It also brings into question our labelling of phases and how this channels our thinking about labour. Given the variety of labour patterns that women express, compartmentalising this process may be more about our need for certainty
Jean Patterson RM, PhD
Principal Lecturer & Postgraduate Programme Coordinator
School of Midwifery
Te kura atawhai ka Kaiakapono te Hakuitaka
Otago Polytechnic
Private Bag 1910
Dunedin 9054
0800 762 786
www.otagopolytechnic.ac.nz
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of MIDWIFERY-RESEARCH automatic digest system
Sent: Wednesday, 10 August 2011 11:02 a.m.
To: [log in to unmask]
Subject: MIDWIFERY-RESEARCH Digest - 8 Aug 2011 to 9 Aug 2011 (#2011-145)
There are 7 messages totaling 765 lines in this issue.
Topics of the day:
1. query about the use of vaginal examination in labour and/or the use of the
partogramme
2. Two research posts Mother & Infant Research Unit, University of York
3. Sevoflurane as inhaled analgesia during labour (2)
4. FW: Science, evidence, experts and the new parenting culture update: A
Policy Driven By Prejudice Masquerading As Research
5. Science, evidence, experts and the new parenting culture update: A Policy
Driven By Prejudice Masquerading As Research
6. Using MMI to select student midwives
----------------------------------------------------------------------
Date: Tue, 9 Aug 2011 11:01:40 +0100
From: Denis Walsh <[log in to unmask]>
Subject: Re: query about the use of vaginal examination in labour and/or the use of the partogramme
Couple of other things to throw into the mix. Zhang and colleagues from the USA have written three papers challenging conventions on when active phase of labour starts. In their cohorts of low risk US women, they suggest that 5 to 6 cms represents transition to active phase for many and that adapting this would reduce the incidence of C/S for dystocia in mid labour. Then the focus is on delay after this point where vaginal exam would have an assessment purpose. Prior to this it would not be clinically required unless requested and some midwifery-led units in the UK tend not to do VE's in the latent phase, though of course this opens up the related 'can of worms' around how to care for women with long latent phases.
Best wishes,
Denis
Dr Denis Walsh
Associate Professor in Midwifery
Academic Division of Midwifery
University of Nottingham
East Block
Queens Medical Centre
Derby Rd
Nottingham NG7 2UH
United Kingdom
Tel: +44(0)115 8230987
Mobile: 07905735777
Email: [log in to unmask]
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Scamell, Amanda
Sent: 08 August 2011 16:17
To: [log in to unmask]
Subject: Re: query about the use of vaginal examination in labour and/or the use of the partogramme
Hi everyone/Soo,
This is a fascinating thread thank you.
I recently noticed (when searching google images for representations of a partograms) that some partograms/partographs measure 'active labour' from 8cm onwards - that is, the progress line and action line only start at this point in the labour. I have never come across this, what I as a English midwife would classify as an extended 'latent labour', in the UK but suspect that such a classification of the stages of labour would have a powerful impact, not only on how VEs can and are recorded but also on when and how frequently they would be legitimately carried out.
I don't know where the 8cm latent phase comes from or where it is practiced unfortunately but I would be interested to find out!
As far as observations from clinical practice goes, my research data suggests that a VE operates as a precursor for the partogram as well as, as you suggest, the other way round. The process of recording the findings of a VE functioned as a kind of boundary symbol used by practitioners to justify the commencement of 'labour care' practices, which included the use of the partogram. In many circumstances this examination procedure, this symbolic boundary, appeared to be used to usurp the embodied experiences of the mother, particularly with primips, and therefore was applied for two quite distinct purposes - the first, mentioned above, was the intensification of care but equally it was also used as a mechanism for the withdrawal of midwifery care and support e.g. sending a mother home because 'she was not in labour' or refusing her access to hydro therapy or other pharmaceutical forms of pain relief (interestingly with the exception of opiates in some cases)
I did also observe midwives avoid performing the labour diagnosis VE with the principle objective of postponing the commencement of the partogram. The justification for such a 'delay' was to provide individualised care where the mother could labour spontaneously at her own personal pace.
Warm wishes
Mandie Scamell
________________________________________
From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of Jans, S.M.P.J. [[log in to unmask]]
Sent: 02 August 2011 13:49
To: [log in to unmask]
Subject: Re: query about the use of vaginal examination in labour and/or the use of the partogramme
Dear Soo,
Very interesting discussion! (as is evident from the reactions that your
query generated).
