Dear Belinda,
I always become somewhat dismayed when I
hear about trusts adopting “knee jerk” reactions to isolated
incidents. Where is the evidence for implementing the practice of scanning all
nulliparous women in labour? I would also question where they intend to obtain
the resources for such a policy, particularly out of office hours. Are they
going to rely upon the already over burdened junior doctors? Perhaps the
consultant will be called each time a woman is admitted in labour? If they
intend to train all the midwives in ultrasonography I would argue that the time
and resources required would be better spent developing their basic midwifery skills
and confidence in abdominal palpation in the antenatal period.
Perhaps you could suggest that an audit of
all women admitted to your unit in labour with an undiagnosed breech
presentation be undertaken to ascertain how many women this actually affects. Once
you have obtained the figures a clinical skills and education initiative could
be implemented which focuses on diagnosis and management of breech presentation
both antenatally and in the intrapartum periods followed by another audit to
assess whether this has been effective in reducing the incidence.
I think developing midwives’ skills
seems rather more sensible than an over reliance upon USS and a consequent
decrease in basic midwifery.
Claire
Claire Davenport
Research Midwife
Research
Midwives' Office, Level 6, Leazes Wing, Royal Victoria Infirmary,
Tel: 0191
2820436
From:
A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] On
Behalf Of Belinda Cox
Sent: 11 May 2010 14:27
To:
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Subject: Breech presentation
Dear all, Apologies for cross posting this. I really need some advice and support here - I'm
almost in tears!! The Trust I work for has identified that we're
having an increased number of women diagnosed with breech presentation in
established labour, and are exploring the implementation of scanning all
nulliparous women on admission in labour to confirm presentation!! My view is that we need to look at why the
presentation isn't being confirmed PRIOR to labour if there's a query
about it (e.g USS), and then if breech presentation is confirmed offering
appropriate counselling and ECV. IF a woman chooses to have a CS for breech
presentation it's better that she gives true consent (not in labour) and
that it's done electively and calmly rather than her being
'encouraged' to have an emergency CS in labour. Have any other Trusts identifed this as a problem?
does anyone have any teaching or assessment tools that they use which would
support the midwives and obstetricians to decrease the number of breech
presntations that are missed prior to labour? Any other thoughts on this? Best wishes, Belinda |