We listened in every 30 minutes in the first stage of labour in Derby,
England, at least since 1982 (when i started midwfiery) until the NICE
guidelines recommended (forced?!) a change to more frequent listening
in. During my personal home births, my attending midwives listened in as
they thought fit in the early part of labour, and with increasing
frequency (but no particular regularity) as the labour progressed. Ive
been frustrated by the change in practice in this area for a long time,
and I strongly agree with Robyn that the timing of listening in is long
overdue - in fact, the impossibility of listening in regularly is given
by midwives as the reason hwy they dont use intermittent monitoring - so
this regime is potentially influencing less than optimal practice, as
midwives use continuous monitoring in conditions of low staffing levels
as they are unable to listen in as freely as guidelines demand:
Luyben AG, Gross MM.Intrapartum fetal heart rate monitoring: do Swiss
midwives implement evidence into practice?
Eur J Obstet Gynecol Reprod Biol. 2001 Jun;96(2):179-82.
Walker DS, Shunkwiler S, Supanich J, Williamsen J, Yensch A. Labor and
delivery nurses' attitudes toward intermittent fetal monitoring.
J Midwifery Womens Health. 2001 46(6):374-80.
Id be really interested to know how the project progresses Robyn
all the best
Soo
Professor Soo Downe
Director
Midwifery Studies Research Unit
University of Central Lancashire
Preston PR1 2HE
Lancashire
England
+44 (0) 1772 893815
tel: 01772 893815
>>> [log in to unmask] 06/14/07 10:01 am >>>
15 minutes must be a British tradition. The Norwegian tradition used to
be every 30 minute during most of first stage, more often at the end of
stage 1 and after every contraction during active pushing. New
guidelines from 2006 recommends every 15 min during first stage. These
guidelines are based on systematic rewiev of meta-analysis of RCTs (and
thereby evidence level 1a) comparing IA with continuous electronic fetal
monitoring, the RCTs are mainly conducted in countries where
auscultation every 15 min is the tradition. The knowledge that IA every
15 min is better than continuous CTG in low risk women is extrapolated
to that IA every 15 min is best in low-risk women.
I have no idea about what is the best, but how can you do auscultations
every 15 min if you do not have one-to-one care?
Ellen
----- Original Message -----
From: Ann Thomson
To: [log in to unmask]
Sent: Thursday, June 14, 2007 10:11 AM
Subject: Re: intermittent auscultation
Could I just point out that when I was a student midwife in 1967 we
were taught that the fetal heart should be auscultated every 15 minutes.
So this time interval existed before the RCTs, but I have no idea where
it came from. This is a very interesting project.
Ann
Ann M Thomson
Professor of Midwifery,
School of Nursing, Midwifery & Social Work,
University of Manchester,
Coupland III Building,
Manchester M13 9PL,
UK
Tel (0)161 275 5342
Fax (0)161 275 5346
------------------------------------------------------------------------------
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of Robyn
Maude [CCDHB]
Sent: 14 June 2007 00:50
To: [log in to unmask]
Subject: intermittent auscultation
Hello Everyone
In March last year, just prior to my first PhD school, I emailed the
list to make an initial contact with those of you interested in and/or
doing or done some work around fetal moniotiring in labour
specifically intermittent auscultation. Since then I have had a really
enjoyable year engaging with the literature and have conducted an audit
of the practice of fetal monitoring in the hospital where I work. Now I
am ready to think about how I may go about designing my research around
this aspect of care.
The literature frequently points out the lack of evidence around
timing, freqency and duration of IA. Current fetal moniotirng guidelines
(RCOG/NICE, ACOG, SOGC, RANZCOG etc ) recommned IA for 'low risk' women
and have outlined the timing, frequency and duration. These are based
on protocols developed for RCT's comparing IA and EFM . Over time these
IA guidelines have become common practice without being 'tested'.
I am particularly interested in exploring whether IA guidelines
(timing, frequency and duration) are appropiate, necessary, are being
used, take into account other variables like 1 to 1 care in labour,
continuity of care, fetal movements etc
My supervisor and I have toyed with a few ideas, but I am keen to
hear your ideas as well. Some ideas are :
a.. An RCT comparing 15 min with 30 min auscultation -potentially
problematic as the numbers needed to demonstrate no difference would be
huge
b.. A survey (nationally, internationally)of current practice
around IA and what informs this practice - i.e if midwives' practice
does not reflect the current guidelines for IA (i.e 15-30 min in first
stage and 5min or after each contraction in second stage, for 1 full
minute, after a contraction, comparing with maternal pulse) then what do
they do and how do they ressure themselves and women about the baby's
well-being in labour?
c.. An international eDelphi study - the creation of international
expert midwifery opinion to inform practice around IA
d.. developing a (midwifery) model for IA and testing it
I would be grateful for any feedback or advice you could give me.
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
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