In addition to the comments of my colleagues Trudy and Ank, I would like
to add the following:
In 2006 the Dutch midwives organisation published the guideline "Failure
to progress in second stage of labour". The introduction of the
partogram was part of this guideline and as Ank said the VE is part of
this. The Dutch partogram contains an action line.
Before publication of the guideline very few Dutch midwives used or were
familiar with the partogram.
Officially midwives can only deviate from national guidance with good
(supported) arguments which means that the use of the patrogram is
currently official midwifery policy in the Netherlands.
Unfortunately all the material is in Dutch but it is freely available
through the website of the Dutch midwives organisation, KNOV.
The extended version of the guideline contains all the literature used
(see page 273.
I am giving you the links below:
The partogram:
http://www.knov.nl/docs/uploads/KNOV_standaard_NVO_praktijkaart_partogra
m_2008.pdf
and the extended version of the guideline with refs on page 273:
http://www.knov.nl/docs/uploads/standaard_NVO_wetenschappelijke_versie.p
df
The authors are contactable through the KNOV. I am sure they are happy
to talk to you should you wish to do so.
Best wishes
Suze Jans
Suze Jans RM, MSc.
Researcher,
Community Genetics
EMGO Instituut voor onderzoek naar gezondheid en zorg
VU medisch centrum | BS7, D428
Postbus 7057 | 1007 MB Amsterdam
T 020-4446446
E [log in to unmask]
-----Oorspronkelijk bericht-----
Van: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] Namens Klomp, Trudy
Verzonden: dinsdag 2 augustus 2011 11:27
Aan: [log in to unmask]
Onderwerp: Re: query about the use of vaginal examination in labour
and/or the use of the partogramme
Dear sue,
In the Netherlands an VE is often used without a Partogramme, to measure
progress in labour. Most of the primary care midwives use a partogramm
only with nulliparous and only when they are in active labour. In the
learning environmont of students however, we advice to use a partogramm
in every labour.
When a partogram is used, all the elements included are usually used on
whether to intervene including the capacity/ability of the women
herself.
With best wishes,
Trudy Klomp
Verloskunde Academie Amsterdam
Louwesweg 6, 1066EC Amsterdam
T0031-20-5124231
[log in to unmask]
________________________________________
Van: A forum for discussion on midwifery and reproductive health
research. [[log in to unmask]] namens Soo Downe
[[log in to unmask]]
Verzonden: dinsdag 2 augustus 2011 9:34
Aan: [log in to unmask]
Onderwerp: query about the use of vaginal examination in labour and/or
the use of the partogramme
Dear all
We are completing a protocol for a review on the value of the vaginal
examination as a measure of progress in labour. We have been advised
that the VE is never used without the partogramme (and without attention
to all the elements on the partogramme). From our clinical experience,
we are not sure that this is the case - we have practical experience of
the VE being used as a measure of progress in labour without reference
to the partogramme (even where it is part of the routine recording
process) but our experience may well be very limited. We would be very
interested in your experience in the following areas:
1. In your experience, is vaginal examination ever used on its own,
without using a partogramme?
2. Where the partogramme is used as a record, are all the elements of it
usually used in a decision on whether to intervene?
Many thanks for your advice
All the best
Soo
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------------------------------
Date: Tue, 9 Aug 2011 12:58:20 +0100
From: Jo Green <[log in to unmask]>
Subject: Two research posts Mother & Infant Research Unit, University of York
[Message contains invalid MIME fields or encoding and could not be processed]
------------------------------
Date: Tue, 9 Aug 2011 14:36:26 +0100
From: Trudy Klomp <[log in to unmask]>
Subject: Sevoflurane as inhaled analgesia during labour
Dear collegues,
I'm doing a systematic review for inhaled analgesia for pain management in labour. We found a rct from Yeo (2007) about the use of Sevoflurane as analgesic agent during labour. There's some controversy about this agent because there should not be any analgesic activity at subanesthetic concentrations. Before we decide to include this paper (and maybe others about Sevoflurane) we would like to know if it is still used.
1. Is anybody still using Sevoflurane as analgesic agent for inhaled pain managment during labour? Or perhaps you know other settings where they still use it?
2. What kind of inhaled analgesia (agent, concentration, during which part of labour and how administered) do you use in your own setting or do you know settings in your neighbourhood where they use it?
I would be very gratefull if you could help me with these questions.
