Re: Re: [ozmidwifery] ctg stuff
Well said, Sue. There are 2 sides to the face of the choice coin...we may not agree with some women's choices, but if they are adamant and they have been given all the pros and cons then, really, who are we to dictate to them about what they choose? Sally - Original Message - From: Susan Cudlipp To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 2:20 PM Subject: Re: Re: [ozmidwifery] ctg stuff Choice is an interesting concept: if we trulysupport choice then surely even 'bad' choices should be respected? One of our obs has joked about having a sign made for the ANC saying 'please do not ask for an induction as a refusal often offends' because the request comes so often. However, the other obs will often agree to a woman's request without too much argument. I have seen instances where the Ob has told the woman - you are not ready to birth, there is no reason to induce and if we try you will have a lengthy and horrible labour. The reply was "I DONT CARE- I WANT TO BE INDUCED" How can the ob refuse in this instance? The reverse is not true - if a woman reaches T+10 she is booked for IOL - there is little 'choice' within our policy for anyone who wishes to wait longer - despite the evidence or the individual circumstances. Occasionally requests for'social' induction can be for very valid personal reasons and such instances should also be respected. I have discussed with some of our obsthe mentality of agreeing to elective C/S for no other reason than maternal request, given that we are a public hospital -should we bewasting taxpayers money on non-essential surgery etc etc. Again the question of choice. If a woman demands an elective C/S despite discussion of the pros and cons, the usual route is to go with her wishes - presumably for fear of litigation if the birth does not go well. I did challenge one ob who agreed without hesitation to a woman's request for repeat C/S and asked him what his attitude would have been if she had asked for VBAC - did not get much in the way of response! Not saying that I agree with this you understand but it does cause some tricky moral dilemmas. I feel the key issue is one of respect and honest discussion - ah but that is all too often missing within the medical model of care. That and education - women don't know that they have choices to challenge the usual practice of whoever their care provider happens to be, sadly those who do challenge are often seen as 'troublesome radicals' if their challenge is against 'routine' interventions. (Of course they are not seen the same way if their challenge is to request unecessary interventions! :-)) Sue - Original Message - From: Emily To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 8:49 AM Subject: Re: Re: [ozmidwifery] ctg stuff hi all i have just finished the 'obstetrics' term of my course and over the 9 weeks i repetitively brought up my disgust with the use of CTGs against all the very high quality evidence that is out there against them, that noone refutes they just ignore. the wonderful obstetrician who was my supervisor (only one ive ever met that i like) agreed and said it is only collective inertia and fear that has led to everyone still using it. the fact that it has sneakily become the best practice standard. in the big cochrane review on the subject the only benefit seen was a reduction in neonatal seizures seen in the CTG group. this was used as evidence that it may reduce the incidence of cerebral palsy in this group also. actually, there was follow up studies done on all the studies included in the review some years later and it actually showed no difference in cerebral palsy rates in most studies. one study amazingly actually showed a higher rate of cerebral palsy in the CTG group !! this has been conveniently forgotten. CTGs are still sold to women as being a safety net to prevent cerebral palsy despite the fact that there is absolutely no evidence whatesoever of this being the caseall that remains to be the benefit of CTGs is for care providers. it makes many people feel safe to have a neat little print off documenting what has been happening. the other thing is that apparently in the court system, parents can only be 'compensated' if a no fault verdict is made and that requires a CTG. anyway i wrote a huge article about this titled 'the irony of obstetric risk analysis' and handed it in with my end of term work. i am waiting with bated breath to hear the feedback and whether i will fail for being so blatently anti-obstetrics to my obstetric supervisors!!! but i figured t
Re: Re: [ozmidwifery] ctg stuff
