Fantastic Denis. Some hospitals in Australia take the temperature of healthy
newborns daily. At least one unit actually measures the length of the baby
on discharge (whatever day that is, 2,4,6) even though it was done at birth.
I mean literally at birth, in the birth suite within an hour of birth. So
much for gentle beginnnings. Cop that for ritualistic, non evidence based
(in fact possibly damaging) practice. Believe you me I tried hard to change
that behaviour and it is the midwives who continue it. How much can a baby
grow in length in 4 days!! And what use is that information anyway? Now I've
had my rave, I'll go to work. Cheers
jenny
Jennifer Cameron FRCNA FACM
President NT branch ACMI
PO Box 1465
Howard Springs NT 0835
08 8983 1926
0419 528 717
----- Original Message -----
From: "Denis Walsh" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, July 10, 2007 4:03 AM
Subject: Re: SV: intermittent auscultation
Out of interest, I know at least one birth centre that does not take the
temperature of babies at birth because of the assumption of normative
physiology. The practice of taking the baby's temp at birth is routine in UK
hospitals.
Denis Walsh
Reader in Normal Birth
University of Central Lancashire
Independent Midwifery Consultant
Home address:
366 Hinckley Rd
Leicester LE3 0TN
Mobile: 07905735777
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] On Behalf Of Céline Lemay
Sent: 09 July 2007 12:25
To: [log in to unmask]
Subject: Re: SV: intermittent auscultation
Robyn,
I think that the dynamic of "surveillance" is logic in a condition of high
risk or pathology. Surveillance is derived from a deep cultural ( and a
scientific construction) doubt about qualification of the female body to
take care of the unborn.
In this context, we need to do surveillance but if we are in a perspective
of physiology, the baby is OK before we check anything.
Does physiology need surveillance? I think that physiology need vigilance.
The question is about putting vigilance in action. What is midwifery
practice in a perspective of physiology and vigilance?
How do we deal with uncertainty in a perspective of physiology and
vigilance?
all the best,
Céline
----- Original Message -----
From: "Robyn Maude [CCDHB]" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, July 08, 2007 7:44 PM
Subject: Re: SV: intermittent auscultation
Celine
This is what I am hoping to do in my investigation. I am coming at it from
the perspective of normal physiology i.e. how do we (women and midwives)
reassure ourselves that the baby is OK. In the context of 'fetal
surveillance' (this is term I am delving into as well!!!)What are the
factors/practices that support physiological birth?
Cheers, Robyn
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] On Behalf Of Céline Lemay
Sent: Monday, 09 July 2007 3:58 a.m.
To: [log in to unmask]
Subject: Re: SV: intermittent auscultation
I think that it is a fundamental question.
Even the expression "intermittent auscultation" is coming from the "norm" of
continous auscultation, which is derived from a medical perspective of the
potential pathology.
Can we do a research with the premiss of physiology?
How can we formulate a question to study foetal monitoring from the A PRIORI
of physiology? Physiology as THE norm and not the tolerable extension of
pathology.
Céline Lemay, PhD
sage-femme, Québec
----- Original Message -----
From: "Jenny Cameron" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, July 07, 2007 10:02 PM
Subject: Re: SV: intermittent auscultation
If the woman is experiencing a healthy pregnancy & labour, (i.e. with
adequate rest time between contractions, and no hypertension), what is the
rationale for 15 minutely ausculation?
Jenny
Jennifer Cameron FRCNA FACM
President NT branch ACMI
PO Box 1465
Howard Springs NT 0835
08 8983 1926
0419 528 717
----- Original Message -----
From: "Julie Harrison" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, July 08, 2007 5:30 AM
Subject: Re: SV: intermittent auscultation
Regarding counting strategies you might like to look at the following
references which outline the principles and give some evaluation.
Steer PJ Beard RW (1970) A continuous record of fetal heart rate
obtained by serial counts. The Journal of Obstetrics and Gynaecology
of the British Commonwealth (77): 908-914.
Schifrin BS Amsel J Burdorf G. (1992) The accuracy of auscultatory
detection of fetal cardiac decelerations: A computer simulation,
American Journal of Obstetrics and Gynecology. (166): 566-76.
Best wishes
Julie Harrison
Senior Lecturer (Midwifery and Womens Health)
Faculty of Health and Social Care Sciences
Kingston University and St George's University of London.
----- Original Message -----
From: Beatrice Hogg <[log in to unmask]>
Date: Friday, July 6, 2007 1:48 pm
Subject: SV: intermittent auscultation
To: [log in to unmask]
> I have been working as a midwife in Stockholm, Sweden, and we were
> taught to
> listen every 15 minutes after a contrction and at least for 15
> seconds x 4
> to count out the frequency. Sometimes we listened for a minute if
> we were
> unsure of the FHR.
>
> Beatrice Hogg
>
>
>
> _____
>
> Från: A forum for discussion on midwifery and reproductive health
> research.[mailto:[log in to unmask]] För Ellen Blix
> Skickat: den 14 juni 2007 11:02
> Till: [log in to unmask]
> Ämne: Re: intermittent auscultation
>
>
>
> 15 minutes must be a British tradition. The Norwegian tradition
> used to be
> every 30 minute during most of first stage, more often at the end
> of stage 1
> and after every contraction during active pushing. New guidelines
> from 2006
> recommends every 15 min during first stage. These guidelines are
> based on
> systematic rewiev of meta-analysis of RCTs (and thereby evidence
> level 1a)
> comparing IA with continuous electronic fetal monitoring, the RCTs
are
> mainly conducted in countries where auscultation every 15 min is the
> tradition. The knowledge that IA every 15 min is better than
> continuous CTG
> in low risk women is extrapolated to that IA every 15 min is best in
> low-risk women.
>
>
>
> I have no idea about what is the best, but how can you do
> auscultationsevery 15 min if you do not have one-to-one care?
>
>
>
> Ellen
>
> ----- Original Message -----
>
> From: Ann <mailto:[log in to unmask]> Thomson
>
> To: [log in to unmask]
>
> Sent: Thursday, June 14, 2007 10:11 AM
>
> Subject: Re: intermittent auscultation
>
>
>
> Could I just point out that when I was a student midwife in 1967
> we were
> taught that the fetal heart should be auscultated every 15
> minutes. So this
> time interval existed before the RCTs, but I have no idea where it
> camefrom. This is a very interesting project.
>
>
>
> Ann
>
>
>
> Ann M Thomson
>
> Professor of Midwifery,
>
> School of Nursing, Midwifery & Social Work,
>
> University of Manchester,
>
> Coupland III Building,
>
> Manchester M13 9PL,
>
> UK
>
> Tel (0)161 275 5342
>
> Fax (0)161 275 5346
>
>
>
>
> _____
>
>
> From: A forum for discussion on midwifery and reproductive health
> research.[mailto:[log in to unmask]] On Behalf Of
> Robyn Maude [CCDHB]
> Sent: 14 June 2007 00:50
> To: [log in to unmask]
> Subject: intermittent auscultation
>
>
>
> 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
> specificallyintermittent 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
> protocolsdeveloped 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
>
>
>
>
>
>
>
>
>
>
> _____
>
>
>
>
>
>
>
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