It is interesting to me here in this conversation the 'language' that is used of 'failed induction'. Two thoughts come to mind: one is that if our methods of trying to start labour isn't working then it is likely the woman's body is not ready to give birth and the baby is not ready to come. That smacks to me of an incorrect measurement of 'dates'. Are we trying to 'mess around' with the process of birth too soon? Secondly the issue of 'failure' is interesting in that induction is a process of intervention. Once you start on intervention you cannot go back from it - Sally inch wrote about this years ago- therefore once you have started the interfering it is not going to reverse but will have made a difference- our plans for this may be a 'failure' but it will have affected the woman so not a 'failure' as such... Sticking 'failed' induction on her notes just adds to the negativity around this.
Just a thought
Sent from my iPhone
On 19 Oct 2016, at 04:13, Trish Ross <[log in to unmask]<mailto:[log in to unmask]>> wrote:
There is another article (which I don’t have at hand), describing the most effective ways to do the induction. The method does include using prostaglandins to ripen the cervix.
ALSO is a class in emergency care, which often doesn’t allow for time for cervical ripening.
It was interesting to see how the instructors balanced all these issues in care. Some of the doctors present kept saying they’d “bring out the knife” and go straight to surgery. The younger doctors, the female doctors, and the midwives were much more focused on helping a woman’s body back to normal. I was really glad that this class emphasized avoiding a “first C-section.”
I was really glad that the American College of OB/Gyn finally acknowledged the studies showing that Friedman’s curve is inappropriate and leads to too much surgery. Setting a dilation of 6 cm as the official start of active labor, and allowing at least an hour per centimeter dilation after that will save a lot of women from the knife - and the anxiety of being threatened with surgery if she doesn’t labor faster. It also know allows 3 hours for second stage when augmented with pitocin and 4 hours when not augmented.
US midwives have been calling for these changes based on experience and studies. The ACOG changing their recommendations is good.
Trish Ross, CPM
Midwives on Missions of Service
www.GlobalMidwives.org<http://www.globalmidwives.org>
www.facebook.com/GlobalMidwives<http://www.facebook.com/GlobalMidwives>
Deacon, Diocese of California
Gualala, CA
On Oct 18, 2016, at 7:29 PM, Lucia Ramirez-Montesinos <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Thank you very much for your response Trish
I have now read the article you suggested, it's very interesting, especially the bit about differentiating failed induction from arrest in the 1st and 2nd stage
I think the definition of failed induction should take into consideration what is used, if anything, for the cervical ripening. The paper says that it shouldn't be deemed as failed until you have given at least 24h of IV oxytocin as if the time spent trying to ripen the cervix doesn’t count. I don't know if this is because in the USA women are not normally given prostaglandins and they go straight for IV oxytocin regardless of the state of the cervix?
One might argue that if the cervix is not favourable, then the woman shouldn’t be offered an induction in the first place, but the reality is that a lot of women with an unfavourable cervix are induced every day for more or less legitimate reasons. However, NICE 2008 guidleine on Induction of labour says "Failed induction is defined as labour not starting after one cycle of treatment", that is 12h for prostin, max of 2 doses 6h apart or 24h for propess (1 dose). "If induction fails, the subsequent management options include: a further attempt to induce labour or caesarean section"
Where I work (NHS hospital in the UK), I have seen women who are being induced for conditions where the wellbeing of the mother or the baby are not expected to deteriorate rapidly. These women would be given 1 Propess over 24h, if no cervical change, cervix not favourable, and mum and baby ok, a 2nd propess for another 24h (given by an O&G), then if no change, they would be offered a day of rest followed by a 3rd propess for 24h (given by O&G), and then according to this definition, they should have 24h of IV oxytocin...we are talking about 120h (5 days) before an induction is to be diagnosed as a failure...Obviously prostin would have a different schedule.
Either way, it never ceases to amaze me the amount of time that women who undergo an induction are given in comparison to those experiencing spontaneous and non-augmented labour
Best wishes
Lucia
On 18 October 2016 at 19:38, Trish Ross <[log in to unmask]<mailto:[log in to unmask]>> wrote:
The definition of failed induction from the ALSO Provider Syllabus, January 2016, Chapter F: Labor Dystocia, page 4, Table 2: Failed induction of labor:
Failure to generate regular (e.g., every 3 min) contractions and cervical change after at least 24 hr of oxytocin administration, with artificial membrane rupture if feasible.
Source: Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade, GR. Preventing the First Cesarean Delivery. Obstet Gynceol 2012;120:1181-93.
There is a big discussion that 6 cm is now the milestone for active labor, rather than 4 cm. So, a woman at 4cm is now finally considered to be in latent labor rather than active.
Trish Ross, CPM
Midwives on Missions of Service
www.GlobalMidwives.org<http://www.globalmidwives.org/>
www.facebook.com/GlobalMidwives<http://www.facebook.com/GlobalMidwives>
Deacon, Diocese of California
Gualala, CA
On Oct 17, 2016, at 4:05 PM, MIDWIFERY-RESEARCH automatic digest system <[log in to unmask]<mailto:[log in to unmask]>> wrote:
There are 2 messages totaling 494 lines in this issue.
