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Hello Amanda. You have taken up a challenging post! I must comment on your statement that 'there is not a transparent process of identifying women for whom obstetric care is a necessity'. I don't think we should be looking for or expecting this 'transparency'. Life an birth is unpredictable and we cannot look at a person and say 'you are going to need specialist obstetric care' just as much as we can't look at people and say 'you are going to need specialist oncology care' . My argument would be that we should be changing our philosophies and mind sets and say' this woman is going to have a normal natural process and if something is not right we will refer her to the obstetricians and return her to normal care once the issue has been corrected or the baby has been born.'' We have got too much into putting women into high risk boxes because we 'expect' things to be going wrong. I know this doesn't help in issues of risk management (I don't like that concept anyway!!) but we can't predict things to that extent and each woman's concept of her own risk taking is different as well! Best wishes Jennifer Hall -----Original Message----- From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]]On Behalf Of Amanda Mansfield Sent: 24 September 2002 09:12 To: [log in to unmask] Subject: Re: Midwifery-led care- Dear All I have recently taken up post at the Royal Free Hospital, charged with leading the guideline development group for midwife-led care and assisting the process of our move to a temporary ward in 4 weeks time, and establishing 3 "normal-birth" rooms. It is interesting reading Declan's comments, as at present, at the Free, there is not a transparent process of identifying women for whom obstetric care is a necessity!, and I would find this information particularly useful. We are severely restricted by our inhouse maternity system, which does not currently have 100% coverage of hospital births, and it excludes home-births at present. In clearly identifying from our local population, what proportion of women actually achieve a birth without intervention, we are faced with many challenges, as you can image. If anyone can send me some ideas, postive thoughts, or you have experienced the same process of setting up in-hospital birth facilities, I would be really appreciative. Declan, good luck with finding the information, I would be happy to share any information I fall upon also. Kind regards to the group Amanda Amanda Mansfield - Midwife Currently on Secondment to The Royal Free Hospital >Apologies for cross posting > >Dear all, > >I am seeking information on two issues related to the pilot implementation >of midwifery-led units in Southern Ireland and would be very grateful for >any information on the following issues: > >1. In order to establish some kind of a number analysis on how many women >would be eligible to use and would indeed choose the service, I need some >figures on the percentage of women that are classified as low-risk at >booking and antenatal & intrapartum transfers and transfers back if these >figures are available. Has anyone, or is anyone aware, of any published >data on this information? If not, has anyone done clinical audits in this >area? > >2. With regard to selection/eligibility (again, not sure these words are >appropriate...) and transfer criteria, I have seen a few sources of same but >was wondering if there is any recognised, evidence based standard from which >to work rather than re-invent the wheel? I hear rumblings that the >Netherlands have developed an 'Obstetric Manual' that contains this >information but I believe it is in draft format only and I am not sure how >evidence based it is although I suspect that coming from the Dutch system, >the will be based on many years of experience with midwifery-led care. > >In anticipation... > >Declan > >Declan Devane, >Doctoral Student, >School of Nursing and Midwifery Studies, >University of Dublin Trinity College, >Trinity Centre for Health Sciences Education, >St. James's Hospital, >Dublin 8. >Tel: 087 659 6923 >Email: [log in to unmask] > >******************************************* >Please note that electronic mail to, >from or within Trinity College may be >the subject of a request under the >Freedom of Information Act >******************************************* > Amanda Mansfield Lecturer in Midwifery mailto:[log in to unmask]