Dear Lesley,
I think I would agree with you regarding your comments on CS and the
definition of risk. However, the guidelines I mentioned are not mine (i.e.
it not what I consider, but what the Dutch consider). Moreover, I'm a
sociologist not even a practitioner in the field of maternity care. The
Dutch selection guidelines consider the detailed regulations regarding the
responsibilities and the capabilities of the midwives in the Netherlands,
and the working of the Dutch system of maternity care. These guidelines are
nation-wide, unlike the ones in the UK where there is a great variety across
different health boards and health authorities. National Dutch guidelines
are not drawn up by either midwives or doctors independently, but by a
national committee (Werkgroep Bijstelling Kloostermanlijst) consisting of
representatives of the professional organisations of midwives, GPs,
obstetricians, paediatricians, health-insurance officials and civil servants
in the Ministry of Health.
Hope this make it a little clearer,
Edwin
Edwin R. van Teijlingen
Department of Public Health & Dugald Baird Centre for Research on
Women's Health
University of Aberdeen
Aberdeen AB25 2ZD
Tel. +(44)-1224-552491
Fax. +(44)-1224-662994
E-mail address: [log in to unmask]
Web address http://www.abdn.ac.uk/public_health/phstaff/phevt.htmi
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]On Behalf Of Lesley
Hobbs
Sent: 08 April 2000 22:40
To: [log in to unmask]
Subject: Re: Home birth guidelines
Dear Edwin
I was interested to note that you consider a previous CS to be grounds for
hospital birth and OB involvement. I have to say I disagree. Depending, of
course, upon the reason for the CS, and the background. I help many women
to give birth at home following a CS; the research is very clear that the
so-called risks are both overstated and overexaggerated.
The risk of uterine rupture is virtually no greater in women following 1 CS
than in women who have never had surgery and that most ruptures occur in
women who have never had uterine surgery, yet this is the scenario which is
always quoted. I believe I am knowledgeable enough to work with a woman in
establishing her needs and wishes for the place of birth, and following a
CS, I hope that I can be relied upon to give accurate, research-based
information without routinely involving an obstetrician. There will be
instances when this involvement is entirely appropriate, but not always.
Lesley
----------
> From: Edwin van Teijlingen <[log in to unmask]>
> To: [log in to unmask]
> Cc: [log in to unmask]
> Subject: Home birth guidelines
> Date: Sunday, April 09, 2000 15:26
>
> Dear Andrew,
>
> I am not sure which country you are living, but last year there was an
> article called 'Review and assessment of selection criteria used when
> booking pregnant women at different places of birth' (Campbell, British
> Journal of Obstetrics & Gynaecology vol. 106, June 1999). In this survey
a
> wide range of selection criteria for place of birth were identified.
These
> criteria vary widely between trusts as previously expected. One
interesting
> finding is that none of the 128 different individual criteria was
mentioned
> by all 22 trusts in Campbell's study.
>
> I wrote a letter in reply to this article highlighting the Dutch
selection
> criteria:
>
> "The Dutch criteria are mentioned by one of Campbell's trusts as
evidence,
> but these are not further explained. Selection for place of delivery of
the
> pregnant woman is an important part of the basic philosophy of obstetrics
in
> the Netherlands. Their criteria are interesting, not because they add
yet
> another set of criteria, but because of the way they are established.
The
> process of establishing the Dutch criteria (the so-called Kloosterman
list)
> has been described in detail by Professor Treffers. The selection
process
> in the Netherlands addresses two basic issues: (a) Who should provide
> maternity care for the woman in question?; and (b) Where should the
delivery
> take place? There are four areas of decision making, relating to the
> following questions:
> 1. What are the nature and the seriousness of possible complication(s)
> involving increased risk?
> 2. What are the possibilities of preventing the occurrence of
> complication(s)?
> 3. What is the likelihood that any complication(s) which may occur will
be
> promptly recognised?
> 4. What are the possibilities of adequate intervention in the event of
> complication(s)?
> In the light of these strategic questions, optimum referral policies for
the
> whole of the Netherlands were accepted by the Medical Insurance Board,
based
> on 124 selection criteria.
> These selection criteria are subdivided into four categories:
> 1. risk factors before the pregnancy, namely medical history (covering
> neurological disorders, medical disorders, gynaecological disorders and
> miscellaneous) and obstetrical history;
> 2. abnormalities originating during the antenatal period;
> 3. abnormalities during labour and delivery; and
> 4. abnormalities in the postnatal period.
> For illustration, if a woman's obstetric history includes one previous
> premature delivery in weeks 35 to 37, the recommended birth attendant is
the
> midwife or GP, and a home birth or a short-stay hospital delivery
(=DOMINO
> in UK) is recommended. However, if one premature delivery has taken
place
> at 34 weeks or earlier the recommended birth attendant is the midwife or
GP
> in consultation with obstetrician and the place of birth could be home or
> hospital, depending on consultation. An example of having the
obstetrician
> as the recommended birth attendant and a hospital birth would be a
previous
> caesarean section. This example highlights the clear selection criteria
for
> both birth attendant and place of birth.
> Campbell suggests that "what is required ideally is a systematic review
of
> the evidence", but recognises that this would be difficult. We would
> suggest that a first step might be to collect all selection criteria from
> all UK trusts and develop a national draft guideline based on common
> criteria. Some criteria could be based on research evidence and some on
> best practice, as long as all criteria remain under constant discussion
and
> are updated as new evidence emerges.
>
> References
> 1. Teijlingen van E., Bryar R., Selection guidelines for place of birth,
> Modern Midwife, 6, 1996: 24-27.
> 2. Eskes M, Alten van D, Review and assessment of maternity services in
the
> Netherlands, In: The Future of the Maternity Services. G. Chamberlain, N.
> Patel (eds.) London: RCOG Press, 1994: 37.
> 3. Treffers P.E., Selection as the basis of obstetric care in the
> Netherlands, In: E. Abraham-Van der Mark (ed.), Successful Home Birth and
> Midwifery: the Dutch Model, Westport: Bergin & Garvey, 1993.
>
>
>
> What this indicates is that there is a confusion across the Uk as to
which
> guidelines for home births should be used. Hope this is of use to you.
>
> PS. My letter was published earlier this year: Teijlingen van E. (2000)
'
> Review and assessment of selection criteria used when booking pregnant
women
> at different places of birth' (letter) British Journal of Obstetrics &
> Gynaecology, 107: 298
>
>
>
> Edwin R. van Teijlingen
> Department of Public Health & Dugald Baird Centre for Research on
> Women's Health
> University of Aberdeen
> Aberdeen AB25 2ZD
> Tel. +(44)-1224-552491
> Fax. +(44)-1224-662994
>
> E-mail address: [log in to unmask]
>
> Web address http://www.abdn.ac.uk/public_health/phstaff/phevt.htmi
>
>
>
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Andrew
> Symon
> Sent: 08 April 2000 12:14
> To: [log in to unmask]
> Subject: Home birth guidelines
>
>
> I have a colleague who is thinking of devising a protocol / check list
for
> women who request a home birth. Does any member of the list know if
anyone
> is using something along these lines? An information leaflet or similar
> might be what we're looking for. The crux is ensuring that all women
> requesting a home birth are given the same information, regardless of
which
> midwife they see, and that consent is informed.
> Many thanks
> Andrew Symon
>
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