A bit upset at the language used in his leaflet - AIBU?

[StarlightMcKenzie]

www.bcf.nhs.uk/dl/9420_2400159727.pdf/as/Misoprostol.pdf?_ts=31375&_ts=31375

Er, I have read the leaflet and cannot see anything wrong. Am I missing something?

I don't understand either... OP - can you let us know specifics?

I've read it through twice and can't see anything that would be upsetting?

You banged your head op?

from what i can see it's not used routinely but only in an emergency.

It made me squeamish, assuming that's not what you mean?

Seems pretty informative to me..

Clear, direct and to the point. Seems to be just the job.

Whats wrong with the leaflet? Do you feel that it should dicuss other ways of having a managed second stage.

is the use of the word "failure" that bothers you in the context of failure to contract. I was a bit "hmm" at the medical interactions between misoprostol and other meds not being relevant to birth centres, as surely not every prescribed medication would take a woman out of the low risk category?

I don't think there is anything with the policy and decision that drives the information. Of course it is reassuring to know that they have a plan for dealing with heavy blood loss.

But I don't think it is entirely balanced. I think it presents a natural third stage as a risk which isn't exactly what the research shows.

And yes LightPassenger, there is far too much focus at the beginning on the failure of women's bodies.

But it is not a leaflet about managing third stage. It is specifically providing details of one specific medicine used in an emergency situation.

It still implies that a natural third stage is more risky than a managed third stage, - which all things being considered it isn't.

And it fails to mention that you can have heavy bleeding with a managed third stage too.

I don't know why the focus on the natural causing the problems. Why mention it at all? It looks like a way of scaring people into accepting the injection in the first place.

There is research that shows a physiological third stage is more likely to result in a heavy ebl or pph. That's why it's only suitable for low risk women. There is some thinking now that perhaps with a physiological third stage there is a heavier initial blood loss, but it's not a true pph and that the overall blood loss over the first few days is the same. Is that what you mean?

As far as I'm aware that second theory hasn't been proven yet, so drs will still err on the side of caution and say that a managed third stage reduces the risk of a pph.

I don't think that's their intention starlight, they say at their birth unit a physiological third stage is the norm.

Even with an entirely natural third stage it is still possible to heammorage. This leaflet justs tells you of one way of dealing with this. It isn't just about the delivery of the placenta, it is how your vessels close off afterwards.

No, Viva. I expect you are right that there is no intention to mislead, but it still uses quite negative language about 'failures', and could be read to suggest that some things about a more 'natural' birth are irresponsible or dangerous.

TBH, I am encouraged by the skilling up of midwives to be able to deal with such medical emergencies (although would be a bit worried if the end result was that medical emergencies became expected and then prevented and then turned them all into pro-interventionalists).

I just don't understand why it couldn't just speak about having a bleed or bloodloss of levels that midwives are concerned about can now be dealt with in this way, rather than talking about it being about the choices the woman has made or because of the failure of her body.

Do these leaflets actually go out for consultation on wording and message?

I am on the panel for my local NHS trust to review & comment on stuff like this, so in my area yes, new leaflets that are produced go out for consultation. I tend only to comment on stuff that relates to issues I have personal experience of though.

I do think you are reading too much into the word 'failure'. It's not a personal attack, to me the word is used in a neutral sense. It means something didn't happen.

But if it bothers you, contact the NHS trust who produced it.

Thank you em I might do that.

TBH my issues with langue surrounding childbirth is a lot wider than this particular leaflet and know that the word 'failure' is common and normalised. But it is still bad language for service users to hear.

Failure to dilate
Failure to progress
Faliure to latch on
Failure to breastfeed
Poor maternal effort

etc etc etc.

It puts the blame for poor outcomes in birth completely on the woman when many of the above can be addressed by improving the environment, providing better support and more attentive care that is currently pretty impossible to do so within current resourcing constraints.

I don't read it as being about an issue with the choice a woman makes or the failure of her body, and I am usually pretty narky about terminology such as 'failure' in relation to childbirth. I think that it's excellent that women are still openly offered the choice of natural third stage, that there is acknowledgement that there is the possibiilty of increased blood loss early on and still the majority of women decide that it's worth giving it a go.

As a woman at suspected higher risk of PPH following an atonic uterus first time round (so yes, my uterus failed to contract - I didn't fail to contract my uterus, nothing to do with a failure on my part!) and still aiming for a physiological third stage this time round, I actually find it quite a reassuring leaflet - just a shame that I'm not in that area! I know Misoprostol is used here but I only know this from reading the guidelines issued to our MWs, not from anything directed at patients.

I've just read it. What I feel it doesn't cover explicitly is that this is an Off license use, it is a tablet for oral administration , being given rectally, and given at the discretion of the MW on duty - hence the PGD so no Dr is going to explain to you that is not formally tested and approved for this use and the prescribing Dr is responsible for any issue that may arise.

Viva - isn't a bit unusual to have an off label drug being given through a PGD? I would be worrying about my PIN number.