Hi Patricia,
I think you're very right...
This is kind of premature what I am going to say right now. I am doing
interviews in Scotland, Holland and Switzerland in order to define
effectiveness of antenatal care ( what is "care" ?).
One country was very different from the other ones and I did not get a clue
why... The problem most certainly is that midwives ( although is still
defined as "midwifery care") have become part of the medical system, and act
as such. Which suggests that as soon as midwives loose their ability to
DECIDE on their own ( are dependent of the system), women are not cared for
anymore in an appropriate way.
The upcoming results are also shocking a lot of things I thought was right
about evidence based care according to the Cochrane database.......
This must somehow fit within Soo's thoughts though..
With regards,
Ans
----- Original Message -----
From: "Patricia Burkhardt" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, September 19, 2002 4:24 PM
Subject: Re: Effectiveness of Nurses as Providers of Birth Labor Support in
North American Hospitals
> 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
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