Advantages and Disadvantages of the Epidural

Advantages and Disadvantages of the Epidural Is epidural the best of all words – no pain but full consciousness? (Yerby, 2000). Discuss During pregnancy many women give some thought on what they will do to cope with labour pain. Some women aim to have the most natural type of birth, with the least possible pharmacological interventions. Others request a pain free labour, such as opting for an epidural anaesthesia as a type of pain relief. But do women actually know about the risks epidural anaesthesia can create for them and their baby? Or do they opt for it just because they heard other mothers say that it was the best? Epidural anaesthesia is a type of regional anaesthesia which is rapidly increasing in its popularity. Epidural works by blocking nerve conductions from the lower spinal segments, resulting in a decreased sensation in the lower half of the body, while at the same time the mother is still awake and conscious (Fraser Cooper, 2009). The drug is administered in the lower back, into the epidural space, specifically in the lumbar region between lumbar 1 and 4. This is achieved by cautiously inserting a Tuohy needle through the lumbar intervertebral space. Once the epidural space is reached, a catheter is threaded through the needle, which will facilitate the administration of the drug either by bolus top ups or continuous infusion. Once epidural is injected, it will start to exhibit its effect within approximately 20 minutes (Johnson Taylor, 2011). Indications for using epidural anaesthesia There is no absolute indication for opting for epidural anaesthesia, however clinical instances may include: Maternal request: mothers now acknowledge the fact that they can give birth with the least possible amount of pain. Today the majority of parents already have a plan in mind of what they wish and request for their birth experience. Having ongoing accessibility to internet encourages parents to search for types of pain relief, allowing them to make their own choices of what they think is best for them. Upon searching and from what they hear from other mothers, they are actually believing that epidural is one of the best choices of pain relief medication (Johnson Taylor, 2011). Pain relief: prolonged labour can be very tiring and stressful for the mother. Having an epidural can help in reducing the continuous stress of contractions and can possibly help the mother to relax, making her able to conserve energy for later use during the active phase of the second stage of labour (Johnson Taylor, 2011). Hypotension: epidural has the potential to lower down the blood pressure. This can be used as an advantage for women who suffer from high blood pressure. Thus this anaesthesia can possibly stabilise the blood pressure during labour, aiming to reduce complications (Johnson Taylor, 2011). Preterm labour: epidural aims to decrease the sensation of powerful contractions and so can be opted for to possibly lower the desire to push during a preterm labour. Use of such anaesthesia depends on the specific condition of the mother and the baby (Johnson Taylor, 2011). Side effects of epidural anaesthesia on the mother Opting for an epidural can deliver a good experience amongst many women. Mothers are able to rest and relax from the painful contractions while at the same time they are awake and conscious. However, opting for this anaesthesia is very likely to be the beginning of a cascade of interventions. This means that birth can be transformed into a very medicalised experience, ending up with the mother feeling that she has lost control over her own birth experience. In fact, the World Health Organization states that, â€Å"epidural analgesia is one of the most striking examples of the medicalisation of normal birth, transforming a physiological event into a medical procedure.† Generally, decision of opting for such a pain relief is made without the mothers awareness of the possible complications it can create. Hypotension: Studies show that epidural can be the cause of a sudden drop in blood pressure. Although the drug is injected around the spinal cord, there can be a degree of the anaesthesia that passes into the maternal blood stream, with the consequence of lowering the blood pressure (Healthline Editorial Team, 2012). This in turn would require, prompt venous access in order to administer fluids to quickly correct the blood pressure. Low blood pressure will result in less oxygen reaching the baby, which upon prolonged exposure can result in hypoxia of the baby. In much more severe cases, medications and oxygen may also be required in order to maintain a stable condition (Mehl-Madrona Mehl-Madrona). Delayed labour: Studies have shown that epidural anaesthesia, can be the cause of slowing down labour