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Dear Mary I'm not sure why your message did not get through, as the list is not moderated. My only thinking is that messages are rejected for the following reasons. 1) They contain an attachment (including an address attachment) 2) Have embedded pictures and graphics 3) The email address is not recognised. Sometimes this happens when people have two email addresses, nd only one is registered. It looks like things have got sorted. Could you let me know if you still have problems. bw Jane Sandall list moderator Professor Jane Sandall Professor of Women's Health Programme Director (Innovations) NIHR King's Patient Safety and Service Quality Research Centre Department of Primary Care and Public Health Sciences King's College London School of Medicine, Floor 7, Capital House, 42 Weston St London SE1 3QD, UK Tel: +44 (0)20 7848 6261/6604 Mobile: +44(0)7713 743150 e-mail:[log in to unmask] http://www.kingspssq.org.uk/ http://myprofile.cos.com/sandall http://www.kcl.ac.uk/about/campuses/guys.html <http://www.kcl.ac.uk/about/campuses/guys.html> ________________________________ From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of Stewart, Mary [[log in to unmask]] Sent: 03 November 2010 13:48 To: [log in to unmask] Subject: FAO List Moderator Hello there I posted the following e-mail last week but notice it has not appeared on the discussion list. It would be very helpful to have some feedback on how/why the decision was made not to add the e-mail. Dear Maggie Many thanks for this. Yes, my thesis is available from the British Library. Here’s the weblink you need: http://catalogue.bl.uk/F/?func=full-set-set&set_number=081496&set_entry=000001&format=999 If you type ‘stewart vaginal’ (!) on to the freetext box it should take you to my thesis. I was interested in your comments about how and when practitioners learn non-invasive strategies of assessing progress. In fact, I think this learning starts on day one, but it tends to be entirely subconscious and therefore is neither recognised nor valued. Two stories, for what’s it’s worth … I trained as a midwife in Scotland in the 1980s. At that point, midwives hardly ever did vaginal examinations on women in labour – not, I’m sorry to say, because we were very progressive, but because all the examinations were done by doctors – sad but true. At the time, I felt I was missing out, and that I hadn’t been taught a very important skill. However, although it was never discussed, I learnt to assess labour in other ways – from the noises the woman was making; noticing where I was hearing the fetal heart with my Pinard, and observing descent etc etc. In the late 80s I worked as a community midwife in London, and I came to really value my experience and recall those ‘untaught’ skills. Another story; in my research, one of the midwife participants recounted a time when she had been with a woman in labour. The doctor came into the room and said ‘Sounds like she’s progressing’ and proceeded to berate the midwife for not doing a vaginal examination ‘to check’. What is interesting here, is that clearly the doctor had also learned to assess labour in non-invasive ways, but didn’t recognise his own knowledge. One final thought (sorry – as you can tell, I love this subject to death): I feel as though I am left with a bit of a conundrum. My personal feeling (and this is absolutely personal, not evidence-based) is that we rarely need to do vaginal examination to assess progress – as you so rightly say, we don’t often find something we really didn’t expect. However, I also absolutely believe that there is a time and a place for a vaginal examination and, when there is a clear clinical indication, it needs to be done really well – the whole point of doing it, in such a situation, is to discover as much as possible about presentation, position etc. So how do we, as midwives, become very skilled at an intervention that we rarely use? I’m not sure what the answer is, and would be very glad to hear other people’s opinion. Warm good wishes Mary Mary Stewart Consultant midwife Room J334 Chelsea and Westminster Hospital NHS Foundation Trust 369 Fulham Road London SW10 9NH Tel: 07872 423085 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ [log in to unmask]: This e-mail is confidential and may well also be legally privileged. If you have received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person: to do so could be a breach of confidence. Any views expressed in this message are those of the individual sender, except where the sender specifically states them to be the views of the Trust. Thank you for your co-operation. 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