"if we trulysupport choice then surely even 'bad' choices should be respected?" Why? Solely in the name of blindly supporting "choice" as a concept? How does this benefit Mothers and babes?We also have the choice to beat our children, men have the choice to rape women, and we can also choose to be cruel to helpless animals if we like. Should we respect these "choices" so as to indiscriminately uphold the paradigm of choice? Of course not. Why are innately harmful birthing choices (that affect not only the birthing woman but also her child) any different? If a Mother has made the decision to bring her child to birth, then shouldn't the Mother and babe be able to do so as optimally and safelyas possible - why is the "choice" to do so by mutilation and trauma even available, where it is not optimal practice? Besides which, do women birthing truly have "choice"? Or are the options they are TOLD they have presented to them by a patriarchal system directed at pacifying and controlling them in order to maintain the status quo and secure the balance of power; rewarding "good" (compliant) behaviour and brutally punishing "bad" (well-informed and assertive) behaviour? Women aren't making their "choices" in a vacuum and the incredible external pressures and aggressive campaign of misinformation they face strongly influences any directions they may take. We're far too focused on the choice and not focused enough on the Mothers and babes at the mercy of those choices. We need to stop singing about "choice" and focus on the facts; change the system, squash the misinformation,advocate for safety of Mother and baby, place the power back in their hands, and not be afraid to get REAL. Political correctness has no place in birth and nor does beauracracy. - Original Message - From: Susan Cudlipp To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 2:20 PM Subject: Re: Re: [ozmidwifery] ctg stuff Choice is an interesting concept: if we trulysupport choice then surely even 'bad' choices should be respected? One of our obs has joked about having a sign made for the ANC saying 'please do not ask for an induction as a refusal often offends' because the request comes so often. However, the other obs will often agree to a woman's request without too much argument. I have seen instances where the Ob has told the woman - you are not ready to birth, there is no reason to induce and if we try you will have a lengthy and horrible labour. The reply was "I DONT CARE- I WANT TO BE INDUCED" How can the ob refuse in this instance? The reverse is not true - if a woman reaches T+10 she is booked for IOL - there is little 'choice' within our policy for anyone who wishes to wait longer - despite the evidence or the individual circumstances. Occasionally requests for'social' induction can be for very valid personal reasons and such instances should also be respected. I have discussed with some of our obsthe mentality of agreeing to elective C/S for no other reason than maternal request, given that we are a public hospital -should we bewasting taxpayers money on non-essential surgery etc etc. Again the question of choice. If a woman demands an elective C/S despite discussion of the pros and cons, the usual route is to go with her wishes - presumably for fear of litigation if the birth does not go well. I did challenge one ob who agreed without hesitation to a woman's request for repeat C/S and asked him what his attitude would have been if she had asked for VBAC - did not get much in the way of response! Not saying that I agree with this you understand but it does cause some tricky moral dilemmas. I feel the key issue is one of respect and honest discussion - ah but that is all too often missing within the medical model of care. That and education - women don't know that they have choices to challenge the usual practice of whoever their care provider happens to be, sadly those who do challenge are often seen as 'troublesome radicals' if their challenge is against 'routine' interventions. (Of course they are not seen the same way if their challenge is to request unecessary interventions! :-)) Sue - Original Message - From: Emily To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 8:49 AM Subject: Re: Re: [ozmidwifery] ctg stuff hi all i have just finished the 'obstetrics' term of my course and over the 9 weeks i repetitively brought up my disgust with the use of CTGs against all the very high quality evidence that is out there against them, that noone refutes they just ignore. the wonderful ob
RE: Re: [ozmidwifery] ctg stuff
Hi Emily, Good on you! As far as induction and c/s on demand the rule of weighing up the benefits vs risks still applies. Some women's emotional state may make it sensible although regrettable, to concur with their wishes. However, if you have been caring for a woman throughout her pregnancy, and have build up a good trusting relationship, I think this situation would be rare. Women don't feel safe in our disjointed system, where they can see up to 25 health professionals in one childbearing experience. Warm regards,Nicole Carver. