Dear Colleagues,
Please see attached the
IFM Training and Competency Assessment Best Practice resource 2019 developed by NHS London maternity Clinical Networks. A mulit0-disciplinary group have developed this and it has links and exemplars. It was developed precisely to stop these non evidence
based responses, have an evidence based consensus across London for all staff, reduce variation in practice and improve outcomes.
Here is the link to the resource, please disseminate widely:
http://www.londonscn.nhs.uk/wp-content/uploads/2019/11/IFM-Resource-FINAL-1.11.19.pdf
It provides guidance for a holistic assessment of mother and baby in all settings.
It states
Employing a ‘fresh ears’ approach to intermittent auscultation, whereby a second midwife listens in to the fetal heart rate pattern every hour, may reduce interpretation errors but this is yet to be investigated
in a research setting.
Regards
Jane Sandall
From: A forum for discussion on midwifery and reproductive health research. <[log in to unmask]>
On Behalf Of Margaret Jowitt
Sent: 20 February 2020 12:10
To: [log in to unmask]
Subject: Re: 'Fresh ears'
Just wanted to say heaven forbid that EFM is brought into women's homes. There is no evidence for its efficacy for low risk women, they have often chosen home to avoid such intervention (yes, I do think it is an intervention)
regards
Margaret
On 20 February 2020 at 11:31 Mary Edmondson <[log in to unmask]> wrote:
Dear Claire,
This is a very pertinent discussion to have.
Listening to the FH over the phone, is by far so disrespectful - if the midwife is concerned at all about the FH in any setting, then she should be advised to transfer to hospital/delivery suite etc. immediately via ambulance. The Trust
in my opinion should be providing a second midwife, and if there isn’t one available, a senior midwife should attend.
This is a very important discussion…. Look forward to further posts and ideas.
I wonder if any Trust is offering home fetal monitoring to women who are in labour? The data could be transferred easily.
It was also in V1, but I recall the language was more caveated in the previous version.
This idea that midwives require a second midwife to listen to the FH during IA once an hour appears to have taken traction in some trusts, without any evidence to support
its use. Concerning enough...I was particularly alarmed by the report from one midwife who reported that at a home birth, they are 'required' to phone the labour ward coordinator for them to listen to the FH over the phone!
While I appreciate there have been some poor outcomes during uncomplicated labours due to errors using IA (audit attached here from one trust), I am concerned that once again
we're in a position of what 'seems like a good idea' may have unintended (negative) consequences. I understand that the Consultant Midwives group are in the process of writing a position statement on this which is awaiting publication. However, I do not know
how other concerns can be raised- hence my desire to flag it to this group for advice of what to do/what can be done to challenge this?
Also from the fb conversation, one person said their trust was operating a 'trial' basis, yet that comes under service improvement/auditing cycles, and not 'official' research.
Therefore, I am also concerned that such an intervention hasn't gone through the usual ethics procedures that we would be obliged to do, raising ethical issues all of its own.
Any advice on what to do next would be gratefully received!
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