process. This is mainly due to the interaction of the drug with the birthing hormones. Epidural anaesthesia tends to decrease the production of oxytocin (Rahm, Hallgren, Hogberg, Hurtig Odlind, 2002). Oxytocin is one of the main hormones of labour, that is episodically released from the posterior Pituitary gland in order to stimulate the uterine myometruim to contract and retract, facilitating the foetal ejection reflex of birth (Fraser Cooper, 2009). Moreover, epidural also lowers the production of prostaglandin. This uterotonic hormone is essential for cervical ripening, effacement and dilation during labour (Kresser, 2011). As a result to this reduction of birthing hormones, the process of labour is hindered and thus upon medical decision, synthetic oxytocin known as Syntocinon is given in attempt to accelerate labour process, aiming to strengthen and increase the frequency of contractions (Fraser Cooper, 2009). Prior to the administration of Syntocinon, amniotomy is to be performed, unless membranes were previously ruptured. Having Syntocinon infusion, requires continuous electronic foetal monitoring in order to accurately observe the foetal heart and uterine activity. This in turn restricts mobility. The rate of Syntocinon infusion should be carefully observed in order to exclude uterine hyperstimulation. This is when having four or more contractions in a ten minute period, which in turn causes poor placental perfusion ending up with the foetus getting compromised, as blood flow between the mother and the foetus tends to decrease during contractions (Royal Cornwall Hospitals NHS Trust, 2012). In addition, if uterine hyperstimulation is ignored, it can ultimately cause uterine rupture or placental abruption. It is the role of the midwife to continuously monitor the state of the mother. Palpation of the fundus is one of the skills used to determine the strength, frequency and length of contractions, altogether with electronic foetal monitoring (Buckley, 2005). Moreover, Syntocinon can create a feeling of lack of breath, confusion, fast and irregular heartbeats, severe headaches and chest pains. In-coordination of Pelvic Floor Muscles: Epidural also negatively affects the strength and coordination of the pelvic floor muscles. These muscles guide the foetal head to enter the pelvis in the best position for the delivery of the baby. Lack of such coordination results in foetal malposition (Mander, 2011). Changing labour positions aids in the rotation of the foetal head, however if malposition persists, instrumental delivery is next in choice. The decision to proceed with an instrumental delivery would increase the likelihood of performing an episiotomy, in order to enlarge the pelvic outlet to provide the necessary room for the clinicians hands to deliver the baby (Fraser Cooper, 2009). Episiotomy on itself can be very detrimental to the mother. Not only can it be a bleeding point, but also a source of pain and discomfort especially during urination and rest. Moreover, lack of hygiene further increases the risk of acquiring an infection (Enkin ,Keirse, Neilson, et al., 2000). Having an episiotomy, may also instigate a feeling of uncertainty and fear of when to resume to sexual life, which ultimately may create unnecessary conflict between partners. It is the midwifes role to give the mother advice on perineal care in order to reduce such negative incidences. Urination Difficulties: Epidural anaesthesia may cause numbness of the bladder, this is exhibited as decreased sensation to urinate. Inability to pass urine during birth can possibly impede the rotation of the foetal head with the consequence of inadequate foetal descent (Baston Hall, 2009). During birth, the midwife is to encourage the mother to urinate frequently. If she is unable to do so, the midwife should look for other signs that may indicate a full bladder. Abdominal palpation is one of the skills that can be carried out to indicate such a measure. In urinary retention, the mother may require catheterisation. A urinary catheter is inserted through the mothers urinary orifice. This is temporarily situated in the bladder, and allows the mothers urine to drain freely (Johnson Taylor, 2011). The procedure of catheterisation itself may make the mother feel uncomfortable. Moreover, the catheter pipe provides the perfect pathway for the entry of bacteria possibly ending up with a urinary tract infection, especially if there is a poor level of hygiene (Fraser Cooper, 2009). Pyrexia: If epidural anaesthesia happens to be in place for more than 5 hours, there is an increased tendency to a rise in maternal temperature, resulting in the foetus getting compromised which is generally manifested as tachycardia. An increased maternal temperature altogether with a raised foetal heart rate could