My original 'tongue-in-cheek' response is backed up by the fact that some
midwives who are not involved with case load practise do give women
instructions to call the labour ward when they 'go into labour' or 'when
their waters break'. These women tell their story to a midwife on the end of
a phone who will then suggest 'they come in to be checked' because that's
what their trust protocol tells them to do!! It would be ideal to have all
women checked at home in early labour ( this is what Caroline Flint
advocated all those years ago...) and then the woman could choose whether
she wants to stay at home and have her baby or go into hospital! You never
know, it may even increase the home birth rate!

I liked Denis Walsh response about a triage system, but that doesn't resolve
the anxiety factor which an available community-based midwife may solve by
visiting.

Jenny


-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]]On Behalf Of Chris at TVU
Sent: 29 May 2002 08:43
To: [log in to unmask]
Subject: Re: Birthrate plus

on 5/28/02 6:43 PM, Jenny Hall at [log in to unmask] wrote:

> Perhaps they come in because they are 'told to' by the midwives!
>
> Jenny Hall
> -----Original Message-----
> From: A forum for discussion on midwifery and reproductive health
research.
> [mailto:[log in to unmask]]On Behalf Of Jane sandall
> Sent: 27 May 2002 23:14
> To: [log in to unmask]
> Subject: Re: Birthrate plus
>
> I think from your responses, that this is a significant issue for both
women
> and labour ward staffing. has anyone come up with any solutions or thought
> why women come in early. has anyone noticed a change in this trend over
the
> last 5 years??
> Jane
>
Hi Jane and others

When studying the introduction of caseload midwifery in West London we
observed that women with a caseload midwife were less likely to be admitted
early to the labour ward (or antenatal ward as happened when v busy) because
the midwife was able to visit them at home to provide assessment and
re-assurance/support. Over time, the midwives appeared to develop more
selectivity, and, knowing the women, tended to use visiting or telephone
support as appropriate.

In interviewing women about their care we heard from a number who had come
in very early because they were having pains and felt unsure what was
happening and how 'far on' in labour they were. From their accounts, they
seemed to lack assurance that would help them to cope with early/latent
labour at home. Staff tended to give women the option to go home, but to do
so by telling the women they weren't in labour. This did not fit well with
the women's own experience (of pain), leading to feelings of confusion and
lack of confidence in their ability to cope (along the lines of - well if
I'm feeling bad now and I'm not even in labour, how will I get through
this).

One of the issues to consider here, maybe, is the nature of the
categorisation - in labour/not in labour - as dichotomous and the medical
understanding of the process as linear. This does not seem to fit well with
women's experiences and perceptions as reported in the interviews we have
done. Perhaps more explicit recognition that something is happening prior to
'active labour' would actually help to reduce the numbers of anxious women
pitching up early?

Chris