Vaginal Delivery of Breech Dissertation Example | Topics and Well Written Essays - 7000 words

Vaginal Delivery of Breech - Dissertation Example The discussion will be based on the author’s perspective, available evidence and current practice. It shall discuss women’s options during births, especially where infants are in the breech position. This dissertation will further evaluate if the women’s choices with regards to delivery of the breech are significantly impacted by the deskilling of health professionals or by the actual risks of the procedure itself. Current practice, as supported by the NICE and RCOG Guidelines (2001) discourages women from having vaginal deliveries when their babies are presenting in a breech position. Many midwives have only ever experienced vaginal breech deliveries in a simulated environment. Since practice is now dominated by the opinion that the safest option for these babies is a caesarean section and the opportunities to gain experience in safe vaginal breech delivery are limited, the dominance of caesarean section is reinforced. This paper aims to highlight the evidence t hat underpins the current practice as well as investigate the emerging evidence that is the basis for certain midwives now considering breech vaginal birth to be a safe option. Historically vaginal deliveries were the chosen method for the delivery of babies with a cephalic or breech presentation. ... he current indications for caesarean births in developed countries include breech babies along with foetal distress, malposition, malpresentations, placenta previa, and other related complications (Fischer, 2012). Some of these complicated births have been delivered vaginally even though the risk for these births has been considered significant. At present, the training for Obstetricians has mostly related to the delivery of breech babies via caesarean Section. This development has been re-evaluated by midwives because some midwives believe that obstetricians must equally train in normal deliveries of breech babies, especially as women’s options have been limited by the risks involved in the birth as well as the decreased skill of midwives (Jadoon, 2008). Breech presentation deliveries are deliveries where the foetus is at a longitudinal position, with either the buttocks or the feet presenting at the cervical area during delivery. This presentation is seen at about 3-4% of al l term deliveries (Fischer, 2012). This type of presentation may be attributed to prematurity, uterine malformations, placenta praevia, multiple births, and sometimes foetal abnormalities (Fischer, 2012). Breech presentation is classified into: frank, complete, and footling. Frank breech is observed with hips flexed, knees extended; complete is seen with hips flexed and knees flexed; and footling or incomplete with one of both hips extended and foot presenting (Fischer, 2012). The issue of whether or not vaginal breech deliveries should be considered over Caesarean section is now also based on the skill of midwives. There are major concerns surrounding vaginal delivery of breech presentation and generally limited data on safe vaginal deliveries of a breech. There is also a lack of honesty on the

Suppliers Relationship at Pfizer Essay Example | Topics and Well Written Essays - 2000 words

Suppliers Relationship at Pfizer - Essay Example As of 3rd quarter of 2010, the company reported its total revenue of $16.2 billion despite the economic recession in some parts of the world (Pfizer, 2010 c). This figure is 39% more than the total revenue of Pfizer during the 3rd quarter of 2009. (See Table I – Comparison between Pfizer’s 3rd Quarter Revenue between 2009 and 2010 below) In the past, majority of the purchasers are searching for a wide-range of sources of raw materials provided that the supplier can offer the company the lowest market price for the same product (Gadde and Hakansson 1993, pp. 165 – 166). Today, purchasers are after the need to develop a long-term collaborative relationship with its suppliers in order to avail cheaper high quality raw materials (Chobra and Meindl 2001; Araujo, Dubois and Gadde 1999; Bensaou 1999). In relation to the business growth of Pfizer, this report wide-range of will discuss about the importance and ways on how to properly manage the supply side of raw materia ls by establishing a good relationship with its suppliers. Aside from discussing the different degrees of involvement in which Pfizer can establish good relationship with its suppliers, this report will discuss some strategies that will enable Pfizer maintain a strong and long lasting relationship with its accredited suppliers. Supplier relationship management has been a common practice in supply chain management of multinational companies like Pfizer. As explained by Wisner, Tan and Leong (2009, p. 95).