be an indication of a possible infection such as chorioamnionitis. This would require prompt action, so as to reduce the risk of adverse morbidity to the foetus. Usually an emergency caesarean section is the option (Mander, 2011). Having to follow such a procedure may create a lot of anxiety and fear amongst the parents, as suddenly they are receiving an unexpected news which leaves them confused on the health of their baby. Caesarean section is one major operation, which on its own carries a lot of risks. In fact there is a greater tendency of bleeding. Also, the mother has to cope with a lot of after pains following the procedure. Furthermore, following delivery the baby is most probably admitted to the neonatal intensive unit for investigations regarding the possibility of infection. This early separation surely creates a lot of fear and uncertainty in the newly parents. Limited Mobility: Since epidural numbs the body from the waist down, it creates a lot of restrictions in mobility. Nevertheless, it is very likely that continuous foetal monitoring is required to monitor the baby and uterine activity. This restricted mobility does not help in the physiology of normal labour (Baston Hall, 2009). Other side effects of epidural anaesthesia may include: pruritus, generalised itching of the skin, nausea, vomiting, shivering, headache, permanent nerve damage, heart and breathing difficulties. Side effects of epidural anaesthesia on the baby As discussed earlier, epidural can be the cause a variety of side effects on the labouring women, nonetheless, the baby is also very likely to be negatively effected. When epidural is injected, there may be a degree of the drug that enters the maternal blood stream. Blood eventually passes through the placenta, with the consequence of drug components ending up into the foetal circulation. Studies show that the degree of drugs in the foetus can reach levels that are equal to or even higher than that in the maternal blood stream. In addition, the elimination process of a newborn is still quite immature, with the consequence of taking longer for the drug to be eliminated from the body. Foetal distress: this is the commonest side effect of epidural. As discussed earlier, epidural tends to lower down the maternal blood pressure with the consequence of decreasing the amount of oxygen and nutrients that reach the foetus. This phenomena is better known as foetal distress. This is commonly manifested as bradycardia as well as abnormal variations in the foetal heart rhythm (Lohse, 2015). This distress puts the baby and the mother at greater risk of intervention, which may include opting for instrumental or operative delivery. Such choice depends on the explicit condition of the mother and baby. Furthermore, the baby is also prone to experience difficulties after birth, which may include: Breastfeeding difficulties: Epidural drug components are likely to interfere with the release of oxytocin. This hormone plays an important role in the let down reflex of breastfeeding; when the baby sucks, oxytocin is released which positively feedbacks to release even more oxytocin which in turn altogether with the aid of other hormones, milk is released (Amis Green 2008). Epidural anaesthesia also has the tendency to effect the babys neuro-behavior. The newborn may show signs of drowsiness, difficulty in latching and sucking which will make breastfeeding far much more difficult to establish (Amis Green 2008). This will require more intensive care and time to acquire efficient breastfeeding, which may put the mother under great stress and anxiety. Poor condition: as stated earlier, epidural anaesthesia may cause maternal fever during labour. This in turn affects the babys condition in having poor muscle tone, may require resuscitation immediately after birth, and to a greater extent may experience seizures. This all sums up to a low apgar score at birth (Buckley, 2010). Having said that, the baby may be admitted to the neonatal intensive care for more intensive observation in order to stabilise and maintain his/her condition. This early separation from the parents surely interferes with bonding. It may even create a sense of anxiety and stress in the parents; being greatly concerned on the heath of their child. It is the role of the midwife to inform the parents on the daily condition of their baby and as much as possible find measures and ways to make them feel reassured and closer to their child (Buckley, 2010). Other side effects seen in infants are: rapid breathing and low blood sugar levels. As we midwives are knowledgable of all the risks this pharmacological pain relief brings with it, it is our role that during labour we suggest other methods of pain relief, possibly non pharmacological ones. If the mother happens to request