Hi Mary

My tupp'ence worth....

One of the interesting things for me is that the Cochrane review on continuous CTG demonstrated no benefit for women with risk factors (or their infants) yet that doesn't seem to be reflected as well as the finding of no benefit (other than reduction in neonatal seizures) for women without risk factors or regarded as low 'risk'. Of course none of the included studies or the meta analysis as a whole is adequately powered for specific clinical circumstances (such as for women with a previous caesarean section) but as Enkin et al said in the effective care 'the only justification for practices that restrict a woman's autonomy, her freedom of choice, and her access to her baby, would be clear evidence that these restrictive practices do more good than harm' and 'that any interference with the natural process of pregnancy and childbirth should also be shown to do more good than harm. ... the onus of proof rests on those who advocate any intervention that interferes with either of' these principles.'

Le gach dea-mhéin
 
Declan
 
Declan Devane
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School of Nursing and Midwifery
National University of Ireland Galway
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-----Original Message-----
From: Rachel Reed [mailto:[log in to unmask]] 
Sent: 11 January 2011 23:52
Subject: Re: A quick query

Hi Mary
I get contacted by women looking for a homebirth VBAC who have done their research and decided the risks of a hospital birth and the routine interventions associated with that setting ie. CTG, cannula, obs involvement etc. are greater than a 0.5% risk of a uterine rupture at home. They have a better chance of achieving a safe vaginal birth surrounded by people who view them as 'normal' and are not waiting for a disaster to strike. To attempt this in hospital and decline interventions requires a fight - and women in labour should not be fighting!
There is no research showing that EFM improves outcomes - only that it increases the chance of another c-section. EFM is about identifying a uterine rupture which is rare, particularly in the absence of syntocinon.
I don't know if you already have it, but here is a good evidence based resource for women considering a VBAC:
http://givingbirthwithconfidence.org/2010/10/a-womans-guide-to-vbac-putting-uterine-rupture-into-perspective/
Ultimately as others have said - she doesn't need to back her wishes up with evidence. If she is birthing in hospital she will need someone to negotiate her wishes with the staff. Perhaps this is why she contacted you? Putting in writing that she is aware of the rationale for EFM but declines and takes responsibility for that decision might help the hospital staff to support her.
Rachel




Rachel Reed
http://midwifethinking.com






On 12/01/2011, at 5:40 AM, Deborah Caine wrote:

> Hi Mary, it might be worth also putting this to an independent mw list as I am sure they deal with the situation of HBAC without continuous monitoring frequently. At the end of the day, though, if she understands the rationale for continuous monitoring and she declines how can you not go with her wishes? 
> Deborah 
> Mary Stewart writes: 
>> Hello everyone,  I have just been contacted by a woman who is 38 weeks pregnant with her third baby.  Her first babe was born by emergency C/S.  She then had a successful VBAC with her second babe, but it was quite a 'managed' labour.  She has asked to talk to me about her birth plan, as she is very keen to avoid continuous monitoring (which she had last time), and she wants to be as active as possible.  These are great choices - but I can't put my hand on any research that she can use to back up her request.  Of course, it's not essential to have any research to back up her wishes, but it always helps.  Equally, I know that there is no research which shows that EFM improves outcomes.  However, I wanted to ask all of you lovely people for any other support you can offer. A very happy new year to you all Mary
>>