Hello Amanda.

You have taken up a challenging post! I must comment on your statement that
'there is not a transparent process of identifying women for whom
obstetric care is a necessity'. I don't think we should be looking for or
expecting this 'transparency'. Life an birth is unpredictable and we cannot
look at a person and say 'you are going to need specialist obstetric care'
just as much as we can't look at people and say 'you are going to need
specialist oncology care' .

My argument would be that we should be changing our philosophies and mind
sets and say' this woman is going to have a normal natural process and if
something is not right we will refer her to the obstetricians and return her
to normal care once the issue has been corrected or the baby has been
born.'' We have got too much into putting women into high risk boxes because
we 'expect' things to be going wrong. I know this doesn't help in issues of
risk management (I don't like that concept anyway!!) but we can't predict
things to that extent and each woman's concept of her own risk taking is
different as well!

Best wishes


Jennifer Hall



-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]]On Behalf Of Amanda Mansfield
Sent: 24 September 2002 09:12
To: [log in to unmask]
Subject: Re: Midwifery-led care-

Dear All
I have recently taken up post at the Royal Free Hospital, charged with
leading the guideline development group for midwife-led care and
assisting the process of our move to a temporary ward in 4 weeks time,
and establishing 3 "normal-birth" rooms.
It is interesting reading Declan's comments, as at present, at the
Free, there is not a transparent process of identifying women for whom
obstetric care is a necessity!, and I would find this information
particularly useful. We are severely restricted by our inhouse
maternity system, which does not currently have 100% coverage of
hospital births, and it excludes home-births at present. In clearly
identifying from our local population, what proportion of women
actually achieve a birth without intervention, we are faced with many
challenges, as you can image.
If anyone can send me some ideas, postive thoughts, or you have
experienced the same process of setting up in-hospital birth
facilities, I would be really appreciative. Declan, good luck with
finding the information, I would be happy to share any information I
fall upon also.
Kind regards to the group
Amanda

Amanda Mansfield - Midwife
Currently on Secondment to The Royal Free Hospital
>Apologies for cross posting
>
>Dear all,
>
>I am seeking information on two issues related to the pilot
implementation
>of midwifery-led units in Southern Ireland and would be very grateful
for
>any information on the following issues:
>
>1. In order to establish some kind of a number analysis on how many
women
>would be eligible to use and would indeed choose the service, I need
some
>figures on the percentage of women that are classified as low-risk at
>booking and antenatal & intrapartum transfers and transfers back if
these
>figures are available.  Has anyone, or is anyone aware, of any
published
>data on this information?  If not, has anyone done clinical audits in
this
>area?
>
>2. With regard to selection/eligibility (again, not sure these words
are
>appropriate...) and transfer criteria, I have seen a few sources of
same but
>was wondering if there is any recognised, evidence based standard
from which
>to work rather than re-invent the wheel?  I hear rumblings that the
>Netherlands have developed an 'Obstetric Manual' that contains this
>information but I believe it is in draft format only and I am not
sure how
>evidence based it is although I suspect that coming from the Dutch
system,
>the will be based on many years of experience with midwifery-led
care.
>
>In anticipation...
>
>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
>*******************************************
>
Amanda Mansfield
Lecturer in Midwifery
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