for pharmacological ones, we should make her aware of all the benefits and risks, and in this way we enable the mothers make an informed choice. Reference List Amis, D., Green, J. (2008). Prepared childbirth the family way (Revised ed.). Family Way Publications Inc. Baston, H., Hall, J. (2009). Midwifery essentials: Labour: Volume 3 (1sted.). Churchill Livingstone. Buckley, S. J. (2005). Epidurals: Risks and concerns for mother and baby. Buckley, S. J. (2010). The hidden risk of epidurals. Mothering the Home for Natural Family Living. Enkin,M., Keirse, M., Neilson, J., Crowther, C., Duley, L.,Hodnett, E., Hofmeyr, J. (2000). A guide to effective care in pregnancy and childbirth (3rd ed.). Oxford: Oxford University Press. Fraser, D.M., Cooper, M.A. (2009). Myles textbook for midwives (15th ed.). London:Churcill Livingstone. Healthline Editorial Team. (15 March 2012). Risks of epidurals during delivery. Johnson, R., Taylor, W. (2011). Skills for midwifery practice (3rd ed.) London:Churcill Livingstone. Kresser, C. (2011). Natural childbirth IV: The hormones of birth. Lets Take Back Your Health — Starting Now. Lohse, M. (2015). Epidural side effects for a baby. Livingstrong.Com. Mander, R. (2011). Pain in childbearing and its control (2nd ed.) London:Wiley Blackwell. Mehl-Madrona, L. Mehl-Madrona, M. (2008). Medical risks of epidural anaesthesia during childbirth. Rahm, V., Hallgren, A., Hogberg, H., Hurtig, I., Odlind, V. (2002). Plasma oxytocin levels in women during labor with or without epidural analgesia: A prospective study. Acta Obstet Gynecol Scand 81. Royal Cornwall Hospitals NHS Trust. (2012). Use of oxytocin. Clinical Guideline for the use of Oxytocin (Syntocinon) in the First and Second Stage of Labour, Danica Chetcuti

Indian Relations in Chesapeake and New England Essay

In the 1600’s English settlers came to America seeking refuge, and land. Upon coming to America the settlers crossed paths with the natives and eventually lead to a variety of relationships. There were various factors that shaped the relations in certain regions such as the Chesapeake Bay and New England. The events that lead up to tension between the natives were the settler’s lust for new land, diseases and the on-going disputes between the natives and the settlers. In the Chesapeake Bay the Powhatans were originally the dominant power among the Native Americans. The Powhatan tribes flourished under the Powhatan Confederacy until the arrival of the Europeans. Tension arouse between the natives and the settlers as the new colonist began establishing their town and had a scarce amount of food leading them to raid the Powhatan’s food source. The natives fought back and attempted to restore their supply of foods when Lord De La Warr declared war against the Powhatan’s therefore marking the beginning of the Powhatan war. The Powhatan villages were raided, burned and the cornfields were torched down cutting off their main food source. A peace treaty ended although it was shortly broken after the Powhatans attacked the Settlers due to them further expanding and into English territory. Like many wars the gain of territory is one of the fundamental reasons as to why many people start a war. The Powhatan were defeated due to lack of unity despite of their confederacy while they were attacked by diseases and the Europeans advance weapons which gave the Europeans the upper hand. Unlike the Powhatans and the English Settlers in the Chesapeake region, the relation between the Puritan Colonist and the natives started in mutual respect. The natives were first attacked by a new set of diseases causing nearly three-quarter of the population to die. Although the natives were introduced to diseases they befriended the Quakers. They formed an alliance and established the treaty with the Plymouth pilgrims in 1621 and aided the Quakers in celebrating the first thanksgiving. Despite the treaty and tension began when new English settlers began to migrate to America further settling inland to the natives’ region. Like the Powhatan Indians the Pequot Indians were attacked where their homes were burned and the fleeing natives were shot. The Puritans then pushed forward to converting the natives into Christianity further creating tension through resistance from the natives. The Indians final form of resistance was the alliance between tribes in the war against king Phillip. Roughly about 52 puritans towns were attacked at the end of the war where the English won. In conclusion the English Settlers came to America in search of land. The land-hungry settlers caused tension that arouse from the colonist moving into natives’ land as well as diseases and constant attacks to each other. The two regions share the commonality that both shared hostility between the natives and English settlers.

