Hi Elaine,
If you are interested in decision making processes, my own work on third stage practices may be of interest to you. I conducted a grounded theory study to explore practice variation in the third stage of labour among midwives. The study revealed significant inter and intra practice variation in third stage care which was represented by a practice continuum where care ranged from completely interventionist at one end of the continuum to completely non interventionist at the other. A midwife's practice could sit at any point along this continuum with a mid point being identified as flexible practice.
An explanation for practice variation was linked to multiple factors influencing a midwife's decision making during care situations and this was called The theory of Contingent Decision Making. Practice variation was explained by reference to variation in the learning midwives were exposed to during and after training, variation in the context in which midwives practiced and variation in individual midwives values and beliefs.
Please feel free to contact me on [log in to unmask] if you would like further information.
Regards
Tina Harris
________________________________
From: A forum for discussion on midwifery and reproductive health research. on behalf of Robyn Maude [CCDHB]
Sent: Mon 21/01/2008 22:17
To: [log in to unmask]
Subject: Re: Feeling for cord at birth.
Hi Elaine,
I wondered when you would pop in to the discussion!!!
cheers, Robyn
________________________________
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Jefford, Elaine
Sent: Tuesday, 22 January 2008 11:09 a.m.
To: [log in to unmask]
Subject: Re: Feeling for cord at birth.
Hi
I am very interested in the direction that this conversation has taken - feeling for the nuchal cord - as this is my PhD topic.
I have explored the historical aspect of this practice and presented some of my findings at the Australian College of Midwives national conference in September 2007. I am now in the process of having this work reviewed with the hope of having it published in Women and Birth. It will also be presented at the ICM conference in Glasgow (2008) under the title: Reviewing the history of how feeling for the nuchal cord came in to fashion and some of its implication to women centred midwifery care today.
My main focus is linked around the processes midwives take in making the decision to feel of not to feel rather than the implications/actions of finding a nuchal cord such as clamping and cutting as this aspect has work is/has been undertaken by Judith Mercer. Soo Downe and her team have also published a paper related to this topic.
Regards
Elaine
Elaine Jefford
Senior Officer
Clinical Governance Section
ACT Health
Level 2 11 Moore St
ACT 2601
62051084
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]]On Behalf Of Amanda Hutcherson
Sent: Tuesday, 22 January 2008 8:32 AM
To: [log in to unmask]
Subject: Re: Feeling for cord at birth.
I think I might try it with my mandatory training groups.
________________________________
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Amanda Hutcherson
Sent: 21 January 2008 21:21
To: [log in to unmask]
Subject: Re: Feeling for cord at birth.
An interesting snapshot study to do, Amanda
________________________________
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Carolyn McIntosh
Sent: 21 January 2008 20:03
To: [log in to unmask]
Subject: Feeling for cord at birth.
I was taught to feel for cord and always did this. I started to question the practice when I attended a seminar with Yehudi Gordon, Janet Blalaskas and Sheila Kitzinger here in New Zealand in 1990. Yehudi said that he no longer did this and that babies, even if they have cord around the neck will be born anyway without problems. If the cord is tight and causing problems for the baby then there will be delay with the second stage, fetal distress etc that would already have alerted the practitioner to a problem. I decided to trial this in my own practice and have never gone back to routine feeling for the cord. I believe that many midwives in New Zealand do still do this though. Has any data been gathered on this? Is there any evidence to support feeling or not feeling for the cord?
Carolyn McIntosh
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Susanne Houd
Sent: Tuesday, 22 January 2008 6:40 a.m.
To: [log in to unmask]
Subject: Svar: Vedr.: Re: water birth
Dear jette, It has been part of midwifery training - at least when i became a midwife and I still do it - ok I became a midwife 40 years ago.
greetings from Greenland
Susanne
>>> Jette Aaroe Clausen <[log in to unmask]> 01/21/08 12:17 >>>
Thought you might like to know, that the idea that a midwife should fell for the umbillical cord around the babies neek before it is born, has newer been part of Danish midwifery training/curriculum (at least I have never encountered traces of such a practice). I still remember how surprised I was, when I heard about this practice the first time.
Of course it could happen, that a Danish midwife will do such a maneuvre in a special situation, but it is not part of routine practice.
Robyns mail make me wounder. she writes that she was thought this practice during the early seventies. Has this practice gone into the history books or is it still thought somewhere ?