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of EmilySent: Saturday, June 17, 2006 10:49 AMTo: ozmidwifery@acegraphics.com.auSubject: Re: Re: [ozmidwifery] ctg stuffhi all i have just finished the 'obstetrics' term of my course and over the 9 weeks i repetitively brought up my disgust with the use of CTGs against all the very high quality evidence that is out there against them, that noone refutes they just ignore. the wonderful obstetrician who was my supervisor (only one ive ever met that i like) agreed and said it is only collective inertia and fear that has led to everyone still using it. the fact that it has sneakily become the best practice standard. in the big cochrane review on the subject the only benefit seen was a reduction in neonatal seizures seen in the CTG group. this was used as evidence that it may reduce the incidence of cerebral palsy in this group also. actually, there was follow up studies done on all the studies included in the review some years later and it actually showed no difference in cerebral palsy rates in most studies. one study amazingly actually showed a higher rate of cerebral palsy in the CTG group !! this has been conveniently forgotten. CTGs are still sold to women as being a safety net to prevent cerebral palsy despite the fact that there is absolutely no evidence whatesoever of this being the caseall that remains to be the benefit of CTGs is for care providers. it makes many people feel safe to have a neat little print off documenting what has been happening. the other thing is that apparently in the court system, parents can only be 'compensated' if a no fault verdict is made and that requires a CTG. anyway i wrote a huge article about this titled 'the irony of obstetric risk analysis' and handed it in with my end of term work. i am waiting with bated breath to hear the feedback and whether i will fail for being so blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres less harm saying it all now, on my way out :)the reason im writing this is that the (good) obstetrician wants me to put together my views on social inductions and social elective caesars and how we should respond to women who sometimes demand these things and whether it is ethical to refuse. im really struggling with it because if we all always say inform and then follow the mothers wishes, what right do we have to refuse this? it is often for what i see as ridiculous reasons (ie the woman recently who demanded an induction so she wouldnt birth on 6/6/06 and threatened to kill herself if we didnt) but who am i to judge women's choices like others judge non-interventionalist choices?id love to know everyones thoughts on this one love emily Do you Yahoo!?Everyone is raving about the all-new Yahoo! Mail Beta.
Re: Re: [ozmidwifery] ctg stuff
By 'bad' I meant -choices that I or most midwives would disagree with - such as social (non-medically indicated) induction or elective C/S. They might be 'bad' choices in my view but there are plenty of intelligent women out there whose views are opposite to mine. I may disagree, I may attempt to inform (and I do, often), I may even avoid caring for them, but I cannot ultimately make their choice for them. They are making choices regarding what happens to their own bodies, not anyone else's, so it cannot be put in the same context as rape or child beating- I know that these choicesaffectbabies too, but because they are so commonplace it is hard to convince women that their choice to intervene unecessarily might also impact negatively on the baby. An example was on front of me recently: a mum had a child with Leukaemia, was due to birth the second one. Life was getting very hard with the care of sick child and increasing pregnancy, she asked to be induced early to make this time easier, for all sorts of personal reasons as well as medical ones. This was not the best option for babe-to-come, not the best birthing option for mum-to-be but it was the best option for the family unit as a whole. Who would deny this woman's choice in this situation? Have you ever tried to talk a smoker into quitting? The evidence is undisputably in their face but the choice to continue or not is theirs to make. Yes, misinformation must be fought. Yes, women must have good support and advocacy. Yes, to all those things but do we want to be accused of forcing 'our' beliefs on women?Because our truth is not necessarily their truth. Love this stimulating discussion - and please know that I am in no way trying to offendanyone, just playing Devil's advocate :-) Sue - Original Message - From: Stephen Felicity To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 3:21 PM Subject: Re: Re: [ozmidwifery] ctg stuff "if we trulysupport choice then surely even 'bad' choices should be respected?" Why? Solely in the name of blindly supporting "choice" as a concept? How does this benefit Mothers and babes?We also have the choice to beat our children, men have the choice to rape women, and we can also choose to be cruel to helpless animals if we like. Should we respect these "choices" so as to indiscriminately uphold the paradigm of choice? Of course not. Why are innately harmful birthing choices (that affect not only the birthing