and inspiring.

Subsections on this page:



URGENT!

Overall Recall Information from Triad

From Triad: Facts: Lube Jelly Recall and  Product recall involving Sterile Lubricating Jelly manufactured by Triad Group.

From Triad: Facts: Alcohol Recall
There has been ONE report of a potential contaminant out of hundreds of millions of products sold.

From the FDA: Triad Group Issues a Voluntary Nationwide Recall of All Lots of Alcohol Prep Pads, Alcohol Swabs, and Alcohol Swabsticks Due to Potential Microbial Contamination

From the FDA: Class 2 Recall - Sterile Lubricating Jelly see related information - Date Posted  January 21, 2011




 



Donating Expired Supplies



Donating expired medicines to developing countries and countries in central and eastern Europe.



Bumi Sehat can always use stuff, depending on what it is of course.  They have their US office in VT.  You can contact Katherine who is the US contact - (domain name gentlelanding.com, username katherine.  The updated list of needs is on the Bumi website but there's always other things also.

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?



Where to Buy Supplies



NOTE - Information about these suppliers is provided for your convenience, and I provide information about all suppliers who contact me.  I cannot personally vouch for the reliability of these suppliers.


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


Everything Birth, inc. – Professional Medical Supplies that cater to midwives, holistic medicine, midwifery and medical students


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!!!


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.


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:


Homebirth Supplies in the UK

My Birth Pools - offer advise and information on home birthing products our vaules are to engage, understand and fulfill womens home birth needs.


Midwifery Supplies Canada


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


Medical Equipment Exchange


PEMED


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.


Various Sources of Scrubs

smartscrubs.com (now includes the old S.C.R.U.B.S. line - Simply Comfortable, Really Unique, Basic Scrubs) - (800) 231-5965 - 100% cotton - my favorite

Green Scrubs - great selection, used to carry hemp scrubs.

Uniform Store - Internet discounts - 800-542-1732

Sassy Scrubs - has maternity scrubs


Cheap Office Furniture

If you have Kaiser in your area or other in-house type HMO, they often have a warehouse where used and unneeded "things" go. I picked up a used exam table for very little $$. Cheap even if it needs recovering -- call a vinyl expert and the cost to custom cover is around $100 (your choice of colors!) Also, call local hospitals and clinics -- some are downsizing and have extras in good condition. New exam tables can run well over $1000 (or so I'm told). I also picked up an adult medical scale, a used Doppler, two desk chairs, desk, exam table chair, the list goes on.


Free Samples



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


Lansinoh Samples (For Moist Wound Healing during Breastfeeding)

Call (in the USA) 1-800-292-4794 and Lansinoh will send you free samples with an informational brochure that includes LLLI's endorsement, history and phone number. They will send you a supply monthly. [They can also be reached by e-mail.] 

Astroglide (vaginal lubricant)

BioFilm, Inc., 3121 Scott St., Vista, Ca. 92083, (800) 848-5900 in Ca. (800) 325-5695 rest of U.S.

AYR Saline Nasal Drops/Mist/Gel and Baby AYR Saline Nose Spray/Drops (for allergies, sinusitis or dry, irritated nasal passages)

Write to B.F. Ascher & Company Inc., P.O. Box 2408, Shawnee Mission, KS  66201-9823 to request AYR trial samples or Patient Information Pads.  Or phone Joan Bowen at 913-888-1880 or FAX 913-888-2250

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.


Other Freebies

Weleda-1-800-289-1969 - will send you a box of samples of their baby products - calendula creme, their diaper care stuff, and calendula oil (which we  tell moms is for their legs after shaving, or in their bath to make it  smell good, but shouldn't be used on the baby.)

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


Thoughts on Free Samples of Formula

I am still on the fence about freebies.  Most midwives that I know give out everything they can get their hands on.  I have some of the free diaper bags from the formula companies and now I hear that they have come up with a diaper bag for breastfeeding moms.  It has a breast pump and storage bags for the milk and an ice pack to keep it cold.  Of course it also has a small can of powered formula.  I am very suspicious.  In trying to think of marketing skills, I think that perhaps this is just clever marketing.  The breast pumps are probably the low quality ones, which can be very frustrating to an inexperienced breastfeeder.

