 |
 |
Just to add to this - Ive just returned from doing some workshops on ways of maximising normal birth with some wonderful midwives in Hong Kong (following on from some similar workshops there by Paul Lewis and Cathy Warwick), and the participants were very clear that they routinely did not undertake VE's if they thought women were approaching full dilation, because, once confirmed, the second stage was strictly time limited - so they delayed as long as possible in making the confirmation. As we discussed in the workshops, this practice protects the individual woman from intervention to some extent, but skews the recorded 'norms' for length of second stage for the population of women, as Chris has noted in an earlier posting.I think this is probably a fairly universal practice? This is why Im hoping to do some work with women having truly spontaneous labours in a case-holding setting to see what the norms are in that circumstance, following on from the work of Leah Albers, but also taking into account that labour is unlikely to be a linear process (ie progressing at any specific number of centimetres per hour). I'm also interested in correlations between maternal and sibling labour patterns on that of a currently labouring woman, particularly when she enters the realm of 'unusual normal'. It might be good to try to do some cross cultural work on this if anyone out there is interested, or to join you if you are doing it currently...? All the best soo all the best soo Professor Soo Downe Director Midwifery Studies Research Unit University of Central Lancashire Preston PR1 2HE Lancashire England +44 (0) 1772 893815 tel: 01772 893815 >>> [log in to unmask] 02/15 3:05 pm >>> Hello Chris, Billie and everyone - yes, I am keen to join in the discussion! As you mentioned, Chris, I am currently writing up my PhD which focuses on power and power relationships within the context of vaginal examination in labour. During interviews, all the midwife participants acknowledged that there is sometimes a discrepancy between what they feel on vaginal examination, and what they actually record in the notes. This happens most often when the midwife cannot feel any cervix (i.e. full dilatation) but states in the records that it is 8 or 9cm dilated. The rationale for doing this (and midwives were very clear on this) was that they were protecting the woman from the threat of perceived, unnecessary intervention. As the participants said, once they record full dilatation 'the clock starts ticking'. I think this is an intriguing example of the ways in which midwives use their own midwifery knowledge to subvert the dominant discourse which is, of course, based on Friedman's curve. I'm not for a minute trying to suggest it is good practice - far from it - but I think it is interesting that midwives have developed this strategy and that it appears to be so widely used. As I am writing-up at the moment I can get very, very boring on the subject but will stop here ... However, the findings throw up all sorts of interesting questions and dilemmas about how we assess cervical dilatation as well as ''normal' length of labour etc. Best wishes to all - Mary From: A forum for discussion on midwifery and reproductive health research. on behalf of Chris McCourt Sent: Thu 15/02/2007 13:42 To: [log in to unmask] Subject: Re: length of labour good points Billie there is also the issue of what or how professionals choose to measure and record and why Mary Stewarts's doctoral work highlighted, and we noticed the same phenomenon (and commented on it briefly in an article) that midwives tend to manipulate records in response to various agenda. Delaying recording their assessments or amending the observations they record can, they feel, give them and the woman more time in which to allow labour to progress. This needs to be taken into account by anyone researching labour duration using casenote audit. If anyone is interested in this further, our article was: Beake S, McCourt C, Page L. The use of clinical audit in evaluating maternity services reform: a critical reflection. Journal of Evaluation in Clinical Practice 1998. can't remember Mary's title now, but maybe she'll respond! Chris -----Original Message----- From: A forum for discussion on midwifery and reproductive health research. on behalf of Hunter, Billie Sent: Wed 14-Feb-07 5:34 PM To: [log in to unmask] Cc: Subject: Re: length of labour Hi Chris and other interested list members I've been following this discussion with interest. It seems that another relevant issue is likely to be how labour duration is measured, in particular what the start point is considered to be ( the end point being fairly clear!) This may be something that has shifted over time. For example, there are new developments which aim to differentiate between 'active' and 'latent' phases of labour (the All Wales Clinical Pathway for Normal Labour that I have recently been researching is one of these). If labour is not considered to have started until a woman is in active labour ( as defined by her attendants), this will clearly impact on the length of labour that is officially recorded (though this may not necessarily reflect the length of labour as experienced by the woman herself!) This issue could be compounded in units where women are encouraged to stay at home until they are in established (active) labour, so that the experiences of the woman prior to admission become invisible. This would seem to have all sorts of implications for labour duration norms - and also for the experiences of women. (I am also interested in how it may affect the work of midwives - so that only caring women in active labour is seen as 'real work') Billie Billie Hunter Professor of Midwifery Centre for Midwifery and Gender Studies School of Health Science Floor 2, Vivian Tower University of Wales Swansea Swansea SA2 8PP 01792 518584 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 Chris McCourt Sent: 12 February 2007 17:05 To: [log in to unmask] Subject: length of labour dear all I'm interested to know whether there is any written or research evidence on whether norms of the length of labour have changed in the recent past. I'm aware of the impact of Friedmans work on practices in labour wards, but am wondering whether there is anything to suggest further trends in what is seen as a 'normal' length of labour (and by association, whether this could be related, in either direction, to rising intervention rates) all ideas on relevant evidence sources, or personal/professional observations welcome Chris This incoming email to UWE has been independently scanned for viruses by McAfee anti-virus software and none were detected This email was independently scanned for viruses by McAfee anti-virus software and none were found