woman but also her child) any different? If a Mother has made the decision to bring her child to birth, then shouldn't the Mother and babe be able to do so as optimally and safelyas possible - why is the "choice" to do so by mutilation and trauma even available, where it is not optimal practice? Besides which, do women birthing truly have "choice"? Or are the options they are TOLD they have presented to them by a patriarchal system directed at pacifying and controlling them in order to maintain the status quo and secure the balance of power; rewarding "good" (compliant) behaviour and brutally punishing "bad" (well-informed and assertive) behaviour? Women aren't making their "choices" in a vacuum and the incredible external pressures and aggressive campaign of misinformation they face strongly influences any directions they may take. We're far too focused on the choice and not focused enough on the Mothers and babes at the mercy of those choices. We need to stop singing about "choice" and focus on the facts; change the system, squash the misinformation,advocate for safety of Mother and baby, place the power back in their hands, and not be afraid to get REAL. Political correctness has no place in birth and nor does beauracracy. - Original Message - From: Susan Cudlipp To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 2:20 PM Subject: Re: Re: [ozmidwifery] ctg stuff Choice is an interesting concept: if we trulysupport choice then surely even 'bad' choices should be respected? One of our obs has joked about having a sign made for the ANC saying 'please do not ask for an induction as a refusal often offends' because the request comes so often. However, the other obs will often agree to a woman's request without too much argument. I have seen instances where the Ob has told the woman - you are not ready to birth, there is no reason to induce and if we try you will have a lengthy and horrible labour. The reply was "I DONT CARE- I WANT TO BE INDUCED" How can the ob refuse in this instance? The reverse is not true - if a woman reaches T+10 she is booked for IOL - there is little 'choice' within ou
Re: Re: [ozmidwifery] ctg stuff
Hi Emily, Could you please email me off list? Re your supervisor's request. Regards, Lynne - Original Message - From: Emily To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 10:49 AM Subject: Re: Re: [ozmidwifery] ctg stuff hi all i have just finished the 'obstetrics' term of my course and over the 9 weeks i repetitively brought up my disgust with the use of CTGs against all the very high quality evidence that is out there against them, that noone refutes they just ignore. the wonderful obstetrician who was my supervisor (only one ive ever met that i like) agreed and said it is only collective inertia and fear that has led to everyone still using it. the fact that it has sneakily become the best practice standard. in the big cochrane review on the subject the only benefit seen was a reduction in neonatal seizures seen in the CTG group. this was used as evidence that it may reduce the incidence of cerebral palsy in this group also. actually, there was follow up studies done on all the studies included in the review some years later and it actually showed no difference in cerebral palsy rates in most studies. one study amazingly actually showed a higher rate of cerebral palsy in the CTG group !! this has been conveniently forgotten. CTGs are still sold to women as being a safety net to prevent cerebral palsy despite the fact that there is absolutely no evidence whatesoever of this being the caseall that remains to be the benefit of CTGs is for care providers. it makes many people feel safe to have a neat little print off documenting what has been happening. the other thing is that apparently in the court system, parents can only be 'compensated' if a no fault verdict is made and that requires a CTG. anyway i wrote a huge article about this titled 'the irony of obstetric risk analysis' and handed it in with my end of term work. i am waiting with bated breath to hear the feedback and whether i will fail for being so blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres less harm saying it all now, on my way out :)the reason im writing this is that the (good) obstetrician wants me to put together my views on social inductions and social elective caesars and how we should respond to women who sometimes demand these things and whether it is ethical to refuse. im really struggling with it because if we all always say inform and then follow the mothers wishes, what right do we have to refuse this? it is often for what i see as ridiculous reasons (ie the woman recently who demanded an induction so she wouldnt birth on 6/6/06 and threatened to kill herself if we didnt) but who am i to judge women's choices like others judge non-interventionalist choices?id love to know everyones thoughts on this one love emily Do you Yahoo!?Everyone is raving about the all-new Yahoo! Mail Beta.
