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Once a month, where I work, we have a Practice Improvement
Committee Meeting. Here midwives and obstetricians gather to
discuss the ongoing direction of our unit, (low risk, mainly midwife
led). We also discuss any adverse outcomes together, no finger pointing,
no laying of blame, to make sure that in that same situation next time
we can all work better as a team for the greater good of the woman, her
baby, and her family.
So far, this has worked very well.
Sally
-------Original
Message-------
Date: 07/30/05
21:25:46
Subject: Re:
[ozmidwifery] intermittent auscultation
This is so true.
We constantly have to justify our belief in the natural process of
birth and
should a mishap happen in midwifery care, the midwife is all but
burnt at
the stake.
By contrast, most hospitals have regular mortality meetings to
discuss
medical mishaps, these are "in house" and only for the purpose of
medicos
discussing amongst themselves. The results are not for sharing with
midwives
or any other interested parties.
I often wonder why it is that so much utter stupidity becomes
common
practice - not only in medical circles - and yet the common sense
approach
is ignored, riduculed or just not taken seriously.
Sue
"The only thing necessary for the triumph of evil is for good men
to do
nothing"
Edmund Burke
----- Original Message -----
Sent: Saturday, July 30, 2005 9:33 AM
Subject: Re: [ozmidwifery] intermittent auscultation
>I notice that it is expected that Midwives base their practice
on evidence
>& research.
> It would appear on the other hand that the medical profession
are able to
> practice on whatever they believe. They do not feel obliged to
justify
> their preference or practice.
> Why is this so?
> Why are midwives always feeling they must justify
themselves?
> Why do you allow it ?
> Who in fact are we accountable to in real life?
> Our clients, ourselves & our peers only ? Or
..............??
>
> Brenda
>
> ----- Original Message -----
> Sent: Saturday, July 30, 2005 11:15 AM
> Subject: RE: [ozmidwifery] intermittent auscultation
>
>
>> Pete, the only problem is that the "somebodies", in
positions of power,
>> have
>> set a standard that "a reasonable midwife" has to adhere
to, or suffer
>> the
>> consequences if there is an adverse outcome, ie, a dead or
compromised
>> baby.
>> Also, when one is employed by the Govt. there is an
expectation that the
>> standard will be adhered to. There was not
extensive trials or even
>> large
>> scale retrospective research to compare 1/2 hrly or 1/4
hrly to
>> continuous
>> EFM. Unfortunately, common sense does not
prevail. When we don't have
>> the
>> midwifery research knowledge to back it up, we have no
other choice. I
>> wish
>> it were otherwise, MM
>>
>> se- d-oes -n--Original Message-----
>> Sally I agree with what both you and Gloria are saying,
with a low risk
>> women term and all progressing well in labour where is the
evidence to
>> support any auscultation, I also believe that it can he
horribly
>> invasive and could easily be construed as
intervention. Surely as
>> professionals we can use our skills to make the call on
whether
>> auscultation is needed or not. I also believe
that there can be a lot
>> of angst built up over listening too often in what in most
situations is
>> the normal physiology of 2nd stage.
>>
>> yours in midwifery pete malavisi
>>
>> On Fri, 29 Jul 2005 16:24:32 +0800, "Sally Westbury"
>>>
>>> OK. What the Nice Guideline have based the bulk of
their guideline on
>>> are the following three studies. All of these studies
have randomized
>>> high and low risk pregnancies.
>>>
>>>
>>> I would like to propose that the auscultation
intervals set are
>>> reflective of a lack of risk screening.
>>>
>>>
>>> I would like to us think about is whether it is
appropriate to try to
>>> translate these auscultation interval to a low risk
client group??
>>>
>>>
>>> What do other people thinks??
>>>
>>>
>>>
>>>
>>>
>>> Efficacy and safety of intrapartum electronic fetal
monitoring: an
>>> update
>>>
>>> SB Thacker, DF Stroup, and HB Peterson
>>>
>>> STUDY SELECTION: Our search identified 12 published
RCTs addressing the
>>> efficacy and safety of EFM; no unpublished studies
were found. The
>>> studies included 58,855 pregnant women and their
59,324 infants in both
>>> high- and low-risk pregnancies from ten clinical
centers in the United
>>> States, Europe, Australia, and Africa. DATA
>>>
>>>
>>> Vintzileos, A. M. et al. 1993. "A randomized trial of
intrapartum
>>> electronic fetal heart rate monitoring versus
intermittent
>>> auscultation." Obstetrics & Gynecology
81:899-907.
>>>
>>> METHODS: The study was conducted simultaneously at two
university
>>> hospitals in Athens, Greece (Alexandra and Marika
Iliadi Hospitals) from
>>> October 1, 1990 to June 30, 1991. All patients with
singleton living
>>> fetuses and gestational ages of 26 weeks or greater
were eligible for
>>> inclusion. The participants were assigned to
continuous EFM or
>>> intermittent auscultation based on the flip of a
coin.
>>>
>>>
>>>
>>>
>>>
>>>
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>>
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