Goodness me!  I can't let Claire's

"the stats for 37 weeks are similar to that of 42?  Maybe if clinicians worked with visual tools, they'd understand it better too?  For all I tend to see is the overstated risk of postdates"

go without comment.



The risks of remaining undelivered are NOT the same at 37 and 42 weeks.  The reason is the denominator changes because by 42 weeks most women are already delivered.  So the stillbirth risk per undelivered woman is MUCH higher at 42 weeks.  I've tried to explain it here.  http://ripe-tomato.org/2014/11/09/the-risks-of-postmaturity/   There's also a link to a much more sophisticated explanation by Gordon Smith. 



We must get our understanding about this right.



Jim Thornton





-----Original Message-----

From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of MIDWIFERY-RESEARCH automatic digest system

Sent: 15 June 2015 00:02

To: [log in to unmask]

Subject: MIDWIFERY-RESEARCH Digest - 13 Jun 2015 to 14 Jun 2015 (#2015-130)



There is 1 message totaling 145 lines in this issue.



Topics of the day:



  1. Isn’t the concept of low risk induction a category error?



----------------------------------------------------------------------



Date:    Sun, 14 Jun 2015 20:44:56 +0100

From:    Lucia Ramirez-Montesinos <[log in to unmask]>

Subject: Re: Isn’t the concept of low risk induction a category error?



Thanks Claire!

It would be great to have a toolkit, something simple and concise, like a flow-chart, something that starts from the beginning with how the pregnancy can be dated, mentrual cycles, etc..and I would very happy to collaborate in it once I finish my PhD!



I think thanks to this amazing debate, and the contribution of everyone, it's easy to understand perhaps why more women appear to prefer to be induced, and as Soo has pointed out, part of the problem is that it is presented as a low risk procedure, a very frequent procedure, (making it very normal), which re-inforces that underlying lack of trust in women's bodies and physiological labour and birth which in turn reinforces the point that Soo has also made about the false belief that "if we are in control of the labour everything will be fine"!?



In regards to the other 2 toolkits that we were asked for feedback - I have read them and, I think the one about the place of birth is particularly good, well done for that! and the one about "continuity of care" is also good in principle, but I think it could be improved by clearly defining what it is meant by continuity of care, as to me it is not really clear.

Well, there is a definition but then it gives examples that contradict the definition.

This is because it gives examples of continuity of care and one of those examples is team care, when women receive care by a team of midwives up to 6-8, to me that might be continuity of care, since the woman is always receiving care according to the same principles, but she is certainly not receiving continuity of carer,(If this is what this toolkit is intended to

promote?) if she has to see 6-8 midwives, there is a slight difference in the concept again.

In my opinon and having worked as a caseloading midwife in the NHS delivering continuity of care and carer, I think the benefits of the relationship come when that woman can easily identify who is "her midwife"

and has had the chance to choose to develop a trusting relationship with that person, which to me it is hard if you have to be seen by 6-8 midwives.



Best wishes



Lucia















On 13 June 2015 at 16:08, Claire Feeley <[log in to unmask]> wrote:



> Great idea Lucia.  I for one would welcome them when I counsel women 

> in the community RE induction.  I would like to see one of the charts 

> like we use for prophylactic antibiotics i.e. how many we need to 

> treat in order to prevent one admission to SCBU.  Maybe with a visual 

> demonstration of the apparent risks of post dates, wherein the stats 

> for 37 weeks are similar to that of 42?  Maybe if clinicians worked 

> with visual tools, they'd understand it better too?  For all I tend to 

> see is the overstated risk of postdates and I am in a frustrating 

> position where I am meant to refer a woman to a SOM/consultant/consultant mw if she chooses to decline IOL.

>

> That said I work with more women who are desperate to be induced than 

> the other way around.

>

> Best wishes

>

> Claire Feeley

> Midwife

> MSc Student.

>



------------------------------



End of MIDWIFERY-RESEARCH Digest - 13 Jun 2015 to 14 Jun 2015 (#2015-130)

*************************************************************************





This message and any attachment are intended solely for the addressee
and may contain confidential information. If you have received this
message in error, please send it back to me, and immediately delete it. 

Please do not use, copy or disclose the information contained in this
message or in any attachment.  Any views or opinions expressed by the
author of this email do not necessarily reflect the views of the
University of Nottingham.

This message has been checked for viruses but the contents of an
attachment may still contain software viruses which could damage your
computer system, you are advised to perform your own checks. Email
communications with the University of Nottingham may be monitored as
permitted by UK legislation.