Re: Re: [ozmidwifery] ctg stuff
hi all i have just finished the 'obstetrics' term of my course and over the 9 weeks i repetitively brought up my disgust with the use of CTGs against all the very high quality evidence that is out there against them, that noone refutes they just ignore. the wonderful obstetrician who was my supervisor (only one ive ever met that i like) agreed and said it is only collective inertia and fear that has led to everyone still using it. the fact that it has sneakily become the best practice standard. in the big cochrane review on the subject the only benefit seen was a reduction in neonatal seizures seen in the CTG group. this was used as evidence that it may reduce the incidence of cerebral palsy in this group also. actually, there was follow up studies done on all the studies included in the review some years later and it actually showed no difference in cerebral palsy rates in most studies. one study amazingly actually showed a higher rate of cerebral palsy in the CTG group !! this has been conveniently forgotten. CTGs are still sold to women as being a safety net to prevent cerebral palsy despite the fact that there is absolutely no evidence whatesoever of this being the case all that remains to be the benefit of CTGs is for care providers. it makes many people feel safe to have a neat little print off documenting what has been happening. the other thing is that apparently in the court system, parents can only be 'compensated' if a no fault verdict is made and that requires a CTG. anyway i wrote a huge article about this titled 'the irony of obstetric risk analysis' and handed it in with my end of term work. i am waiting with bated breath to hear the feedback and whether i will fail for being so blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres less harm saying it all now, on my way out :) the reason im writing this is that the (good) obstetrician wants me to put together my views on social inductions and social elective caesars and how we should respond to women who sometimes demand these things and whether it is ethical to refuse. im really struggling with it because if we all always say inform and then follow the mothers wishes, what right do we have to refuse this? it is often for what i see as ridiculous reasons (ie the woman recently who demanded an induction so she wouldnt birth on 6/6/06 and threatened to kill herself if we didnt) but who am i to judge women's choices like others judge non-interventionalist choices? id love to know everyones thoughts on this onelove emily Do you Yahoo!? Everyone is raving about the all-new Yahoo! Mail Beta.
RE: Re: [ozmidwifery] ctg stuff
It would be good if we could change the ordinary persons thinking from intervention is necessary to save lives and prevent bad outcomes- and that the trade- offs are minimal to the truth about how dangerous and ineffective they can be and how choosing one often means setting yourself up for the whole gamut of intervention. I think women who choose such interventions for non medical reasons in part do so because when they are done for medical reasons we are told that they are safe and in fact necessary to ensure a good outcome. There is an attitude that because it is so frighteningly common it must be safethe path most traveledmust be safe! We all know that it is not actually the case, women and their babies fare so much better, emotionally and physically when empowered to birth under their own steam. It is not about judging women but changing the climate so to speakchanging the common assumption that hospital birthing with its vast array of aids and interventions is the be all and end all of safe birthing, this is obviously a harder task. In the mean timewomen will still want to birth in a multitude of ways... It just seems strange that it is easier to persuade the docs to intervene than to not interfere. Amy From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Emily Sent: Saturday, June 17, 2006 8:49 AM To: ozmidwifery@acegraphics.com.au Subject: Re: Re: [ozmidwifery] ctg stuff hi all i have just finished the 'obstetrics' term of my course and over the 9 weeks i repetitively brought up my disgust with the use of CTGs against all the very high quality evidence that is out there against them, that noone refutes they just ignore. the wonderful obstetrician who was my supervisor (only one ive ever met that i like) agreed and said it is only collective inertia and fear that has led to everyone still using it. the fact that it has sneakily become the best practice standard. in the big cochrane review on the subject the only benefit seen was a reduction in neonatal seizures seen in the CTG group. this was used as evidence that it may reduce the incidence of cerebral palsy in this group also. actually, there was follow up studies done on all the