Topics of the day:
1. Failed Induction
2. Qualitative Research Methods courses at University of Oxford
----------------------------------------------------------------------
Date: Mon, 17 Oct 2016 15:40:38 +0100
From: Lucia Ramirez-Montesinos <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Failed Induction
Hello all,
I am looking at the literature around the definition of "failed induction"
and I am getting very different definitions ranging from "when after 24h of
prostaglandins have not produced any contractions or the cervix is not
favourable enough to allow ARM", to "the inability to get to 4cm and
regular contractions regardless of the treatment necessary to get there or
the amount of hours"
I wonder if anybody here knows of any good papers or reviews around this
topic
Thanks very much in advance
Best wishes
Lucia
------------------------------
Date: Mon, 17 Oct 2016 15:33:47 +0000
From: Jenny Hislop <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Qualitative Research Methods courses at University of Oxford
* Apologies for any cross-posting *
The Health Experiences Research Group (HERG), Nuffield Department of Primary Care Health Sciences, University of Oxford is running the following programme of qualitative research methods courses in 2016/17. The programme comprises the one week Qualitative Research Methods (QRM) course, a two-day Analysis course, and one-day courses in Interview Skills, and Focus Groups. We're also offering a new one-day course on Conversation Analysis. Note that the one-day interview course and the two-day analysis course are scheduled so that participants can take either or both of the courses.
Our courses are very popular so please book early to avoid disappointment. For further details about each course or to make a booking, please go to University Stores<http://www.oxforduniversitystores.co.uk/browse/product.asp?catid=165&modid=5&compid=1>
Please pass the information on to anyone who might be interested and/or display it on your noticeboards.
We look forward to welcoming you and your colleagues on one or more of our courses in 2016/17.
INTRODUCTION TO QUALITATIVE INTERVIEWING*
18 January 2017 BOOKINGS NOW OPEN
"The course has been fantastic! Many thanks for the clear and useful teaching - handouts, clips. All instructors were enthusiastic and very knowledgeable. Really brought qual methods to life. The experiential work was especially useful."
This one-day course is aimed at health professionals, researchers, academics and postgraduate students who have little or no experience of qualitative interviewing. Everyone is welcome, regardless of research background. Previous courses have attracted researchers from a wide range of disciplines including health professionals, social scientists and educators. The only requirements are an interest in qualitative interviewing and the desire to conduct better interviews. The course provides hands on practical experience of different qualitative interviewing skills.
*A further course is planned for May 2017.
ANALYSING QUALITATIVE INTERVIEWS*
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This two day course is aimed at health professionals, researchers, academics and postgraduate students who are planning to undertake or manage qualitative research using in-depth or semi structured interviews or those who have already collected qualitative interview data which they are unsure how to analyse. Everyone is welcome, regardless of research background. The course introduces the principles and practice of qualitative interview data analysis, with particular emphasis on thematic analysis techniques. It uses a combination of practical workshops, group discussions and formal lectures. The course also gives an overview of other approaches to qualitative analysis.
*A further course is planned for May 2017.
INTRODUCTION TO FOCUS GROUPS
18 November 2016 A FEW PLACES REMAINING - BOOK NOW
"I go on a lot of training courses. This was one of the best I have been to! So rarely do you get practical experience whilst training. Excellently structured and facilitated course."
This one day course is aimed at health professionals, researchers, academics and postgraduate students who want to develop skills in organising and facilitating focus groups and in analysing focus group data. Everyone is welcome, regardless of research background. The course is suitable for those with little or no understanding of focus group method as well as those wishing to review and broaden existing skills. Practical exercises and small group work will be used throughout the course to develop competence in designing topic guides, moderating focus groups and analysing data.
*A further course is planned for May 2017.
CONVERSATION ANALYSIS NEW COURSE - BOOK NOW
16 January 2017
This one-day course is aimed at health professionals, researchers, academics and postgraduate students who have no experience of conversation analysis. Everyone is welcome, regardless of research background. This course will introduce newcomers to the field of conversation analysis, help researchers decide if conversation analysis is the most appropriate methodology for their research purposes, and provide practical experience in transcription and data handling.
INTRODUCTION TO QUALITATIVE RESEARCH METHODS*
24-28 April 2017 BOOKINGS NOW OPEN
"This has been a fantastic week, an excellent combination of theory and practice. I feel much more confident to go back to work on my project. This should be an example to others of how to run a course. Excellent."
This one week course is aimed at health professionals, researchers, academics and postgraduate students with little or no understanding of qualitative research methods. Everyone is welcome, regardless of research background. The course provides hands on practical experience of different qualitative methods including in-depth interviewing, focus groups and ethnography, as well as developing skills in thematic analysis. It is particularly suited for people who are starting work on a project with a qualitative dimension, doctoral students at the beginning of their projects, and those who are thinking about using qualitative research methods. The course also provides a useful introduction/refresher for researchers, academics, or managers who are supervising students or staff doing qualitative research projects.
*Note that the one-week Introduction to Qualitative Research Methods course is also run twice a year as part of the MSc in Evidence-Based Health Care (EBHC). For dates and further information please go to www.conted.ox.ac.uk/qrm<http://www.conted.ox.ac.uk/qrm><http://www.conted.ox.ac.uk/qrm> or email [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]&subject=Enquiry:%20Qualitative%20Research%20Methods%20%28O15C199B9Y%29>
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End of MIDWIFERY-RESEARCH Digest - 14 Oct 2016 to 17 Oct 2016 (#2016-217)
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