Re: [ozmidwifery] fetal heart in labour

[Denise Hynd]

Dear Mary The other question that comes to  mind is also a reflection on what we claim as midwives to believe. 1) That child birth is normal life event so when else do we feel we need to take a pulse or other checks that all is as it appears normal? 2) That it is the woman' s birth and preganacy & we are there as her advocates, it is a partnership of trust and empowerment. How empowering is it for us to take FH to allay our fears and keep us in the loop as to when to expedite the birth? The woamn is giving birth not us & she needs to be in tune with her body and her baby not what we need to do to allay our fears, or those of our hierachies.     Adrenaline is contagious & inhibititing in labour!   There are more signs that all is well than a FH and also there are signs that all is not well besides a FH, being fearfull at a birth is one. Similarly doing VE's so we can know ...........   We have all experienced women who have told midwives what is happening regardless or despite the VE similarly many women can tell us they know their baby is fine or not!   Now I am not saying do not do either !! I am saying midwives need higher skills than these!!   We need to develop empathy, high communication skills a 6th sense, (not to be trivialised) to be truly empowering, truly a midwife (with woman). What better start can a woman have to parenthood but to know she is intune with her baby and her body and she can trust herself & her feelings?? Is this not with woman??   If a woman is working with her body and full of endorphins, in a position that is not conducive to us getteing an FH do we disturb them to get that FH in our notes or we risk censure from others? Last night I was in a hospital and the doptone I had with this particular woman every time I used it brought on another contraction, so I was disturbing her labour making her work more than her body might otherwise have done!! I understand many women labour in Holland with out their midwives, in fact the midwives tell them to get on with it and  call their midwives when they feel the birth is iminent or or they need them!! Look at the outcomes, in Holland & everywhere. Women have given birth for thousands of years with out any one, they do it today, it is normal . Even in Africa where thay have x number of problems, yes they die but comparatively few & often not of obstructed labours etc, but because they have X number of diseases on top so they have no reserves!!   Again I am not saying we should leave them but I am saying when at birth (here) be realistic, (our women are healthy, they can & should be helped to listen, be aware of the workings of their bodies) supportive and a guardian of normalcy as we claim   we are suposed to be the supporters of normal, women who listen to their bodies and feel confident THEY know when to expedite the labour (they try to get off beds in hospitals where our profession has helped put them!!) They know when to call for help and when they know we will support them in their knowledge and understanding/attempts to help themselves and their babies  they will call Midwives first as they do in Holland!!   Even Florence is credited with saying First do no Harm!!   Do any one know what the Dutch or Kiwi giudelines are for FH monitoring ??? Denise   Denise       ----- Original Message ----- From: Mary Murphy To: [EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 4:56 PM Subject: Re: [ozmidwifery] fetal heart in labour I acknowledge that Lesley & I are at odds on this question.  The informed choice guidelines ask some very important questions: "How do fetal heart rate patterns reflect foetal compromise?  The understanding and interpretation of variations in the foetal heart rate are still in it's infancy."  My observation is that there has been more harm done to mothers and babies from overzealous monitoring of foetal heart tones and the reaction to normal patterns that sound scary, than there has been from the more traditional frequency of auscultation. Denise asks a very valid question: "when does intermittent auscultation become continuous auscultation (listening after every contraction?) and an intervention in normal progress of birth?? " Cheers, MM I would really appreciate some opinions on frequency of listening to the FH in labour, particularly the second stage. I've always listened in every half hour in early labour, 15 minutely in cracking labour and after every contraction (and through some of them) in the second stage. I know of some midwives who do not feel this is necessary and so I'd love to hear more opinions. What I wonder is if the FH is not being listened in to how would you know whether to expedite the birth? Also if the worst happened how would it stand up in court? Thanks Lesley