studies included in the review some years later and it actually showed no difference in cerebral palsy rates in most studies. one study amazingly actually showed a higher rate of cerebral palsy in the CTG group !! this has been conveniently forgotten. CTGs are still sold to women as being a safety net to prevent cerebral palsy despite the fact that there is absolutely no evidence whatesoever of this being the case all that remains to be the benefit of CTGs is for care providers. it makes many people feel safe to have a neat little print off documenting what has been happening. the other thing is that apparently in the court system, parents can only be 'compensated' if a no fault verdict is made and that requires a CTG. anyway i wrote a huge article about this titled 'the irony of obstetric risk analysis' and handed it in with my end of term work. i am waiting with bated breath to hear the feedback and whether i will fail for being so blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres less harm saying it all now, on my way out :) the reason im writing this is that the (good) obstetrician wants me to put together my views on social inductions and social elective caesars and how we should respond to women who sometimes demand these things and whether it is ethical to refuse. im really struggling with it because if we all always say inform and then follow the mothers wishes, what right do we have to refuse this? it is often for what i see as ridiculous reasons (ie the woman recently who demanded an induction so she wouldnt birth on 6/6/06 and threatened to kill herself if we didnt) but who am i to judge women's choices like others judge non-interventionalist choices? id love to know everyones thoughts on this one love emily Do you Yahoo!? Everyone is raving about the all-new Yahoo! Mail Beta.
Re: Re: [ozmidwifery] ctg stuff
I'd love a copy of that for the JB website, Emily, if you'd like to share and I'd love all your refs What you're describing in terms of "maternal choice" really needs a feminist critique to allow us to manage those "choices" in ways which are not harmful to women. Since induction and elec. c-secs are innately harmful, causing physical and emotional trauma to previously healthy women, we need to stop ranking all these "choices" as somehow equal. Surgery for no reason is no more healthy than formula feeding for no reason yet most of us struggle to work out what to do with cases where women request interventions with no medical need. I cannot support choices which are at heart harmful to women and babies in exactly the same way as I cannot support women to lie down in the middle of the highway despite it being their "choice" so to do. If surgeons weren't setting the agenda, we wouldn't perceive these interventions as normal and healthy. (Thecrap that so many Obs talk to make VB sound like a risky, dangerous, illinformed choice!)Lots of work to do there! You'd really benefit in this from the recent MASSIVE discussions on JB around choice and what many of us feel is more important still - maternal control. J
Re: Re: [ozmidwifery] ctg stuff
www.joyousbirth.info Susan Cudlipp [EMAIL PROTECTED] wrote: What is the JB website please? Sue "The only thing necessary for the triumph of evil is for good men to do nothing"Edmund Burke - Original Message - From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 10:26 AM Subject: Re: Re: [ozmidwifery] ctg stuffI'd love a copy of that for the JB website, Emily, if you'd like to share and I'd love all your refsWhat you're describing in terms of "maternal choice" really needs a feminist critique to allow us to manage those "choices" in ways which are not harmful to women. Since induction and elec. c-secs are innately harmful, causing physical and emotional trauma to previously healthy women, we need to stop ranking all these "choices" as somehow equal. Surgery for no reason is no more healthy than formula feeding for no reason yet most of us struggle to work out what to do with cases where women request interventions with no medical need. I cannot support choices which are at heart harmful to women and babies in exactly the same way as I cannot support women to lie down in the middle of the highway despite it being their "choice" so to do. If surgeons weren't setting the agenda, we wouldn't perceive these interventions as normal and healthy. (Thecrap that so many Obs talk to make VB sound like a risky, dangerous, illinformed choice!)Lots of work to do there! You'd really benefit in this from the recent MASSIVE discussions on JB around choice and what many of us feel is more important still - maternal control.J No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.394 / Virus Database: 268.9.0/368 - Release Date: 16/06/2006 Yahoo! Sports Fantasy Football 06 - Go with the leader. Start your league today!