Hi All
I have been collating all the responses I had to my original email about my PhD research project on intermittent auscultation. Thankyou to everyone who has sent resonses. Many midwives on this list have mentioned how much they enjoying the debate and the resonses demonstarte that there is a fair bit of passion about the topic.
The main discussions have been around:The evidence and guidelines and where the timings came from; One to one care and individualised care of women and babies; Defensive practice; Supporting normal physiology, undisturbed labour.
My particular interest is in the timing, frequency and duration of IA so all of these discussions willcontribute to the investigation. It was great to see that a collegue from the UK is undertaking PhD studies on IA as well ("Identification of the best practice of auscultation of the fetal heart") so maybe we will come up with some good stuff between us.
Cheers, Robyn
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Julie Harrison
Sent: Sunday, 08 July 2007 8:00 a.m.
To: [log in to unmask]
Subject: Re: SV: intermittent auscultation
Regarding counting strategies you might like to look at the following references which outline the principles and give some evaluation.
Steer PJ Beard RW (1970) A continuous record of fetal heart rate obtained by serial counts. The Journal of Obstetrics and Gynaecology of the British Commonwealth (77): 908-914.
Schifrin BS Amsel J Burdorf G. (1992) The accuracy of auscultatory detection of fetal cardiac decelerations: A computer simulation, American Journal of Obstetrics and Gynecology. (166): 566-76.
Best wishes
Julie Harrison
Senior Lecturer (Midwifery and Womens Health) Faculty of Health and Social Care Sciences Kingston University and St George's University of London.
----- Original Message -----
From: Beatrice Hogg <[log in to unmask]>
Date: Friday, July 6, 2007 1:48 pm
Subject: SV: intermittent auscultation
To: [log in to unmask]
> I have been working as a midwife in Stockholm, Sweden, and we were
> taught to listen every 15 minutes after a contrction and at least for
> 15 seconds x 4 to count out the frequency. Sometimes we listened for a
> minute if we were unsure of the FHR.
>
> Beatrice Hogg
>
>
>
> _____
>
> Från: A forum for discussion on midwifery and reproductive health
> research.[mailto:[log in to unmask]] För Ellen Blix
> Skickat: den 14 juni 2007 11:02
> Till: [log in to unmask]
> Ämne: Re: intermittent auscultation
>
>
>
> 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
> auscultationsevery 15 min if you do not have one-to-one care?
>
>
>
> Ellen
>
> ----- Original Message -----
>
> From: Ann <mailto:[log in to unmask]> 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 camefrom. 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
> specificallyintermittent 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 protocolsdeveloped 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 :
>
> * An RCT comparing 15 min with 30 min auscultation -potentially
> problematic as the numbers needed to demonstrate no difference
> would be
> huge
> * 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?
> * An international eDelphi study - the creation of international
> expert midwifery opinion to inform practice around IA
> * 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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