All the best
Jette
Jette Aaroe Clausen
Jordemoderlærer / Midwifery Lecturer
MHH (Master in Health Humanities)
CVU Øresund
Jordemoderuddannelsen/ Faculty of Midwifery
Haraldsade &
2200 København N/ Copenhagen
Denmark
Telephone + 45 8942 9209
Hjemmetelefon + 45 8678 2327
e-mail: [log in to unmask]
Venlig hilsen
Jette Aaroe Clausen
Jordemoderlærer / Midwifery Lecturer
MHH (Master in Health Humanities)
CVU Øresund
Jordemoderuddannelsen/ Faculty of Midwifery
Sigurdsgade 24
2200 København N
Telefon + 45 3531 0511/ + 45 3531 0500
Hjemmetelefon + 45 8678 2327
e-mail: [log in to unmask]
"Robyn Maude [CCDHB]" <[log in to unmask]>
Sendt af: "A forum for discussion on midwifery and reproductive health research." <[log in to unmask]>
20-01-2008 23:39
Besvar venligst til
"A forum for discussion on midwifery and reproductive health research." <[log in to unmask]>
Til
[log in to unmask]
cc
Emne
Re: water birth
My story is similar to Carolyn's. At first I had my hands down there all
the time - to feel the emerging head, not the perineum. This was more
because of the way in which I taught how to 'deliver' a baby in the
early 70's than for any other reason and because of that old notion that
one had to feel for the nuchal cord and pull it over the
head.(incidentally, I do not even do this for land births now).
My practice around waterbirth has changed enormously, both as a result
of simply being with women and watching how they birth in water and from
the work I did for my master's thesis. I rarely get my hands wet now;
most of the women I care for let the baby out by themselves, by
instinctively putting their hand over the emerging head to let it out
gently, then bring the baby to the surface (I am always amazed at the
ease with which babies unravel themselves from their cords when they
need to in the water). At a recent home birth (3rd baby, 3rd waterbirth)
the woman did her own VE to check for full dilataion ["I don't know
where I am at" - "why don't you have feel?" "Oh! The baby's right
there"], she proceeded to catch the baby and bring it to the surface,
then 20 minutes later birthed her placenta and placed it in a dish she
had ready.
With regard to the perineum; most of the women I have had who birthed in
water have had no perineal damage or smallish tears. Never a 3rd degree.
I think this is because the water warms and supports the perienum and
allows the head to move down without the women necessarily getting the
strong expulsive pushing urge that can lead to tears of the genital
tract. Many women have been surprised at how close they are to birthing
the baby when they put their hand down to feel. So I think the water is
protective. We do not need to be interfering at all. But it takes
courage initially to change the practices that were drummed into us and
to learn to trust women and the birth process.
Robyn Maude
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of
Carolyn McIntosh
Sent: Sunday, 20 January 2008 10:01 p.m.
To: [log in to unmask]
Subject: Re: water birth
A couple of colleagues of mine did postgraduate papers on water birth. I
do not have the research they used but I do know that there were several
stimulants for the baby to breathe after birth. One is being born into
air, another is cooling of the skin and another is tactile stimulation
particularly around the face. Yes, babies' faces are obviously
stimulated as they pass through the birth passages but the chest is
compressed at that time and unless they have some foetal distress they
are not otherwise being stimulated to breathe.
When I first started supporting women to have waterbirth I would have my
hands down there to catch the baby. In later times I have been an
observant watcher, ready to act but not 'in there'. One of the beauties
of waterbirth to me is that the baby's body is supported as it is born.
It floats into the world ready to be brought to the surface by the
mother. This is not the case with an air birth and the baby needs to be
caught is some way. I have never had a 3rd degree tear in water and very
few in air.
I believe if hands are on for the birth then you have to be very sure
you know exactly how the baby is presenting at that particular time. If
you are supporting the baby as it is born you need to be sure you are
not actually making the presenting part larger than it needs to be. I
have witnessed some serious manoeuvres involving stretching of the
perineum etc by midwives in the past this has never been part of my
practice.
Regards
Carolyn McIntosh
Midwife and midwifery lecturer
Otago Polytechnic
New Zealand.
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of Rachel
Reed
Sent: Sunday, 20 January 2008 6:25 p.m.
To: [log in to unmask]
Subject: Re: water birth
I have just completed a literature review as part of my PhD. I thought
I'd summarise the findings re.
hands on and hands off. If anyone would like the refs or more detail let
me know.
There is no evidence that hands on reduces perineal tearing. There is
some evidence to associate hands on techniques with 3rd degree tears.
Most risk factors for perineal tearing are fixed and cannot be
controlled by the mw ie. size of baby, ethnicity, etc.
One of the benefits of a waterbirth is that the mw can't get in and
fiddle with the emerging baby.
There is evidence that when women are left to follow their own urges
they birth in the best way for themselves and their babies (and protect
their own perineum).
We need to stop blaming ourselves and colleagues for 3rd degree tears
and start trusting in the physiological process of birth.
Rachel
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