 |
 |
Dear Carolyn I have been meaning to ring and thank you sooooo much for all your kind and warm thoughts both around the time of the interview and then when the job came through ..thank you so much - i do so appreciate your phone messages - and I know I'm hopeless at getting back to you - but I am very thankful - and I think about you heaps!!!! Sx Carolyn Hastie wrote: >Beautifully said Céline. > >"Reading birth and death" Jo Murphy Lawless's book is great for this >conversation. I recommend any one who hasn't read it to get a copy. > >warmly, Carolyn > >Carolyn Hastie >Midwifery Manager >Belmont Birthing Services >Hunter New England Health > >Conjoint Senior Lecturer >School of Nursing & Midwifery >University of Newcastle > >FACMI IBCLC > >Mobile 0428 112 786 >Email [log in to unmask] > >"I can't change the direction of the wind, but I can adjust >my sails to always reach my destination" -- Jimmy Dean > > > >>>>Céline Lemay <[log in to unmask]> 10/07/2007 10:15 pm >>> >>>> >>>> >We have so much opportunity to claim the reality of "unique normality". >Yet, >every physician and anesthesiologist recognise that. >The problem with "normal" is that we never add the most important >questions: >"for whom?" and "related to what?" >With the technological power to deny death, we hang on to the illusion >of >certainty with epidemiological thinking. The notion of "evidence" is >one of >the best illustration of that. >The other problem is our obstinacy to reduce pregnancy and birth to >their >biological components. In a way, physiology is daily life but in >another >way, childbirth is an "extra-ordinary" life event. All societies have >their >own rituals to deal with that. When birth is a passage and a mystery >where >the ancestors and the deities are in presence, the shaman or some "wise > >woman" are needed to "monitor" the energy and the flow. They read >"birth" >(emergence). In western societies, we put all our time and energy to >monitor >the biomedical parameters ( normal most of the time) because we are >reading >"death". > The body/mind split brings a lot of alienation and suffering in that >most >important human process: childbirth. > >all the best, > >Céline >----- Original Message ----- >From: "Denis Walsh" <[log in to unmask]> >To: <[log in to unmask]> >Sent: Tuesday, July 10, 2007 3:32 AM >Subject: Re: SV: intermittent auscultation > > >That is exactly the point Celine. In the normal course of our lives, we >only >start measuring physiological parameters when we begin to feel unwell >or are >injured etc. If we applied the same principle for physiological birth, >we >would start measuring when we were worried that the physiology was >deviating. You've opened up a real can of worms here. Is there any >rationale >for measuring anything much during physiological labour or after birth >in >mother or baby? Some people argue you should to provide a baseline of >later >changes but we do know the broad spread of normal physiological >parameters >which we could assume the healthy woman and baby already fit within. >Others >use the rationale that regular measuring will detect early deviations >from >the norm and enable more timely transfer of you are not in hospital. >But >then if your threshold for deviation is high (in other words you are >not >expecting trouble), you may avoid transfer and have a physiological >birth... >Denis >Reader in Normal Birth >University of Central Lancashire >Independent Midwifery Consultant >Home address: >366 Hinckley Rd >Leicester LE3 0TN >Mobile: 07905735777 > > >-----Original Message----- >From: A forum for discussion on midwifery and reproductive health >research. >[mailto:[log in to unmask]] On Behalf Of Céline Lemay >Sent: 10 July 2007 02:49 >To: [log in to unmask] >Subject: Re: SV: intermittent auscultation > >Thanks for that remark Denis. We do the same in our birthing center. > >The question to ask is: when we are in a physiological situation, is >it >normal "before" we check the mother or the baby, or do we consider that >it >is normal just "after"? > >The chief obstetrician of the collaborative hospital of our birthing >center >said once that in normal obstetric, we should have no routine care! > >What midwives are thinking about that? >easy to say, not easy to put in practice. > >Céline > > > >----- Original Message ----- >From: "Denis Walsh" <[log in to unmask]> >To: <[log in to unmask]> >Sent: Monday, July 09, 2007 2:33 PM >Subject: Re: SV: intermittent auscultation > > >Out of interest, I know at least one birth centre that does not take >the >temperature of babies at birth because of the assumption of normative >physiology. The practice of taking the baby's temp at birth is routine >in UK >hospitals. >Denis Walsh >Reader in Normal Birth >University of Central Lancashire >Independent Midwifery Consultant >Home address: >366 Hinckley Rd >Leicester LE3 0TN >Mobile: 07905735777 > >-----Original Message----- >From: A forum for discussion on midwifery and reproductive health >research. >[mailto:[log in to unmask]] On Behalf Of Céline Lemay >Sent: 09 July 2007 12:25 >To: [log in to