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
ac!
tive labour ( as defined by her attendants), this will clearly
impa
ct 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
h!
ealth
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
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