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MIDWIFERY-RESEARCH  June 2007

MIDWIFERY-RESEARCH June 2007

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Subject:

Re: intermittent auscultation

From:

Carolyn Hastie <[log in to unmask]>

Reply-To:

A forum for discussion on midwifery and reproductive health research." <[log in to unmask]>

Date:

Thu, 14 Jun 2007 11:03:51 +1000

Content-Type:

text/plain

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Hello Robyn,

what a great project.  Here at our freestanding, women centred, midwifery led birthing Service, the midwives use IA and it is (mostly) 30 mins in first stage (from whenever the women come in to the unit! and some come within an hour of birthing) and then in second phase/stage after each contraction - I would be surprised if it was for the full minute.

There are of course variations, like, for example, women whose contractions 'go off' because of one thing or another and they are left to 'rest' and then resume labour after that and IA is resumed when labour does. 

It would be fabulous to know what different groups of midwives are actually doing and what informs their decision making around that. You would have eight participants in that study from this service as I'm sure everyone would love to be involved in your study. 

warmly, Carolyn Hastie 

>>> "Robyn Maude [CCDHB]" <[log in to unmask]> 06/14/07 9:49 am >>>
Hello Everyone
 
In March last year, just prior to my first PhD school, I emailed the
list to make an initial contact with those of you interested in and/or 
doing or done some work around fetal moniotiring in labour specifically
intermittent auscultation. Since then I have had a really enjoyable year
engaging with the literature and have conducted an audit of the practice
of fetal monitoring in the hospital where I work. Now I am ready to
think about how I may go about designing my research around this aspect
of care. 
 
The literature frequently points out the lack of evidence around timing,
freqency and duration of IA. Current fetal moniotirng guidelines
(RCOG/NICE, ACOG, SOGC, RANZCOG etc ) recommned IA for 'low risk' women
and have outlined the  timing, frequency and duration. These are based
on protocols developed for RCT's comparing IA and EFM . Over time these
IA guidelines have become common practice without being 'tested'. 
 
I am particularly interested in exploring whether IA guidelines (timing,
frequency and duration) are appropiate, necessary, are being used, take
into account other variables like 1 to 1 care in labour,  continuity of
care, fetal movements etc 
 
My supervisor and I have toyed with a few ideas, but I am keen to hear
your ideas as well. Some ideas are :

*	
	An RCT comparing 15 min with 30 min auscultation -potentially
problematic as the numbers needed to demonstrate no difference would be
huge
*	
	A survey (nationally, internationally)of current practice around
IA and what informs this practice - i.e if midwives' practice does not
reflect the current guidelines for IA (i.e 15-30 min in first stage and
5min or after each contraction in second stage, for 1 full minute, after
a contraction, comparing with maternal pulse) then what do they do and
how do they ressure themselves and women about the baby's well-being in
labour?
*	
	An international eDelphi study - the creation of international
expert midwifery opinion to inform practice around  IA
*	
	developing a (midwifery) model for IA and  testing it

I would be grateful for any feedback or advice you could give me.
 
Cheers, 
Robyn Maude
Midwifery Advisor
Capital and Coast DHB
Private Bag 7902
Wellington South
New Zealand
Office - Level K - Ward 14 -Grace Neill Block
(04) 3855999 ext. 5298
0274793826
 



This email or attachment(s) may contain confidential or legally privileged information intended for the sole use of the addressee(s). Any use, redistribution, disclosure, or reproduction of this message, except as intended, is prohibited. If you received this email in error, please notify the sender and remove all copies of the message, including any attachments. Any views or opinions expressed in this email (unless otherwise stated) may not represent those of Capital & Coast District Health Board.

http://www.ccdhb.org.nz 

(1C_S1)
 
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