Celine,
As I am currently working as an independent midwife I find the obstetrician's comment interesting - that
in 'normal obstetrics we should have no routine care'. A few quick thoughts -
Even if you take an epidemiological approach, you have a number of women with a range of values for
different indicators. You have the majority of women who are NOT on the mean value....very few in fact
fit the 'average woman' category. If routine care is, as I believe, created to deal with the 'average
woman', then it still does not adequately deal with the majority of women.
From a more sociological point of view, any routine care is, for the same reason, not going to cover the
needs of smaller groups of women representing unusual ethnic or cultural groups.
Thanks for listening!
Kathy Carter-Lee
Independent Midwife
NZ
Date sent: Mon, 9 Jul 2007 21:49:10 -0400
Send reply to: "A forum for discussion on midwifery and reproductive health research."
<[log in to unmask]>
From: Céline Lemay <[log in to unmask]>
Subject: Re: SV: intermittent auscultation
To: [log in to unmask]
> Thanks for that remark Denis. We do the same in our birthing center.
>
> The question to ask is: when we are in a physiological situation, is it
> normal "before" we check the mother or the baby, or do we consider that it
> is normal just "after"?
>
> The chief obstetrician of the collaborative hospital of our birthing center
> said once that in normal obstetric, we should have no routine care!
>
> What midwives are thinking about that?
> easy to say, not easy to put in practice.
>
> Céline
>
>
>
> ----- Original Message -----
> From: "Denis Walsh" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, July 09, 2007 2:33 PM
> Subject: Re: SV: intermittent auscultation
>
>
> Out of interest, I know at least one birth centre that does not take the
> temperature of babies at birth because of the assumption of normative
> physiology. The practice of taking the baby's temp at birth is routine in UK
> hospitals.
> Denis Walsh
> Reader in Normal Birth
> University of Central Lancashire
> Independent Midwifery Consultant
> Home address:
> 366 Hinckley Rd
> Leicester LE3 0TN
> Mobile: 07905735777
>
> -----Original Message-----
> From: A forum for discussion on midwifery and reproductive health research.
> [mailto:[log in to unmask]] On Behalf Of Céline Lemay
> Sent: 09 July 2007 12:25
> To: [log in to unmask]
> Subject: Re: SV: intermittent auscultation
>
> Robyn,
>
> I think that the dynamic of "surveillance" is logic in a condition of high
> risk or pathology. Surveillance is derived from a deep cultural ( and a
> scientific construction) doubt about qualification of the female body to
> take care of the unborn.
> In this context, we need to do surveillance but if we are in a perspective
> of physiology, the baby is OK before we check anything.
> Does physiology need surveillance? I think that physiology need vigilance.
> The question is about putting vigilance in action. What is midwifery
> practice in a perspective of physiology and vigilance?
> How do we deal with uncertainty in a perspective of physiology and
> vigilance?
>
> all the best,
> Céline
>
>
>
>
>
> ----- Original Message -----
> From: "Robyn Maude [CCDHB]" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Sunday, July 08, 2007 7:44 PM
> Subject: Re: SV: intermittent auscultation
>
>
> Celine
> This is what I am hoping to do in my investigation. I am coming at it from
> the perspective of normal physiology i.e. how do we (women and midwives)
> reassure ourselves that the baby is OK. In the context of 'fetal
> surveillance' (this is term I am delving into as well!!!)What are the
> factors/practices that support physiological birth?
>
> Cheers, Robyn
>
> -----Original Message-----
> From: A forum for discussion on midwifery and reproductive health research.
> [mailto:[log in to unmask]] On Behalf Of Céline Lemay
> Sent: Monday, 09 July 2007 3:58 a.m.
> To: [log in to unmask]
> Subject: Re: SV: intermittent auscultation
>
> I think that it is a fundamental question.
> Even the expression "intermittent auscultation" is coming from the "norm" of
>
> continous auscultation, which is derived from a medical perspective of the
> potential pathology.
> Can we do a research with the premiss of physiology?
> How can we formulate a question to study foetal monitoring from the A PRIORI
>
> of physiology? Physiology as THE norm and not the tolerable extension of
> pathology.
>
> Céline Lemay, PhD
> sage-femme, Québec
>
> ----- Original Message -----
> From: "Jenny Cameron" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, July 07, 2007 10:02 PM
> Subject: Re: SV: intermittent auscultation
>
>
> If the woman is experiencing a healthy pregnancy & labour, (i.e. with
> adequate rest time between contractions, and no hypertension), what is the
> rationale for 15 minutely ausculation?
>
> Jenny
> Jennifer Cameron FRCNA FACM
> President NT branch ACMI
> PO Box 1465
> Howard Springs NT 0835
> 08 8983 1926
> 0419 528 717
>
>
> ----- Original Message -----
> From: "Julie Harrison" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Sunday, July 08, 2007 5:30 AM
> 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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==============================
Kathy Carter-Lee
Midwife
Mobile: 021 425 115
Home: 09 425 6749
Warkworth Birthing Centre: 09 425 8201
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