With kind regards,
Trudy Klomp, Msc
lecturer Midwifery/researcher
Departement of Midwifery Science, AVAG and EMGO Institute for Health Care Research, VU University Medical Center
Amsterdam, the Netherlands
[log in to unmask]
+31-622 42 95 02
------------------------------
Date: Tue, 9 Aug 2011 14:55:43 +0100
From: "Scamell, Amanda" <[log in to unmask]>
Subject: FW: Science, evidence, experts and the new parenting culture update: A Policy Driven By Prejudice Masquerading As Research
The forwarded email below represents a body of academic activity within the social sciences which is rarely engaged with within midwifery debate and offers a fascinating and challenging perspective on some of the ideological assumptions which currently underpin contemporary parenting policy and practice in the UK and elsewhere.
Mandie Scamell
________________________________________
From: Ellie Lee [[log in to unmask]]
Sent: 09 August 2011 08:21
Subject: Science, evidence, experts and the new parenting culture update: A Policy Driven By Prejudice Masquerading As Research
Welcome to the latest Centre for Parenting Culture Studies (CPCS) newsletter. This goes to those who have attended events organised by CPCS, and others who have expressed an interest in the work of the Centre. If for any reason you do not want to receive future mailings, let me know.
Ellie Lee, Director CPCS [log in to unmask]<mailto:[log in to unmask]>
Parenting Culture Studies on-line: The Centre for Parenting Culture Studies blog is online at: http://blogs.kent.ac.uk/parentingculturestudies/
-----------------------------------------------------------------------------
1. Monitoring parents: Science, evidence, experts and the new parenting culture
British colleagues may have noticed (and those in other countries may be interested in) the latest demand that parents ‘follow the rules’ when it comes to child rearing.
‘Parenting Matters: early years and social mobility’ was published last week by the think-tank Centre Forum, and its arguments welcomed by Sarah Teather, the Minister of State for Children and Families. (See http://www.centreforum.org/assets/pubs/parenting-matters.pdf )
The report repeats the assertion that, ‘the single most important factor influencing a child’s intellectual and social development is the quality of parenting and care they receive’. Parenting, we are told, is problematically ‘largely viewed as an intensely private matter’, but ‘key scientific concepts behind the development of early brain architecture’ tell us it should not be viewed this way. The case is made that increasing ‘social mobility’ in particular means that parenting must viewed as a central policy problem.
To this end, the family is termed the ‘Home Learning Environment’ throughout the report. It is argued that policy has been too focussed on ‘enabling parents to spend more time with their children’ and not enough attention has been paid to influencing ‘what parents are doing with this time’, to create the right sort of ‘Home Learning Environment’. It is argued that a ‘culture shift’ is needed, and a ‘national parenting campaign’ can help make this happen.
To change how parents spend time with their children the report proposes specifically a ‘5-a-day for child development’ campaign, modelled on the 5-a-day fruit and vegetables campaign. This campaign, apparently, ‘drawing directly on the science of early child development’ would tell parents to: Read to your child for 15 minutes; play with your child on the floor for 10 minutes; Talk with your child for 20 minutes with the television off; Adopt positive attitudes towards your child and praise them frequently; and Give your child a nutritious diet to aid development.
Read a commentary on the report here:
‘They **** you up, Your Parenting Classes’
http://www.spiked-online.com/index.php/site/article/10968/
The upcoming CPCS event Monitoring parents: Science, evidence, experts and the new parenting culture provides the opportunity to analyse and discuss this concerted drive to politicise parenting, and the claims-making about ‘brain architecture’ that justifiy it. Papers will also consider many other related themes, with contributions by colleagues from Canada, the US, Ireland, Norway, Sweden, the Netherlands, Denmark, Belgium Spain, Italy, Australia, as well as England, Wales and Scotland.
The final programme is here:
http://blogs.kent.ac.uk/parentingculturestudies/files/2011/08/Monitoring-Parents-Final-Programme.pdf
Abstracts and other information are here:
http://blogs.kent.ac.uk/parentingculturestudies/pcs-events/forthcoming-events/parenting-science/
On the ‘Read on’ pages for the event you can find a new commentary by Dr Ellie Lee ‘A Policy Driven By Prejudice Masquerading As Research’ as well as articles and other items by/about keynote speakers:
http://blogs.kent.ac.uk/parentingculturestudies/pcs-events/forthcoming-events/parenting-science/read-on/
Registration for the event costs:
Waged (2 days) £85; Waged (1 day) £45; Unwaged / student (1 or 2 days) £35
A booking form is here:
<http://blogs.kent.ac.uk/pare>http://blogs.kent.ac.uk/pare<http://blogs.kent.ac.uk/parentingculturestudies/files/2011/01/Booking-Form.pdf>ntingculturestudies/files/2011/01/Booking-Form.pdf
There are 15 places left and the final date for registration is Friday 2 September
