I know that you have talked about this before, but I can't find it! I am apprenticing with a midwife, and want to start to think about my instrument bag. I have all of my prenatal/postpartum basics, and I want to feel around for what to buy.
I need in a sterile package to have:
2 hemostats (to clamp the cord)
1 umbilical cord scissors (I bought four for WAY too cheap on EBAY, and I need to find better ones...I think!)
1 cord clamp (Hesseltines I think?)
1 general forcept (round end)
I am wondering what brand is good? Miltex hemostats are REALLY expensive, Vanage are medium and then there is another brand that seems too cheap...
What length is appropriate? That is the biggest question. I know that there was a post about length, but I can't find it!! I think you all said 6.25. Curved or straight? I am thinking straight. EEK! There is just so many decisions. I would like to get something nice, that won't wear out but that isn't too expensive. I would like to have three sets, or at least two sets for now. I don't really need any sets yet, but I would like to get them when I am able and still raise three small children.
Stethoscope, blood pressure cuff- regular adult and obese, fetoscope, sterile gloves, gloves, sterile gauze, watch, rice sock, robozo, big mirror for mom to watch baby crowing, herbs, homeopathics, bowl (for vomit) bedpan, cath kits, pan or small red bag for placenta, thermometer, candles, flahlight, money, non perishable snacks and a change of clothes.
I have one curved and one straight hemostat - both 6.25".
I suggest Medline over anything else. Don't go with the cheap (Vantage) brand, you'll end up buying more over and over.
When it comes to umblical scissors, get Medline, too.
Medline has a lifetime warranty and they're not as spendy as Miltex, but the warranty and quality is just the same.
Ollie at birthwithlove.com has the metal cord clamps. I have two in every instrument pack because I use the clamps to clamp off the cord where dad or someone cuts between. I don't like hemostats hanging from the baby.
I rarely use my hemostats at all, but I guess they're nice to have just in case.
Instrument size is personal, as is a preference for curved or straight. Play around with different lengths until you find one that feels right to you. I like curved Rochester Pean hemostats myself, and I like them to be 7.25. Needle holders I like on the smaller side. I HATE those cord scissors with a passion. I prefer blunt/blunt operating scissors or even bandage scissors.
My sterile packs contain one hemostat, one hesseltine cord clamp, and one scissors. I sterilize one hemostat seperately, and one episiotomy scissors seperately (which I never use, but, there it is, in it's own pack). Most of the time, you're only going to use the cord clamp, the one 'stat, and the scissors. No need to re-sterilize the other stuff if you don't use it.
You should get a good suture kit, which you will try your best to never need to use. I put a needle holder, mosquito forceps, and a good sharp scissors in one pack, and another mosquito in seperate pack.
Medline is a great brand. I'm biased towards Miltex, but I know it's because it was drilled into my head that Miltex is the best.
I'm curious about Konig's quality, I don't know anyone who has them.
i like curved hemostats generally. i would also suggest getting a cord bander. you can band cords using a kelly, but i think its alot easier with a bander. we usually clamp the cord with a hemostat or a clamp about a foot away from the baby (this way we arent interfering with mom/baby so much) and then when everyone is ready we trim it up with a bander.
i prefer smaller needle holders as well. and it is definitely worth the $$$ to get really really good scissors that will hold their edge.
tissue forceps are nice to have for suturing, and ring forceps come in handy for sticky trailing membranes.
at the birth center i worked at we had a "birth pack" that consists of a placenta bowl, 2 kellys, blunt/sharp scissors, blunt/blunt scissors (or cord scissors), ring forceps, and some gauze. this is wrapped in fabric and opened for every birth.
then we have a bander pack that has a cord bander, a hemostat, scissors, and some gauze. this is used during the newborn exam to trim the cord.
then we have a suture pack, with needle holder, tissue forceps, scissors, straights hemostat, and some gauze.
i use koenig (medline) instruments only. all my suture stuff are miltex, though, carbNsert. i'd rather spend the extra on stuff that is meant to grip small needles. anything to make that job of suturing easier...
look for some of the heavier duty instruments on Ebay
also think about what to use for suturing ---
the cord bander is a slick tool and you can get some bands now with out the bander that have their own applicator if you want to try out the bands and see how they work-
As far as I know, my midwife doesn't suture. She has the equiptment, and she has the knowledge, she just has other ways of dealing with first and second degree tears. I am not sure about 3rd/4th, but I am assuming she would have someone else doing those. I am just not sure.