Ione's Thoughts

The pumps given by formula companies are low quality. Unfortunately when a mom can't pump with a bad pump, she tends to assume it is because some thing is wrong with her not the pump!  You do have to look at the motivation of the formula companies.  If anyone thinks their motivation in giving stuff to breastfeeding moms is to promote breastfeeding, I have this wonderful bridge they might like to buy also :-).  The formula companies purposely target breastfeeding moms for a good deal of their advertising. Why? Because the woman who switches from breastfeeding to formula is much more likely to stay with formula for a longer time, not switching to plain cows milk after six or eight months, but keeping the baby on for a year.    Some of the companies make breastfeeding "info" videos for moms which may on the surface have accurate info but which are filled with subtle things that detract from breastfeeding (the bottle feeding mom is dressed nicely and looks pretty sharp, while the breastfeeding mom is in her gown and looks frazzled..... subtle things like that).   Yet the general public and even many health care professionals are not aware of the subtle messages contained in the videos or little booklets that detract from breastfeeding.  The formula companies are very good at marketing. Too good.
 I give a postpartum packet to my moms. There are so many nice things that you can give that don't support the formula companies.  I am not particularly comfortable supporting the disposable diaper companies either so I don't give out freebies from them though they have some lovely education material, unfortunately with the name of their product splattered all over them.

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
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                         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
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Client's List of Supplies



Suggestions for Client's Birth Supplies


Supplies Recommended for a Home Birth


Homebirth Supplies



Client's Birth Kit



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.



What's In Your Birth Kit?




Equipment for a homebirth - This midwife made a YouTube video of the supplies from her birth bag.


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.


Flannel-Backed Vinyl as a Super Chux

One very neat addition to the birth kit is a good sized plastic/flannel backed tablecloth. You can toss one down just about anywhere -- over a couch, chair, bed, carpet. The plastic side is slightly textured and will not slip, (as chux or other plastic sheeting will) , and if you use the flannel side under mom it's more comfortable than a chux, won't rip, has no seams to leak, and covers a much larger area. Because they are larger and heavier, moms can move about -- into a Gaskin or whatever[Grin] -- without the tablecloth bunching and/or tearing like chux will. They only cost a few dollars (under 4 here in Oregon for the 48 inch size), so you "could" dispose of them, but they will wash well also. 

Alternatives to Chux


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.


ezwhelp.com 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...



Birth Bags



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:

  1. Oxygen, in a big toolbox. I also have my ambu bag, Res-Q-Vac, airways, masks, tubing, all resuscitation equipment with the oxygen.
  2. Prenatal bag - I don't have duplicates of Doppler, fetoscope, BP cuff etc., so all prenatal supplies, stethoscopes etc. are in this bag, including the newborn exam stuff, since I use those at prenatal home visits and post-partum visits. I have a section for file folders in there too, my calendar and a English/Spanish dictionary. This is my heaviest bag.
  3. Birth bag - A big duffel bag that has many pockets, front, back and both ends, plus two pockets inside and a huge open space, which I have stuff in Rubbermaid containers and Zip-Loc bags. I bought it at Gander Mountain. It has a great shoulder strap. The inside pockets are flat, perfect for gloves, gauze, etc. The end pockets are perfect for bottles, because they stay upright.
I have one problem - no matter how I pack, I can't get a box of gloves into that birth bag and I can't fit my placenta bowl in there either. I can carry it all at once, birth bag over my shoulder, prenatal bag in one hand, oxygen in the other. I find my toolbox for oxygen easier to carry than the upright tanks I've carried for other people. It's balanced better.

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.



Client Files



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).



