Dear Soo,
As a midwife that has worked outside of the mainstream for many years
working in an area where all birth are treated as normal until the
opposite arises, I am very interested in this discussion. I have many
colleagues from Norway, Denmark and Sweden that are burdened with the
very problems that you mention there. The 2 main reasons are often: lack
of time for the individual patients and lack of feeling empowered. I
don't know if this is true other places, but it seems like the case with
the midwives that I have talked with.
It is difficult to give strength and self confidence to the women we
help if we ourselves lack sense of coherence.
Ruth Montgomery
<<< [log in to unmask] 20/ 9 7:29 >>>
Thanks Pat, that is interesting. What were the
professional qualifications of the attendants, do you
know?
This may be extremely controversial for many midwives,
but I am just wondering, how many midwives actually do
take the authority to change the medical managment
plan? It has been my experience, in big consultant
units, in the uk, that, despite the affirmation of our
expertise in normality, many of us succomb to
technologic creep, and even become the architects of
technologic birth.
Recently a consultant obstetrician (the clinical
director of the obstetric division in a Trust) told me
he despaired, because he went around the labour ward
taking women off monitors, and then came back half an
hour later and found the midwives had put them back
on.....I dont deny that there is good and
philosophically physiological midwifery being
practised(not least in the birth centres and teams we
visited Pat) - but I just wonder what percentage of
birthing women have the chance to experience it. I 'm
a bit nervous that any large scale study of the impact
of midwifery in big consultant units on outcomes in
the UK at present will show just what Ellen s study
showed. I do so hope I am wrong...
all the best
Soo
(acknowldegin, fo ou --- Patricia Burkhardt
<[log in to unmask]> wrote: > Soo,
> I don't think that's true. Nancy Lowe presented
> preliminary findings of
> this study at the annual midwifery meeting in May
> and one of her questions
> at the end related to the fact that the nurses had
> no ability to change the
> medical management plan. She wondered if the
> results would have been (wiil
> be?) different if and when the study is done with
> midwives who both support
> and direct the plan of care. Regards, Pat
>
> At 02:24 PM 9/19/02 0100, you wrote:
> >I think the nurses here were actually those who did
> >the midwifery care prior to the study- ie they were
> >the usual CNM care givers in the US. I think
> .ellens
> >point is that normal birth is hard to do in
> consultant
> >units. she will be talking about this at the normal
> >birth conference...!!
> >
> >best wishes
> >
> >Soo
> >
> > --- ddevane <[log in to unmask]> wrote: > Good point
> >Inges!
> > >
> > > Perhaps this article is one deserved of a letter
> to
> > > the editor with a
> > > methodological critique.
> > >
> > > Declan
> > >
> > > Declan Devane,
> > > Doctoral Student,
> > > School of Nursing and Midwifery Studies,
> > > University of Dublin Trinity College,
> > > Trinity Centre for Health Sciences Education,
> > > St. James's Hospital,
> > > Dublin 8.
> > > Tel: 087 659 6923
> > > Email: [log in to unmask]
> > >
> > > *******************************************
> > > Please note that electronic mail to,
> > > from or within Trinity College may be
> > > the subject of a request under the
> > > Freedom of Information Act
> > > *******************************************
> > >
> > >
> > > -----Original Message-----
> > > From: A forum for discussion on midwifery and
> > > reproductive health
> > > research.
> > > [mailto:[log in to unmask]]On
> Behalf
> > > Of Inge
> > > Loos
> > > Sent: 19 September 2002 11:23
> > > To: [log in to unmask]
> > > Subject: Effectiveness of Nurses as Providers of
> > > Birth Labor Support in
> > > North American Hospitals
> > >
> > >
> > > Isn't it funny, with a two day training nurses
> > > should be able to deliver
> > > effective labor care . What was Hodnetts
> intention
> > > for this study? The
> > > importance of experience in midwifery is
> obviously
> > > unknown.
> > > Kind regards
> > > Inge Loos RM BNS Stud. MNS
> > > [log in to unmask]
> > >
> > >
> > >
> > > Effectiveness of Nurses as Providers of Birth
> Labor
> > > Support in North
> > > American Hospitals
> > >
> > > A Randomized Controlled Trial
> > >
> > > Ellen D. Hodnett, RN, PhD; Nancy K. Lowe, RN,
> > > CNM, PhD; Mary E. Hannah,
> > > MDCM; Andrew R. Willan, PhD; Bonnie Stevens, RN,
> > > PhD; Julie A. Weston, RN,
> > > MSc; Arne Ohlsson, MD; Amiram Gafni, PhD; Holly
> A.
> > > Muir, MD; Terri L. Myhr,
> > > MSc; Robyn Stremler, RN, MSc(A); for the Nursing
> > > Supportive Care in Labor
> > > Trial Group
> > > Context North American cesarean delivery rates
> have
> > > risen dramatically
> > > since the 1960s, without concomitant
> improvements in
> > > perinatal or maternal
> > > health. A Cochrane Review concluded that
> continuous
> > > caregiver support during
> > > labor has many benefits, including reduced
> > > likelihood of cesarean delivery.
> > > Objective To evaluate the effectiveness of
> nurses
> > > as providers of labor
> > > support in North American hospitals.
> > > Design Randomized controlled trial with
> prognostic
> > > stratification by center
> > > and parity. Women were enrolled during a 2-year
> > > period (May 1999 to May
> > > 2001) and followed up until 6 to 8 postpartum
> weeks.
> > > Setting Thirteen US and Canadian hospitals with
> > > annual cesarean delivery
> > > rates of at least 15%.
> > > Participants A total of 6915 women who had a
> live
> > > singleton fetus or twins,
> > > were 34 weeks' gestation or more, and were in
> > > established labor at
> > > randomization.
> > > Intervention Patients were randomly assigned to
> > > receive usual care (n =
> > > 3461) or continuous labor support by a specially
> > > trained nurse (n = 3454)
> > > during labor.
> > > Main Outcome Measures The primary outcome
> measure
> > > was cesarean delivery
> > > rate. Other outcomes included intrapartum events
> and
> > > indicators of maternal
> > > and neonatal morbidity, both immediately after
> birth
> > > and in the first 6 to 8
> > > postpartum weeks.
> > > Results Data were received for all 6915 women
> and
> > > their infants (n = 6949).
> > > The rates of cesarean delivery were almost
> identical
> > > in the 2 groups (12.5%
> > > in the continuous labor support group and 12.6%
> in
> > > the usual care group; P =
> > > .44). There were no significant differences in
> other
> > > maternal or neonatal
> > > events during labor, delivery, or the hospital
> stay.
> > > There were no
> > > significant differences in women's perceived
> control
> > > during childbirth or in
> > > depression, measured at 6 to 8 postpartum weeks.
> All
> > > comparisons of women's
> > > likes and dislikes, and their future preference
> for
> > > amount of nursing
> > > support, favored the continuous labor support
> group.
> > > Conclusions In hospitals characterized by high
> > > rates of routine intrapartum
> > > interventions, continuous labor support by
> nurses
> > > does not affect the
> > > likelihood of cesarean delivery or other medical
> or
> > > psychosocial outcomes of
> > > labor and birth.
> > > JAMA. 2002;288:1373-1381
> >
> >__________________________________________________
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>
> Patricia Burkhardt
> 246 Greene St.
> 4th Floor, Chocolate Factory
> New York, NY 10003-6677
> 212 998-5895 Phone
> 212 995-4384 Fax
>
> NB New Email address is:
>
> [log in to unmask] (drop the 'is')
__________________________________________________
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