2. Read on…..
‘Daring to criticise child protection policies’, by Heather Piper
http://www.spiked-online.com/index.php/site/article/10969/
‘The 'Foundation Years': For a New Generation of Mini-Camerons?’ by Jennie Bristow
http://www.huffingtonpost.co.uk/jennie-bristow/the-foundation-years-for-_b_902326.html
------------------------------
Date: Tue, 9 Aug 2011 15:03:37 +0100
From: Lorraine Wall-Jones <[log in to unmask]>
Subject: Re: Sevoflurane as inhaled analgesia during labour
Dear Trudy,
I qualified in 1985, during which I have vague recollection of using inhalation analgesia that involved equipment that you set up by the bed, which normally be used in general anaesthesia. I cannot remember the specifics now.
I am very much an advocate of 'Entonox' a mixture of Nitrous Oxide 50% to Oxygen 50%. Widely used in the UK.
http://www.entonox.co.uk/en/index.shtml
Regards,
Lorraine
________________________________
From: Trudy Klomp <[log in to unmask]>
To: [log in to unmask]
Sent: Tuesday, 9 August 2011, 14:36
Subject: Sevoflurane as inhaled analgesia during labour
Dear collegues,
I'm doing a systematic review for inhaled analgesia for pain management in labour. We found a rct from Yeo (2007) about the use of Sevoflurane as analgesic agent during labour. There's some controversy about this agent because there should not be any analgesic activity at subanesthetic concentrations. Before we decide to include this paper (and maybe others about Sevoflurane) we would like to know if it is still used.
1. Is anybody still using Sevoflurane as analgesic agent for inhaled pain managment during labour? Or perhaps you know other settings where they still use it?
2. What kind of inhaled analgesia (agent, concentration, during which part of labour and how administered) do you use in your own setting or do you know settings in your neighbourhood where they use it?
I would be very gratefull if you could help me with these questions.
With kind regards,
Trudy Klomp, Msc
lecturer Midwifery/researcher
Departement of Midwifery Science, AVAG and EMGO Institute for Health Care Research, VU University Medical Center
Amsterdam, the Netherlands
[log in to unmask]
+31-622
------------------------------
Date: Tue, 9 Aug 2011 16:46:21 +0100
From: Octavia Wiseman <[log in to unmask]>
Subject: Re: Science, evidence, experts and the new parenting culture update: A Policy Driven By Prejudice Masquerading As Research
I signed up to go to this conference a few weeks ago. Looks even more
interesting now. Thank you for this.
X Octavia
-----Original Message-----
From: Scamell, Amanda
Sent: Tuesday, August 09, 2011 2:55 PM
To: [log in to unmask]
Subject: FW: Science, evidence, experts and the new parenting culture
update: A Policy Driven By Prejudice Masquerading As Research
The forwarded email below represents a body of academic activity within the
social sciences which is rarely engaged with within midwifery debate and
offers a fascinating and challenging perspective on some of the ideological
assumptions which currently underpin contemporary parenting policy and
practice in the UK and elsewhere.
Mandie Scamell
________________________________________
From: Ellie Lee [[log in to unmask]]
Sent: 09 August 2011 08:21
Subject: Science, evidence, experts and the new parenting culture update: A
Policy Driven By Prejudice Masquerading As Research
Welcome to the latest Centre for Parenting Culture Studies (CPCS)
newsletter. This goes to those who have attended events organised by CPCS,
and others who have expressed an interest in the work of the Centre. If for
any reason you do not want to receive future mailings, let me know.
Ellie Lee, Director CPCS [log in to unmask]<mailto:[log in to unmask]>
Parenting Culture Studies on-line: The Centre for Parenting Culture Studies
blog is online at: http://blogs.kent.ac.uk/parentingculturestudies/
-----------------------------------------------------------------------------
1. Monitoring parents: Science, evidence, experts and the new parenting
culture
British colleagues may have noticed (and those in other countries may be
interested in) the latest demand that parents ‘follow the rules’ when it
comes to child rearing.
‘Parenting Matters: early years and social mobility’ was published last week
by the think-tank Centre Forum, and its arguments welcomed by Sarah Teather,
the Minister of State for Children and Families. (See
http://www.centreforum.org/assets/pubs/parenting-matters.pdf )
The report repeats the assertion that, ‘the single most important factor
influencing a child’s intellectual and social development is the quality of
parenting and care they receive’. Parenting, we are told, is problematically
‘largely viewed as an intensely private matter’, but ‘key scientific
concepts behind the development of early brain architecture’ tell us it
should not be viewed this way. The case is made that increasing ‘social
mobility’ in particular means that parenting must viewed as a central policy
problem.