About Birth Balls



You can get birth balls from the DONA Boutique, and if you keep looking on that page, you'll find Item Number BBCS, Birth Ball Carry Strap, $14.95


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:
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

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
55 cm 13.95
65 cm 16.95
75 cm 21.95
Add S&H costs, no sales tax if you're outside Colorado.

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.


Birth Ball Covers

Ready-made Birth Ball Covers

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


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



The deBy stool


I bought my Joy Chair some years ago (1998?) from an ad in Midwifery Today.



Hospital Beds



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.



Getting Prescription Medications



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
Published by AVON in Nov. 1990
ISBN 2 are listed:
0380760339
9993548863

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.


Source of OB meds:

Durr Medical (TX)214-243-1551,
Henry Schein (NY)800-356-5788


Sphygmomanometers or Blood Pressure Monitors and Stethoscopes



Selecting a Sphygmomanometer or Blood Pressure Monitor


LITTMANN STETHOSCOPES - An Overview and a Stethoscopes Comparison Guide



Hemoglobinometers/Lancets/Tenderletts



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, Inc.
23263 Madero #A
Mission Viejo, CA 92691
Ms. Yvonne Martenson
Marketing Manager
Telephone: (714)-859-2630 Fax: (714)-859-3066

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


Capillary Puncture


Lancets and Lancing Devices - a review from children with DIABETES


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)



Pulse Oximeters




I just went through EMT training, and the guy explained some of this.  Some of the POs measure the darkness of the blood - they bounce light through the skin and measure the darkness.  Now, blood can been various shades; some of the PO cannot discriminate between dark red and dark blue or light red and light blue.  Further, some of the PO are "fooled" when the baby has darker skin color.  The expensive PO have different technologies that can sort through the variables. 



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
94761 Multiple Noninvasive O2 sats     $71

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.



Insulated Bags for Warming Baby Blankets



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:

  1. Fold the baby blankets to the shape of the bag, only slightly smaller.  When I fold them, I make sure not to line up the corners so there's always a single corner I can grab and shake to open the baby blanket easily.  I hate fumbling to unfold blankets when I'm wearing gloves.  Wrap them in sterile wrap and sterilize in your oven.  (225 degrees for 2 hours.)
  2. Put on pack of sterile baby blankets in the insulated bag, then place a heating pad on top of that, and then put another pack on the very top.  I also put in some extra towels.  If you're creating a large stack or including a blanket for the mom, you might want to use two heating pads to warm them faster, spacing the heating pads out at appropriate intervals in the stack.
  3. Insert the pile into the "warmer" bag with the electric cords at the top, on the side where the zipper will end up when the bag is closed.  This way, the bag can be almost all the way closed while the cords are still peeking out, and you can plug them in right in the birth room.
  4. Voila!  You've got nice warm blankets right there whenever you need them.  If you're worried about people tripping over the electric cords in the excitement of the birth, you can unplug the warmer at the last minute, and the blankets will still stay warm for some time.
  5. I like to use one of those coiled extension cords, which really increase your range for using the heating pad to warm the baby blankets, and mom or baby as needed.  (They're hard to find; I got mine from Starcrest of California mail order products: Satco Polarized 3-Outlet COILED Extension Cord - 12 ft. 93-170 @ $4.80.)
  • Midwives who work in cold climates and serve lots of multips might want to consider an insulated warming bag that is powered by their car's cigarette lighter; that way, you can walk in the door with warmed blankets.



  • Res-Q-Vac



    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



    Belly Binders for Abdominal Support  and Other Support Garments



    I really like the numerous options available from Prenatal Cradle, including support for the baby's weight, a trochanteric "hip brace", and vulvar supports.



    If you're planning to attend a special event and don't want to have to wear a bulky support garment, you could use Kinesio tape to provide belly and back support.  If you're in or near Los Altos, CA, I can highly recommend On Your Mark.  They also carry a variety of arch support insoles, but the ones most useful to pregnant mamas might be the heat-moldable ones that can be reshaped up to five times to accommodate changes throughout pregnancy. 

