Id certainly be interested, if the trial could be designed as a complex
intervention, and contextualised with qualitative data?
all the best
s
>>> Chris McCourt <[log in to unmask]> 07/20/07 3:47 pm >>>
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]>
>Fro
m: 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 M
13 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
>> >
>> >
>> >
>> >
>> >
>> >
>> >
>> >
>> >
>> >
>> > _____
>> >
>> >
>> >
>> >
>> >
>> >
>> >
>> > This email or attachment(s) may contain confidential or legally
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>> > intended, is prohibited. If you received this email in error,
>> > please notify
>> > the sender and remove all copies of the message, including any
>> > attachments.Any views or opinions expressed in this email (unless
>> > otherwise stated) may
>> > not represent those of Capital & Coast District Health Board.
>> >
>> > <http://www.ccdhb.org.nz> http://www.ccdhb.org.nz
>> >
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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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