This is a fascinating debate.
There may be a temptation to believe that the way you were trained was the ‘right’ way (although we’ve changed our minds about a great deal recently). 
Certainly in the mid-1980s in Scotland I was taught to listen for the full minute, and I do believe that that ought to give a good picture of the fetal heart rate.
I would have thought that there must be significant room for error if listening in for five or six seconds and then multiplying up by 12 or 10. Even listening in for 15 seconds and multiplying by four risks inappropriate extrapolation.
I look forward to hearing some good evidence that tells us how to take this forward.
Best wishes,
Andrew Symon

Dr. Andrew Symon
Senior Lecturer
School of Nursing & Midwifery
University of Dundee
01382 496671




Inaugural Research Midwifery Conference, Dundee, 1st November 2007
[log in to unmask] 


>>> "Robyn Maude [CCDHB]" <[log in to unmask]> 24/06/2007 06:46 >>>
Hi Dolores
 
The method of counting/assessing the FHR whilst doing ausultation is
interesting. I have been reading a lot of literature for my PhD studies
and have seen details for multi count methods and the auscultated
accerleration test. It seems to me that these methods have eminated from
US and Canada and quite a lot of work has been done around this. I
haven't seen the multi count method discussed in British/Australian
literature (but am happy for anyone to set me staright). 
I trained in Australia (our training was based around British training)
in early 70's - we auscultated the FH for 1 minute and recorded that
number.
Later in the 70's in  a variety of hospitals I was 'taught' how to count
for 5 secs and x by 12 to get a number or count for 6 secs and x by 10
These days Dopplers with FHR display shows a range i.e variability I
guess, however the literature suggest that we should not be recording
the range but recording the average. I also think it is important to be
sure that what we see is what we hear. Some Dopplers have a little heart
symbol that beats when contact is good.
I will have a look at the article mentioned. I think the notion of how
to count is worth further investigation along with the role of fetal
movements.
 
cheers, 
Robyn Maude
Midwifery Advisor
Capital and Coast DHB
Private Bag 7902
Wellington South
New Zealand
Office - Level K - Ward 14 -Grace Neill Block
(04) 3855999 ext. 5298
0274793826
 

________________________________

From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of
[log in to unmask] 
Sent: Thursday, 21 June 2007 10:29 p.m.
To: [log in to unmask]
Subject: Re: intermittent auscultation


Hello all,

My question concerning this debate about intermittent auscultation
revolves not around frequency but method of counting/assessing the FHR.
I worked as a direct-entry midwife in a solo practice doing home birth
for over 12 years in a rural area of the U.S.  Recently, I started
working as an obstetrics nurse in a small hospital that struggles to
preserve normal birth, including water birth, intermittent auscultation,
and the 6th hospital in the U.S. to get Baby Friendly status.

While working for myself, I followed the recommendation established by
an article in a home birth midwifery journal.

Davis, Cindy.  Detecting Early Hypoxia.  Midwifery Today, #24 Winter
1992, 35 - 37.

Unfortunately, I cannot attach the article to this listserv.  However,
the author states that the FHR should be counted every 5 seconds and
recorded.  Each 5 second number is multiplied by 12 to get an
approximation of the FHR.  While this system is not highly accurate,
what is does provide is a closer look at variability.  Currently, in the
hospital, I am required to count for one full minute to get the FHR.  In
the hospital, then, I have a single number to form a "snapshot of fetal
health" as opposed to the 12 "snapshots" that I had been working with.
I understand the following concepts:

1. beat-to-beat variability cannot be inferred from auscultation
2. short term variability is no longer considered a separate assessment
within the concept of variability
3. there are no evidenced-based parameters established to interpret the
above series of snapshots

However, do any of you on this list have any information (or opinions)
about the merits of these different counting methods of assessing fetal
well-being?  I shall be most grateful for your assistance with this
question.

Dolores Carbonneau, C.P.M., B.S.N. 
707 West Alna Road
Alna, Maine 04535
[log in to unmask] 

 

  


-----Original Message-----
From: Sue Kinross 
To: [log in to unmask] 
Sent: Sat, 16 Jun 2007 4:50 pm
Subject: Re: intermittent auscultation


As an independent midwife, I am very interested in this thread. 
When attending a home birth, my practice is very much as that
highlighted here by others and I will listen in on arrival.  As the
labour cycle becomes well established I will, on separate occasions,
listen in between, after and throughout contractions over a period of
maybe an hour or so in active labour.  If this remains reassuring
(bearing in mind that I have know this woman and listened to her baby
for many weeks) I am likely to check once in 1/2 hour or so ..  until
..very much as Soo recalls, the frequency and duration will increase as
labour progresses.  During second stage, this is usually after each
contraction, subject to accessibility of the abdomen during the final
thrust!   Naturally, there will be individual differences.  My
occasional shift at my old unit fills me with despair, as the CTG is
used in lieu of a midwife.  More tragically, I recently heard that a
Registrar questioned a midwife opinion that all was OK and normal in the
room she was in ..  with the retort "How can you claim that all is
normal in there, if you are not using a CTG to monitor?"  ##!!
 
 
Sue
 
 
Sue Kinross
Independent Midwife
www.Birthbundle.org.uk <http://www.birthbundle.org.uk/> 
Mobile: 0773 8818 549
 
Hope you will be able to support our IM Campaign to save Independent
Midwifery. 
Signing the petition is good, but writing to your MP, Government and
Newspapers is even better!
www.saveindependentmidwifery.org 
<http://www.saveindependentmidwifery.org/>  

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