unmask] >Subject: Re: SV: intermittent auscultation > >Robyn, > >I think that the dynamic of "surveillance" is logic in a condition of >high >risk or pathology. Surveillance is derived from a deep cultural ( and >a >scientific construction) doubt about qualification of the female body >to >take care of the unborn. >In this context, we need to do surveillance but if we are in a >perspective >of physiology, the baby is OK before we check anything. >Does physiology need surveillance? I think that physiology need >vigilance. >The question is about putting vigilance in action. What is midwifery >practice in a perspective of physiology and vigilance? >How do we deal with uncertainty in a perspective of physiology and >vigilance? > >all the best, >Céline > > > > > >----- Original Message ----- >From: "Robyn Maude [CCDHB]" <[log in to unmask]> >To: <[log in to unmask]> >Sent: Sunday, July 08, 2007 7:44 PM >Subject: Re: SV: intermittent auscultation > > >Celine >This is what I am hoping to do in my investigation. I am coming at it >from >the perspective of normal physiology i.e. how do we (women and >midwives) >reassure ourselves that the baby is OK. In the context of 'fetal >surveillance' (this is term I am delving into as well!!!)What are the >factors/practices that support physiological birth? > >Cheers, Robyn > >-----Original Message----- >From: A forum for discussion on midwifery and reproductive health >research. >[mailto:[log in to unmask]] On Behalf Of Céline Lemay >Sent: Monday, 09 July 2007 3:58 a.m. >To: [log in to unmask] >Subject: Re: SV: intermittent auscultation > >I think that it is a fundamental question. >Even the expression "intermittent auscultation" is coming from the >"norm" of > >continous auscultation, which is derived from a medical perspective of >the >potential pathology. >Can we do a research with the premiss of physiology? >How can we formulate a question to study foetal monitoring from the A >PRIORI > >of physiology? Physiology as THE norm and not the tolerable extension >of >pathology. > >Céline Lemay, PhD >sage-femme, Québec > >----- Original Message ----- >From: "Jenny Cameron" <[log in to unmask]> >To: <[log in to unmask]> >Sent: Saturday, July 07, 2007 10:02 PM >Subject: Re: SV: intermittent auscultation > > >If the woman is experiencing a healthy pregnancy & labour, (i.e. with >adequate rest time between contractions, and no hypertension), what is >the >rationale for 15 minutely ausculation? > >Jenny >Jennifer Cameron FRCNA FACM >President NT branch ACMI >PO Box 1465 >Howard Springs NT 0835 >08 8983 1926 >0419 528 717 > > >----- Original Message ----- >From: "Julie Harrison" <[log in to unmask]> >To: <[log in to unmask]> >Sent: Sunday, July 08, 2007 5:30 AM >Subject: Re: SV: intermittent auscultation > > >Regarding counting strategies you might like to look at the following >references which outline the principles and give some evaluation. > >Steer PJ Beard RW (1970) A continuous record of fetal heart rate >obtained by serial counts. The Journal of Obstetrics and Gynaecology >of the British Commonwealth (77): 908-914. > >Schifrin BS Amsel J Burdorf G. (1992) The accuracy of auscultatory >detection of fetal cardiac decelerations: A computer simulation, >American Journal of Obstetrics and Gynecology. (166): 566-76. > >Best wishes > >Julie Harrison >Senior Lecturer (Midwifery and Womens Health) >Faculty of Health and Social Care Sciences >Kingston University and St George's University of London. > > > > >----- Original Message ----- >From: Beatrice Hogg <[log in to unmask]> >Date: Friday, July 6, 2007 1:48 pm >Subject: SV: intermittent auscultation >To: [log in to unmask] > > > >>I have been working as a midwife in Stockholm, Sweden, and we were >>taught to >>listen every 15 minutes after a contrction and at least for 15 >>seconds x 4 >>to count out the frequency. Sometimes we listened for a minute if >>we were >>unsure of the FHR. >> >>Beatrice Hogg >> >> >> >> _____ >> >>Från: A forum for discussion on midwifery and reproductive health >>research.[mailto:[log in to unmask]] För Ellen Blix >>Skickat: den 14 juni 2007 11:02 >>Till: [log in to unmask] >>Ämne: Re: intermittent auscultation >> >> >> >>15 minutes must be a British tradition. The Norwegian tradition >>used to be >>every 30 minute during most of first stage, more often at the end >>of stage 1 >>and after every contraction during active pushing. New guidelines >>from 2006 >>recommends every 15 min during first stage. These guidelines are >>based on >>systematic rewiev of meta-analysis of RCTs (and thereby evidence >>level 1a) >>comparing IA with continuous electronic fetal monitoring, the RCTs >> >> >are > > >>mainly conducted in countries where auscultation every 15 min is the >>tradition. The knowledge that IA every 15 min is better than >>continuous CTG >>in low risk women is extrapolated to that IA every 15 min is best in >>low-risk women. >> >> >> >>I have no idea about what is the best, but how can you do >>auscultationsevery 15 min if you do not have one-to-one care? >> >> >> >>Ellen >> >>----- Original Message ----- >> >>From: Ann <mailto:[log in to unmask]> Thomson >> >>To: [log in to unmask] >> >>Sent: Thursday, June 14, 2007 10:11 AM >> >>Subject: Re: intermittent auscultation >> >> >> >>Could I just point out that when I was a student midwife in 1967 >>we were >>taught that the fetal heart should be auscultated every 15 >>minutes. So this >>time interval existed before the RCTs, but I have no idea where it >>camefrom. This is a very interesting project. >> >> >> >>Ann >> >> >> >>Ann M Thomson >> >>Professor of Midwifery, >> >>School of Nursing, Midwifery & Social Work, >> >>University of Manchester, >> >>Coupland III Building, >> >>Manchester M13 9PL, >> >>UK >> >>Tel (0)161 275 5342 >> >>Fax (0)161 275 5346 >> >> >> >> >> _____ >> >> >>From: A forum for discussion on midwifery and reproductive health >>research.[mailto:[log in to unmask]] On Behalf Of >>Robyn Maude [CCDHB] >>Sent: 14 June 2007 00:50 >>To: [log in to unmask] >>Subject: intermittent auscultation >> >> >> >>Hello Everyone >> >> >> >>In March last year, just prior to my first PhD school, I emailed >>the list to >>make an initial contact with those of you interested in and/or >> >>doing or done some work around fetal moniotiring in labour >>specificallyintermittent auscultation. Since then I have had a >>really enjoyable year >>engaging with the literature and have conducted an audit of the >>practice of >>fetal monitoring in the hospital where I work. Now I am ready to >>think about >>how I may go about designing my research around this aspect of >>care. >> >> >> >>The literature frequently points out the lack of evidence around >>timing,freqency and duration of IA. Current fetal moniotirng >>guidelines (RCOG/NICE, >>ACOG, SOGC, RANZCOG etc ) recommned IA for 'low risk' women and have >>outlined the timing, frequency and duration. These are based on >>protocolsdeveloped for RCT's comparing IA and EFM . Over time >>these IA guidelines >>have become common practice without being 'tested'. >> >> >> >>I am particularly interested in exploring whether IA guidelines >>(timing,frequency and duration) are appropiate, necessary, are >>being used, take into >>account other variables like 1 to 1 care in labour, continuity of >>care,fetal movements etc >> >> >> >>My supervisor and I have toyed with a few ideas, but I am keen to >>hear your >>ideas as well. Some ideas are : >> >>* An RCT comparing 15 min with 30 min auscultation -potentially >>problematic as the numbers needed to demonstrate no difference >>would be >>huge >>* A survey (nationally, internationally)of current practice >> >> >around IA > > >>and what informs this practice - i.e if midwives' practice does >>not reflect >>the current guidelines for IA (i.e 15-30 min in first stage and >>5min or >>after each contraction in second stage, for 1 full minute, after a >>contraction, comparing with maternal pulse) then what do they do >>and how do >>they ressure themselves and women about the baby's well-being in >>labour? >>* An international eDelphi study - the creation of international >>expert midwifery opinion to inform practice around IA >>* developing a (midwifery) model for IA and testing it >> >>I would be grateful for any feedback or advice you could give me. >> >> >> >>Cheers, >> >>Robyn Maude >> >>Midwifery Advisor >> >>Capital and Coast DHB >> >>Private Bag 7902 >> >>Wellington South >> >>New Zealand >> >>Office - Level K - Ward 14 -Grace Neill Block >> >>(04) 3855999 ext. 5298 >> >>0274793826 >> >> >> >> >> >> >> >> >> >> >> _____ >> >> >> >> >> >> >> >>This email or attachment(s) may contain confidential or legally >>privilegedinformation intended for the sole use of the >>addressee(s). Any use, >>redistribution, disclosure, or reproduction of this message, >>except as >>intended, is prohibited. If you received this email in error, >>please notify >>the sender and remove all copies of the message, including any >>attachments.Any views or opinions expressed in this email (unless >>otherwise stated) may >>not represent those of Capital & Coast District Health Board. >> >><http://www.ccdhb.org.nz> http://www.ccdhb.org.nz >> >>(1C_S1) >> >> >>No Viruses were detected in this message. >> >> >> >> >> >> >> >> _____ >> >> >> >> >> >>HealthIntelligence <http://www.healthintelligence.org.nz> eMail >>FilterService >> >> >> >> > > >No Viruses were detected in this message. >HealthIntelligence eMail Filter Service > > >No Viruses were detected in this message. >HealthIntelligence eMail Filter Service > >No virus found in this incoming message. >Checked by AVG Free Edition. >Version: 7.5.476 / Virus Database: 269.10.1/888 - Release Date: >06/07/2007 >06:36 > > >No virus found in this outgoing message. >Checked by AVG Free Edition. >Version: 7.5.476 / Virus Database: 269.10.1/888 - Release Date: >06/07/2007 >06:36 > >No virus found in this incoming message. >Checked by AVG Free Edition. >Version: 7.5.476 / Virus Database: 269.10.1/888 - Release Date: >06/07/2007 >06:36 > > >No virus found in this outgoing message. >Checked by AVG Free Edition. >Version: 7.5.476 / Virus Database: 269.10.1/888 - Release Date: >06/07/2007 >06:36 > > >