----- Original Message -----
Sent: Wednesday, December 03, 2003 4:08
PM
Subject: Re: [ozmidwifery] fetal heart in
labour
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 -----
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