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Id certainly be interested, if the trial could be designed as a complex intervention, and contextualised with qualitative data? all the best s >>> Chris McCourt <[log in to unmask]> 07/20/07 3:47 pm >>> good point Hora - perhaps it's time for a few universities and maternity organisations to get a group together to develop a proposal for a trial? Chris -----Original Message----- From: A forum for discussion on midwifery and reproductive health research. on behalf of Soltani-Karbaschi Hora (Derby Hospitals NHS Foundation Trust) Sent: Thu 19-Jul-07 7:05 PM To: [log in to unmask] Cc: Subject: Re: SV: intermittent auscultation Dear all I have been quietly following this discussion from time to time and am fascinated by this question as well. Especially that I don't think the NICE recommendation on this is really based on a level A evidence. I quite like the idea of developing a multi-centre RCT, focusing on neonatal outcomes (morbidity (e.g. APGAR, respiratory stress, etc and mortality) (which encomapsses physiological aspects as suggested by Celine). It is true that we need a large study sample but there seems to be many people interested to encourage involvement of enough maternity units. I am sorry if this has been already discussed, I don't use this old e-mail of mine regularely and need to update my registration with with my new contacts soon. Hora Dr Hora Soltani Derby City General Hospital Tel: 01332 785134 ---- Original message ---- >Date: Sat, 14 Jul 2007 14:34:45 +0200 >From: Ans Luyben <[log in to unmask]> >Subject: Re: SV: intermittent auscultation >To: [log in to unmask] > >Hi Kathy, > >I really like this discussion and fits my study on "routine" antenatal care. >As my study aims to study its effectiveness, I would even like to argue >stronger- that "routine" care are not effective to meet most women's needs >( it is only more explicit in different ethnic or deprived social groups). > >I would say however, that we need to "care" during the normal passage to >motherhood ( this used to be a characteristic of female society), but in a >different way as it has been defined now ( as in "medical care"). ( Which >might question the definition of "normal obstetrics"). > >Maybe Soo Downe would agree with me, that "routine" is a result of the >development of Cartesian thought... and supports the functioning of the >"well- oiled machinery of the system". Doubtful however whether this should >be the focus of midwifery. > >best wishes, > >ans > >-----Oorspronkelijk bericht----- >Van: A forum for discussion on midwifery and reproductive health >research. [mailto:[log in to unmask]]Namens Kathy >Carter-Lee >Verzonden: Samstag, 14. Juli 2007 14:20 >Aan: [log in to unmask] >Onderwerp: Re: SV: intermittent auscultation > > >Celine, > >As I am currently working as an independent midwife I find the >obstetrician's comment interesting - that >in 'normal obstetrics we should have no routine care'. A few quick >thoughts - > >Even if you take an epidemiological approach, you have a number of women >with a range of values for >different indicators. You have the majority of women who are NOT on the mean >value....very few in fact >fit the 'average woman' category. If routine care is, as I believe, created >to deal with the 'average >woman', then it still does not adequately deal with the majority of women. > >From a more sociological point of view, any routine care is, for the same >reason, not going to cover the >needs of smaller groups of women representing unusual ethnic or cultural >groups. > >Thanks for listening! > >Kathy Carter-Lee >Independent Midwife >NZ > > > >Date sent: Mon, 9 Jul 2007 21:49:10 -0400 >Send reply to: "A forum for discussion on midwifery and reproductive >health research." ><[log in to unmask]> >Fro m: Céline Lemay <[log in to unmask]> >Subject: Re: SV: intermittent auscultation >To: [log in to unmask] > >> 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 M 13 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 >> >> __________ NOD32 2391 (20070711) Information __________ >> >> This message was checked by NOD32 antivirus system. >> http://www.eset.com >> >> > > > >============================== >Kathy Carter-Lee >Midwife > >Mobile: 021 425 115 >Home: 09 425 6749 >Warkworth Birthing Centre: 09 425 8201 ********************************************************************** This message may contain confidential and privileged information. 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