Dear Joy
It is a requirement in the midwifery training for all students to be
confident with using a pinard. Check out Christ Church's assessments.
Helen Foreman
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] On Behalf Of ddevane
Sent: 25 November 2003 22:16
To: [log in to unmask]
Subject: Re: Pinnard use at waterbirth
Apologies for cross-posting
Dear Joy
Perhaps look at it the other way around....where is the evidence that a
Doppler is any more effective in intermittent auscultation of the fetal
heart than a Pinard? I am not aware that there is any. The supervisors
should provide evidence to support their assertion. It would appear in
this case that the woman and midiwfe have agreed an effective form of
monitoring, which doesn't happen to be the Doppler. Absence of evidence
should not equate with evidence of absence.
The NICE/RCOG Guidelines on EFM (2001) looked at different methods of
intermittent auscultation. They found only one RCT (ref below). This
study suggested that "compared with intermittent auscultation performed
with a Pinard used by the attending midwife, intermittent EFM was
significantly more likely to
detect FHR abnormalities than intermittent auscultation performed with a
hand-held Doppler, which, in turn, was more sensitive than intermittent
auscultation performed with a Pinard by a research midwife.
There was a significant increase in the caesarean section rate when FHR
was monitored with either intermittent EFM or with a hand-held Doppler
device.
There were no significant differences in other maternal or neonatal
outcomes between the groups. However, the study only included 1255 women
and, even accounting for the higher perinatal mortality rate, was
underpowered to detect any difference in perinatal mortality. However,
this study was conducted in Harare, Zimbabwe, and the reported adverse
neonatal outcomes in the total study population were significantly
higher than corresponding outcomes in the UK. Thus, generalisation of
the results to the UK may not be appropriate"
Mahomed K, Nyoni R, Mulambo T, Kasule J, Jacobus E. Randomised
controlled trial of intrapartum fetal heart rate monitoring. BMJ
1994;308:497-500.
Royal College of Obstetricians and Gynaecologists. (2001). The use of
electronic fetal monitoring: The use and interpretation of
cardiotocography in intrapartum fetal surveillance. Evidence-based
Clinical Guideline Number 8. London: Royal College of Obstetricians and
Gynaecologists.
Best of luck
Regards
Declan
Declan Devane,
Doctoral Student / Midwifery Research Assistant,
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 Joy
Kemp
Sent: 25 November 2003 21:24
To: [log in to unmask]
Subject: Pinnard use at waterbirth
Dear Colleagues
Can you help us to quickly build our evidence base for the use of a
pinnard for a waterbirth?
I am assisting a colleague who is being bullied as she tries to support
her client's wishes for a home waterbirth without electronic monitoring.
The client is 37 weeks gestation and has declined all forms of
electronic monitoring in pregnancy. She is hoping for a waterbirth at
home. My colleague negotiated to use a pinnard's stethoscope for
auscultation in labour and her client is happy with this.
The local supervisors (who are also all managers) have decided that this
scenario is unacceptable (the argument is that some midwives may not
feel confident with a pinnard's and that it is unfair for midwives to
risk back injury by leaning over the waterbrtih pool in such a
fashion....). They have treated my colleague very unsympathetically and
intend to visit the woman at home to tell her she cannot have a
waterbirth without the use of the sonicaid. If she wishes to have a
waterbirth she will have to be on dry land.
We are trying to find evidence with which to support this woman's
request.
May thanks for your help
Joy Kemp
|