Thank you all for your ideas! I do think now that she has one curved and one straight. I will look into a cord bander.
I am actually glad about the suturing, because I couldn't sew a divider line on a highway, I am that bad at it.
Here is another question though. If you are planning to suture, do you need to be licensed. "Need" being you know...whatever.
If so, and you aren't, how do you prep the area? Can you get the caine drugs without a perscription? I wouldn't think so. We have the option of licensing in this state, but I am not sure about it either way. Seems very confining.
i have worked with some mws who never sutured and saw some problems with that policy- now if some how you have a great self-selecting population that doesn't need sutures because they just don't then fine but if what you get is pot luck and some women just tear, then what is your plan? - I have seen little tags that never healed and the mom went in for abrasion and repair and I have seen an extensive tear where we transfered baby for an emergency and mom did not get sewn up- and on day 2 went to take a look and do some possible repair to look and find it all coming together great no problems ---
as for getting meds and such in an illegal state or while practicing alegally I don't know what to tell you there are ways but they are controlled substances sometimes you can find a care provider who has rx writing ability who will write for you or sometimes you need to make alliances at places where the provider will meet you at the office/clinic to do a repair- ideal would be someone who would show up and do stitching and eventually train you once you have learned from someone and they trust you enough they may get tired of showing up to do simple stitches... this takes time and developing a relationship-- and I hate to say this but you may have better luck with men- say a GP -rather than women because men are more inclined to not overwork themselves... so more willing to have you take care of things yourself..
I will learn how to do it. I know that I have to. I do know that my midwife knows how to do it, I just don't think that she does it often. We do sometimes have conferences on how to do it, where a experienced midwife will teach a lot of different apprentices. I wasn't apprenticing at the time, so I didn't go to it. I will have to think about it more. It is nice to get your advice though. Luckily I am in a state with a lot of really great midwifes!
I am slowly collecting my stuff. I bought good instruments on ebay from chosmic surgical. I have cheap instruments from my husband's many trips to the ER. You can buy a throw away suturing pack, pre-sterilized from about $4-20. That's what the ER uses here.
I picked up an autoclave for $50. I recommend Anne Frye's Healing Passages book for suturing information - both instructions and what to buy.
I use the rubber cord bands that birthwithlove sells which don't require the cord bander. You do need a hemostat, though, for them (they slip over the end of the hemostat). I love them -- they are small and neat and don't fail all the time like cord tape and don't get caught in things like plastic cord clamps.
I have learned, though, to put a plastic cord clamp on the tray as well. They are much faster to clamp the cord and in an emergency that can be important. I have had two ambulance transports in the past six months (for totally different reasons -- kind of like lightening striking twice) and when we were trying to scramble to get baby ready to go there was really no time for the rubber cord band.
Right now I have one expensive hemostat (gets cleaned all the time, so don't want it to rust) one cheap hemostat and bandage scissors in my cord-cutting pack. I have one curved and one straight hemostat. I hope that I never have to cut a cord on the perineum, but I bought the curved thinking that if I do, it would be easier to get the curved underneath a very, very tight cord. In another pack, I have ring forceps and tissue forceps that rarely get used -- so they are sterlized separately (and they are also very cheap -- durability is not an issue with something used twice a year). My suturing kit has a mosquito forceps, a needle holder, and a small pair of scissors. I am comfortable with my suturing instruments right now, but if they ever get replaced I will buy the best I can. Suturing is hard enough without inferior tools.
I sterilize in the oven now, but most of the midwives around here use a pressure cooker. My method takes a couple of hours, but the pressure cooker is about 30 minutes.
Why would you need multiple sets? It is an easy enough ritual to sterilize your instruments the next day after a birth -- if you have two in a row you can use your preceptor's instruments or sterilize them by boiling at the birth (though this is very bad for instruments).