Budget

What are the macroeconomic effects of the budget proposal Movements and shifts of the curve 7. Conclusion 9 8. References O 5. 2 . 6. 2 The first part of the assignment discusses the economic principles and criteria for a assessing a good budget proposal for any country. Section 3 discusses macroeconomic objectives of a budget, role of government and how it intervenes, tools available to government and the practical considerations (lags in the effects of fiscal policy) The next part of the assignment the team selected the 2009 South African budget proposal and listed all revenue and expenditure proposal 2.What is a budget proposal Bedpan describes a budget as a â€Å"blueprint† for the nation, expressing the objectives and aspirations for the present and future for by the party in power. Mohr describes the budget is an instrument of the fiscal policy and determines the level and composition of government spending(G) and taxation(T). The Keynesian school of thought proposes tha t fiscal policy to be the most instrumental policy to influence total spending or aggregate demand (AD).He lists the four functions of the budget as: Used to decide priorities Serves to evaluate specific public programmed, reviewing the state's activities annually used to increase economic growth and impact on development A system of accountability and controls over government officials and agencies, setting limits on their activities and safeguarding against corruption Obedient four groups of people involved in the national budget of South Africa and their roles in brief with regard to the budget are listed in the table below: The cabinet Controls the most critical decisions on the allocation of public funds Civil servants Play supporting roles by providing information to politicians responsible for decision making Members of parliamentActs as the defender of the public interest through its constitutional right to question reasons and feasibility Of each aspect Of the budget The pu blic Through organizations like Noose, interest groups, community based organizations and other bodies provide the voice of all members not directly involved in the budget process 3. Assessing government budget proposal 3. 1 Economic principles and criteria of good budgets The first step in determining economic principle and criteria for good budgets involves identifying what the budget proposal should achieve in terms of macroeconomic objectives. Mohr et al lists the following as the main macroeconomic objectives that can be used to judge a good performance of the economy: Economic growth Full employment Price stability Balance of payments (or external stability) Equitable distribution of income Efficiency T.Manuel in delivering his 2009 South African Budget speech , emphasized the following five principles: Protecting the poor Sustaining employment growth and expanding training opportunities Building economic capacity and promoting investment Addressing the barriers to competitive ness that limit an equitable sharing of opportunities And maintaining a sustainable debt level that would not constrain our development tomorrow Mohr recognizes that the free market system allocates resources in the best possible way. However he also acknowledges that at times market failure occurs where the market system does not achieve efficient allocation Of resources.The market systems failures occurs in the following cases: Monopoly and imperfect competition Public goods Externalities Asymmetric information Common property resources Moor's summary of government's role is summarized on the table below: Role Aim Allocation function Correcting market failure and achieving a more efficient allocation of resources Distributive function Achieving more acceptable distribution of income Stabilization Promoting macroeconomic stability 3. 2. 1 How does government intervene The table below shows the five intervention options and examples of each that the government can use to achieve the above roles: Intervention Examples Public provision of goods and services through ownership or financing National Defense, hospitals, Eskimo, prisons Becoming a market participant Through price stability, income redistribution, Government spendingTransfer payments to change income distribution Taxation Personal Income Tax Regulation Labor laws, competition policy, anti-tobacco laws 3. Practical considerations: Lags in the effects of fiscal policy Recognition lags Implementation lags Response lags (603,608) Therefore a good budget takes into cognoscente the macroeconomic objectives, address issues relating to market failures and takes steps address the needs of society and the scarce available resources. A good budget should also take into considerations the effects of lags in typefaces policy. 4. 