Please forgive the haste of this contribution.
My memory of a study by Klein M et al (Turnbull & Bull & Fisher were
probably also co-authors) of women cared for within what was then the GP
unit system as compared with low risk women within the consultant unit
system, showed a significantly shorter interval between admission in labour
and delivery for the former group. It was suggested that this was because
the GPU women were visited at home by thier community midwife if they
thought they were in early labour. Probably published in the BJOG in the
1980s.
Jo
(Alexander)
At 15:04 13/06/02 +0900, you wrote:
>Hi Jane and others
>
>In response to the query raised about whether different organisations of
>care have an impact on women admitted early..
>
>When studying the introduction of caseload midwifery in West London we
>observed that women with a caseload midwife were less likely to be admitted
>early to the labour ward (or antenatal ward as happened when v busy) because
>the midwife was able to visit them at home to provide assessment and
>re-assurance/support. Over time, the midwives appeared to develop more
>selectivity, and, knowing the women, tended to use visiting or telephone
>support as appropriate.
>
>In interviewing women about their care we heard from a number who had come
>in very early because they were having pains and felt unsure what was
>happening and how 'far on' in labour they were. From their accounts, they
>seemed to lack assurance that would help them to cope with early/latent
>labour at home. Staff tended to give women the option to go home, but to do
>so by telling the women they weren't in labour. This did not fit well with
>the women's own experience (of pain), leading to feelings of confusion and
>lack of confidence in their ability to cope (along the lines of - well if
>I'm feeling bad now and I'm not even in labour, how will I get through
>this).
>
>One of the issues to consider here, maybe, is the nature of the
>categorisation - in labour/not in labour - as dichotomous and the medical
>understanding of the process as linear. This does not seem to fit well with
>women's experiences and perceptions as reported in the interviews we have
>done. Perhaps more explicit recognition that something is happening prior to
>'active labour' would actually help to reduce the numbers of anxious women
>pitching up early?
>
>
>Chris McCourt
>Reader
>Centre for Midwifery Practice
>Faculty of Health and Human Sciences
>Thames Valley University
>32 Uxbridge Road
>London W5 2BS
>020-8280-5287
>--
>
>
>
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