I have been working my way through twentieth text books looking for developments in second stage care, and have not yet pin-pointed the beginning of the 15 minute rule for first stage; in a 1948 textbook it was suggested to listen in 'regularly' with some hosps apparently specifying 15mins, but another author (jellett) said in same yr that fh should be heard every three hours in 1st stage...!
Tania
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Chris McCourt
Sent: 20 July 2007 15:48
To: [log in to unmask]
Subject: Re: SV: intermittent auscultation
good point Hora - perhaps it's time for a few universities and maternity organisations to get a group together to develop a proposal for a trial?
Chris
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. on behalf of Soltani-Karbaschi Hora (Derby Hospitals NHS Foundation Trust)
Sent: Thu 19-Jul-07 7:05 PM
To: [log in to unmask]
Cc:
Subject: Re: SV: intermittent auscultation
Dear all
I have been quietly following this discussion from time to time and am fascinated by this question as well. Especially that I don't think the NICE recommendation on this is really based on a level A evidence.
I quite like the idea of developing a multi-centre RCT, focusing on neonatal outcomes (morbidity (e.g. APGAR, respiratory stress, etc and
mortality) (which encomapsses physiological aspects as suggested by Celine). It is true that we need a large study sample but there seems to be many people interested to encourage involvement of enough maternity units.
I am sorry if this has been already discussed, I don't use this old e-mail of mine regularely and need to update my registration with with my new contacts soon.
Hora
Dr Hora Soltani
Derby City General Hospital
Tel: 01332 785134
---- Original message ----
>Date: Sat, 14 Jul 2007 14:34:45 +0200
>From: Ans Luyben <[log in to unmask]>
>Subject: Re: SV: intermittent auscultation
>To: [log in to unmask]
>
>Hi Kathy,
>
>I really like this discussion and fits my study on "routine" antenatal
care.
>As my study aims to study its effectiveness, I would even like to argue
>stronger- that "routine" care are not effective to meet most women's
needs
>( it is only more explicit in different ethnic or deprived social
groups).
>
>I would say however, that we need to "care" during the normal passage
to
>motherhood ( this used to be a characteristic of female society), but
in a
>different way as it has been defined now ( as in "medical care"). (
Which
>might question the definition of "normal obstetrics").
>
>Maybe Soo Downe would agree with me, that "routine" is a result of the
>development of Cartesian thought... and supports the functioning of the
>"well- oiled machinery of the system". Doubtful however whether this
should
>be the focus of midwifery.
>
>best wishes,
>
>ans
>
>-----Oorspronkelijk bericht-----
>Van: A forum for discussion on midwifery and reproductive health
>research. [mailto:[log in to unmask]]Namens Kathy
>Carter-Lee
>Verzonden: Samstag, 14. Juli 2007 14:20
>Aan: [log in to unmask]
>Onderwerp: Re: SV: intermittent auscultation
>
>
>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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