2009 South African Budget proposal The group selected the 2009 South African Budget proposal. The budget speech was delivered by the Finance minister Mr.. Tremor Manuel on the 1 lath Febru ary 2009.The table below is a list the budget revenue and expenditure proposals: Budget revenue proposals Budget expenditure proposals Taxes on income and profits Source: National Treasury 2009 Budget Review Statistical Table 2 and Table 3 5. Theory on economic principle of equity As stated in the preceding section, tax is one Of the instrumental tool available to government to achieve its roles of allocation and distributive unction's mainly through taxation. The criteria for a good tax proposal is that it must meet the following conditions: Neutrality Equity Administrative simplicity We now focus our attention and evaluate tax relief with reference to the criteria of equity.Case and Fair refers to equity as fairness. Under this principle tax burden is distributed fairly. Two theories of equity or fairness exists. These are : 15, 16, 17 Benefits-received principles Ability-to pay principle 381 Under the benefits-received principle, taxpayers should contribute to overborne in propor tion to the benefits they receive from public expenditures. This theory of fairness does not receive popular support as it is not possible to determine the value that taxpayers receive from public expenditures. The other theory of taxation, ability-to pay principle states that taxpayers should bear tax burdens in line with their ability to pay taxes. 5. 1.Discuss vertical and horizontal equity. 17 In terms of tax revenue collected by government, horizontal equity relates to the concept of tax neutrality. It defines that the tax system should not criminate between similar things or people, or unduly distort behavior . Len other words, the people with a similar ability to pay taxes should pay the same or similar amounts. Vertical equity usually refers to the idea that people with a greater ability to pay taxes should pay more. However, to those that believe in a flat tax, the idea of vertical equity could mean that the rich should not be punished for their success by paying higher tax es than others.

Financial Statement Analysis of Amazon.Com Essay - 1719 Words

Financial Statement Analysis of Amazon.com, Inc. Introduction The purpose of this essay is to perform financial statement analysis on Amazon.com, Inc. (NASDAQ: AMZN ). We start with an introduction of Amazon and its industry. We then evaluate the company’s financial position, liquidity, operating capability and financial flexibility using different ratios. To evaluate the financial performance of Amazon.com, Inc we disclose recurring NICO and do full ROE disaggregation. Amazon.com’s stock price increased from $44.29 per share at the end of fiscal year 2004 to $134.52 per share at the end of fiscal year 2009. Earnings per share increased from $0.63 to $2.06. The stock closed at $118.87 on 02/01/2010. Recommendation Amazon.com is†¦show more content†¦The three liquidity ratios show Amazon has very good liquidity, which means it could easily satisfy current liabilities with current assets. Comparing to Amazon, Ebay is even more liquid as it could satisfy its short term liabilities purely by cash and cash equivalents. | | Amazon.com | | | eBay | | | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2009 | 2008 | Current Ratio (to one) | 1.33 | 1.30 | 1.39 | 1.33 | 1.52 | 1.57 | 2.32 | 1.70 | Quick Ratio (to one) | 1.04 | 1.00 | 1.07 | 0.99 | 1.22 | 1.27 | 2.32 | 1.70 | Cash Ratio (Acid Ratio) (to one) | 0.86 | 0.79 | 0.84 | 0.80 | 1.04 | 1.10 | 1.10 | 0.86 | | | Table 2 | | | | | | Financial Flexibility Financial flexibility (Solvency and leverage) is a company’s ability to adapt to unforeseen events and opportunities. Leverage means using debt (or other third party funds) to increase earnings for the owners. Table 3 presents some financial flexibility and leverage ratios of Amazon.com from 2005 to 2009 and for Ebay from 2008 to 2009. Amazon.com is a fast growing company and in the fiscal year ended 2004, they had a negative total equity, which could skew the ratios. Therefore, we did not present the ratios in 2004. From table 3 we can see that at the end of fiscal year 2009, both Amazon.com and eBay have high financial flexibility due to low or even zero long-term debt. Their usages of leverages are both low. Although a company should try to useShow MoreRelatedFinancial Statement Analysis Of Amazon.com, Inc.1377 Words   |  6 PagesFinancial Statement Analysis AMAZON.COM, INC. History Incorporated in 1994 and launched in 1995 as an online bookstore, Amazon.com was founded by Jeff Bezos with a vision of creating â€Å"the everything store† (Stone, 2013) and the largest of its kind; hence, it was named after the largest river in the world (D’Onfro, 2014). In 1997, Amazon announced IPO and trading began on NASDAQ under â€Å"AMZN†. 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