To this end, the family is termed the ‘Home Learning Environment’ throughout
the report. It is argued that policy has been too focussed on ‘enabling
parents to spend more time with their children’ and not enough attention has
been paid to influencing ‘what parents are doing with this time’, to create
the right sort of ‘Home Learning Environment’. It is argued that a ‘culture
shift’ is needed, and a ‘national parenting campaign’ can help make this
happen.
To change how parents spend time with their children the report proposes
specifically a ‘5-a-day for child development’ campaign, modelled on the
5-a-day fruit and vegetables campaign. This campaign, apparently, ‘drawing
directly on the science of early child development’ would tell parents to:
Read to your child for 15 minutes; play with your child on the floor for 10
minutes; Talk with your child for 20 minutes with the television off; Adopt
positive attitudes towards your child and praise them frequently; and Give
your child a nutritious diet to aid development.
Read a commentary on the report here:
‘They **** you up, Your Parenting Classes’
http://www.spiked-online.com/index.php/site/article/10968/
The upcoming CPCS event Monitoring parents: Science, evidence, experts and
the new parenting culture provides the opportunity to analyse and discuss
this concerted drive to politicise parenting, and the claims-making about
‘brain architecture’ that justifiy it. Papers will also consider many other
related themes, with contributions by colleagues from Canada, the US,
Ireland, Norway, Sweden, the Netherlands, Denmark, Belgium Spain, Italy,
Australia, as well as England, Wales and Scotland.
The final programme is here:
http://blogs.kent.ac.uk/parentingculturestudies/files/2011/08/Monitoring-Parents-Final-Programme.pdf
Abstracts and other information are here:
http://blogs.kent.ac.uk/parentingculturestudies/pcs-events/forthcoming-events/parenting-science/
On the ‘Read on’ pages for the event you can find a new commentary by Dr
Ellie Lee ‘A Policy Driven By Prejudice Masquerading As Research’ as well as
articles and other items by/about keynote speakers:
http://blogs.kent.ac.uk/parentingculturestudies/pcs-events/forthcoming-events/parenting-science/read-on/
Registration for the event costs:
Waged (2 days) £85; Waged (1 day) £45; Unwaged / student (1 or 2 days) £35
A booking form is here:
<http://blogs.kent.ac.uk/pare>http://blogs.kent.ac.uk/pare<http://blogs.kent.ac.uk/parentingculturestudies/files/2011/01/Booking-Form.pdf>ntingculturestudies/files/2011/01/Booking-Form.pdf
There are 15 places left and the final date for registration is Friday 2
September
2. Read on…..
‘Daring to criticise child protection policies’, by Heather Piper
http://www.spiked-online.com/index.php/site/article/10969/
‘The 'Foundation Years': For a New Generation of Mini-Camerons?’ by Jennie
Bristow
http://www.huffingtonpost.co.uk/jennie-bristow/the-foundation-years-for-_b_902326.html
------------------------------
Date: Tue, 9 Aug 2011 17:48:04 +0100
From: "Sheridan, Valerie M" <[log in to unmask]>
Subject: Re: Using MMI to select student midwives
We have piloted the MMI in our midwifery school and are adopting it in the coming academic year.
Valerie
Valerie Sheridan
School of Midwifery & Child Health
Kingston University & St George's University of London
________________________________________
From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of McNiven, Patricia [[log in to unmask]]
Sent: 01 August 2011 23:25
To: [log in to unmask]
Subject: Re: Using MMI to select student midwives
We use the MMI at Midwifery Education Program at McMaster University in Hamilton, Canada. It seems to work very well. Other health programs like Medicine and physiotherapy have used it for a while and we drew from their experience. Some of my colleagues are more knowledgeable and I can connect you with them if you like.
Patty
Patricia McNiven RM, BSc, MSc, PhD
Associate Professor, McMaster University
Midwifery Education Program
905 525 9140 x 26654
[log in to unmask]
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Annabel Jay
Sent: August-01-11 11:20 AM
To: [log in to unmask]
Subject: Using MMI to select student midwives
Dear Everyone,
Following my recent enquiry about selection procedures for student midwives, I have had some very interesting and informative correspondence with several people about the use of MMI (multiple mini interviews) as a method of selecting candidates for pre-registration midwifery programmes.
At the University of Hertfordshire we are considering using an adapted form of MMI and wonder if anyone else who may have missed my recent thread has any experience of using this in their institution? If so, I would love to hear about it,
Kind Regards,
Annabel Jay
Admissions tutor/Senior lecturer
University of Hertfordshire
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