    The Baby Belly Band can be used for vulvar varicosities, round ligament pain, pubic symphasis, hernia, etc.  The Abdominal Band is Velcro adjustable to fit throughout pregnancy, and groin bands or shoulder bands can be Velcro attached to the Ab band for greater support if needed.


    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.



    Baby Scales



    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.



    Baby Scale Sling



    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.

            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.

    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.



    Knit Newborn Baby Hat



    American size 6 or 7 needles
    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



    New Umbilical Clamp And Cutter Invention (Veridien 1997)


    $6.00 Stanley wire stripper or off-brand wire stripper-$3.75
    Sears Craftsman side cuts
    Diaper pin - remove pin intact
    cigar cutter - $15-20
    bandage scissors



    Super Glue and Shoulder-Length Gloves



    1-800-JEFFERS

    Nexaband wound closure "SuperGlue" cyanoacrylate
    item #FACU $7.65 for a 2 ml tube w/extender applicators

    Livestock/equine shoulder-length OB gloves (for waterbirth)
    item #ATG2 $9.90 for a box of 100

    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
    inexpensive instruments and exam and sterile gloves.

    The number to get a catalog is 800-269-0093. Ask for the Pet catalog.



    Midwifery Tee-Shirts and Bumper Stickers



    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
    Dawn Konnerth:
    PO Box 166
    Walden, New York 12586
    914-778-7073
    She'll be happy to take your order.



    Gloves/Latex Allergies



    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


    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.

    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)
    Preventing Allergic Reactions to Natural Rubber Latex in the Workplace from the National Institute for  Occupational Safety and Health (June, 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.



    Leff Fetoscope



    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.



    Amnicators



    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



    Oxygen



    The National Institute for Occupational Safety and Health (NIOSH) provides some information about 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


    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.

    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).
    This, of course, does not usually apply to midwives but makes the Rx a pain.

    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."



    Bedside Crib/Co-Sleeper



    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!



    Portable Ultrasound



    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!



    Dopplers



    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
    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."


    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
    Medical Systems Division
    "Sonicaid Doppler"
    11526 53rd St North
    Clearwater, FL 34620
    Phone: 813-573-4500
    Fax: 813-552-6836


    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.


    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].

    My current favorite is the Oxford, one piece, waterproof, built in speaker and fetal calc. Costs about $750. Sonicaid 121 -- $495 for waterproof version


    Doppler Gel Alternatives


    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.



    Kegel Weight Sets and Exercisers



    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



    Birth Laundry



    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.



    Baby Clothes and Bedding



    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?

    A Collection of Sites about Natural Baby Products: cloth diapers, organic cotton baby clothing, layette, natural baby care, organic baby food

    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.
    There's also the NATURAL  BABY  CENTER, sponsored by Mothering Magazine!

    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.



    Patient Education



    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.


    ICAN White Papers



    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.

    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.


    The use of filter needles is new to many of us experienced midwives.  Here's a nice powerpoint presentation that shows how to draw up meds from glass ampules and the use of filter needles on p. 40.

    Aseptic Technique - Vials and Ampules

    • To withdraw medication from ampule

    • To avoid glass contamination of ampule solution Cascade sells: Needles Only Filter Type BD PrecisonGlide® 19g x 1.5", PK/5

    By convention, these are used for injecting only, NOT for withdrawing.  This is presumably because there might be different people drawing up the meds and administering them, and if you're the one doing the injecting, you can't really be sure what was used to draw up the meds.

    However, in a single-person practice where the meds are drawn up and then used right away, it might make sense to use the filter needle to draw up the meds, rather than inject.  This is especially true when the available filter needles are of a higher gauge than one would use.  In particular, you might want to use something smaller than a 19g needle for perineal repair.  IDEALLY, get vials instead!!!


    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!
    BirthWatch Products LLC, 4044-104 W. Lake Mary Blvd., PMB 328, Lake Mary, FL 32746,  1.877.698.5668


    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!

     




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