[log in to unmask]">
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
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