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 whenelse do we feel we need to takea pulse or other checks that all is as it appears normal?2) That it is thewoman' 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 theloop 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 itand 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 professionhashelped 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 Midwivesfirst 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
Re: [ozmidwifery] fetal heart in labour
Denise, at one levelI agree with you, on another, I couldn't feel comfortable if I hadn't been checking about every half hour, or more often if the labour was really hard and fast.Conditioning maybe? However, after experiencing a stillbirth in 2nd stge labour at home many years ago, I do know that neither the mother or the midwives (2 of us) knew anything about it until the baby was seen to be limp at birth. I realise that more frequent FH wouldn't have "saved" the baby because one couldn't even get to O.T for a C/S in the time it took for baby's HR to stop. A terrible experience for us all. MM
Re: [ozmidwifery] fetal heart in labour
Well I always think that when evrything is going really well and smoothly in labour with no problems then frankly anyone could help at a birth. A midwife is there in order to act quickly when things begin to move away from normality and use her skills to deal with the situation - Original Message - From: Denise Hynd To: [EMAIL PROTECTED] 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 whenelse do we feel we need to takea pulse or other checks that all is as it appears normal?2) That it is thewoman' 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 theloop 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 itand 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 professionhashelped 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 Midwivesfirst 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
Re: [ozmidwifery] fetal heart in labour
Oops, accidentally hit a button which sent off my unfinished email! Sorry. What I was saying was that in the second stage of labour it is possible to hurry a birth along if the condition of the baby deteriorates but how would you know that if you weren't listening in? I can think of 2 instances at home where because of listening after each contraction I was aware of deterioration and so urged huge pushes and (I admit) did episiotomies to get the baby out quickly and in each case the baby was folowed by a lake of meconium and poor apgars but were resuscitatable(?). Would these have been stillbirths otherwise? Who knows but I for one wouldn't be prepared to take the risk of not knowing what was going on. I also feel it needn't be at all intrusive to listen in; it can be done in any position and very gently and women are usually pleased to hear it. Really, any old one can be at an easy, no problem birth; we're not essential for those but we can certainly make a difference when things don't go quite so smoothly. Cheers Lesley - Original Message - From: Denise Hynd To: [EMAIL PROTECTED] 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 whenelse do we feel we need to takea pulse or other checks that all is as it appears normal?2) That it is thewoman' 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 theloop 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 itand 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 professionhashelped 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 Midwivesfirst 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
Re: [ozmidwifery] fetal heart in labour
Dear Mary As I said in my email I am and was not saying do or not take the FH every half hour or any particular time. Rather I was am asking for reflection on why an insistence on an arbitary time pattern for FH and what is the impact of what we are saying is"safe" practice and for whom? I am concerned insistance without consideration of the impact, especiallythe insistance of after every contraction . Is the latter not the equivalent of continuous monitoring ?The research supports intermittent over continuous with the latter linked to increased intervention with no improvement in fetal outcomes! I am also asking for midwives to develop more than skills in charting the FH in facilitating a safe and effective progress of labour, particulalry knowing the impact of the psycho-social environment on the progress of labour for example theinhibiting impact of adrenaline and the converse how to support the flow of oxytocins and endorphins in the woman which will "expedite" the birth !! I understand the risks and the heart ache of sudden death, but no matter what we do, we shall not be in control and save everyone that is what the escalating C/s is partly about! Denise - Original Message - From: Mary Murphy To: [EMAIL PROTECTED] Sent: Wednesday, December 03, 2003 6:31 PM Subject: Re: [ozmidwifery] fetal heart in labour Denise, at one levelI agree with you, on another, I couldn't feel comfortable if I hadn't been checking about every half hour, or more often if the labour was really hard and fast.Conditioning maybe? However, after experiencing a stillbirth in 2nd stge labour at home many years ago, I do know that neither the mother or the midwives (2 of us) knew anything about it until the baby was seen to be limp at birth. I realise that more frequent FH wouldn't have "saved" the baby because one couldn't even get to O.T for a C/S in the time it took for baby's HR to stop. A terrible experience for us all. MM
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
RE: [ozmidwifery] fetal heart in labour
the only reason to listen to the fh is to assess for fetal wellbeing/coping with the stress of labour. the reason you listen before during and after a contraction (not everytime, possibly, but certainly if there is any decelerations noted) is to get a good'feel' of what the heart rate is doing. i agree that some perfectly normal fh patterns can sound scary, however if you KNOW this baby and what it is doing in response to labour, you are much better at judging what is happening in regards to any decelerations, and consequently, are much less likely to over-react to 'scary' fh patterns. love Bethany -Original Message- From: Mary Murphy [mailto:[EMAIL PROTECTED] Sent: Tuesday, 2 December 2003 16:57 To: [EMAIL PROTECTED] 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 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] fetal heart in labour
Dear Lesley, Checking in my little Evidence based guidelines for midwifery led care in labour produced by NHS Sheffield Teaching Hospital, page 12 says all about fetal heart rate monitoring: - every 15 minutes during first stage - every 5 minutes in the second stage Hope this helps Ping Bullock --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.545 / Virus Database: 339 - Release Date: 27/11/2003 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] fetal heart in labour
With this question I would also ask you all to consider when does intermittent auscultation become continuous auscultation (listening after every contraction?) and an intervention in normal progress of birth??Denise Hynd - Original Message - From: Lesley Kuliukas To: [EMAIL PROTECTED] Sent: Monday, December 01, 2003 9:10 PM Subject: [ozmidwifery] fetal heart in labour Hi all 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
Re: [ozmidwifery] fetal heart in labour
The following are extracts from the MIDIRS Informed choice leaflet for professionals 2.Fetal heart rate monitoring in labour , and the NICE The use of electronic fetal monitoring: The use and interpretation of cardiotocography in intrapartum fetal surveillance-Guideline C .The full articles can be found at http://www.midirs.org/nelh/nelh.nsf/welcome?openform and http://www.nice.org.uk/cat.asp?c=20051 respectively .The question of listening during a contraction interests me , as none of the guidelines I've read recommend it but it seems to be common practice .Apart from appearing uncomfortable and difficult, my understanding is that heart rate changes during the contraction are normal so can anyone tell me the reason for listening during a contraction? Cheers, David Intermittent auscultation (IA) with a stethoscope (eg Pinard) or hand-held doppler device. Typically, the fetal heart rate is measured for one minute after a contraction every 15-30 minutes during the first stage of labour and after every maternal push during the second stage. As it is obtained in a non-permanent format, it requires the midwife to make contemporaneous records of the observations of the fetal heart rate in the woman's notes. 2.3. Appropriate monitoring in an uncomplicated pregnancy A For a woman who is healthy and has had an otherwise uncomplicated pregnancy, intermittent auscultation should be offered and recommended in labour to monitor fetal wellbeing. A In the active stages of labour, intermittent auscultation should occur after a contraction, for a minimum of 60 seconds, and at least: Every 15 minutes in the first stage. Every 5 minutes in the second stage. Continuos EFM should be offered and recommended in pregnancies previously monitored with intermittent auscultation If there is evidence on auscultation of a baseline less than 110 or greater than 160 bpm. If there is evidence on auscultation of any decelerations. If any intrapartum risk factors develop. B Current evidence does not support the use of the admission cardiotocography (CTG) in low-risk pregnancy and it is therefore not recommended. - Original Message - From: Lesley Kuliukas To: [EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 12:10 AM Subject: [ozmidwifery] fetal heart in labour Hi all 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
