Dear Mandy,
Very eloquent and well researched. In your hands a partogram may well
be an overview, and may well be a personally important tool and I
indeed can respect that.
However the monster arose from Frankenstein and had to be slain.
Midwives providing continual one on one care should be constantly
assesing and re-assesing the people in her/his care.
O'driscoll and lines of intervention be damned correlation of all
factors should be assessed closely not just dilational progress and
decent.
The emotional "am I ready to be a mother and the" and the consequence
of unresolved emotional decisions are as important. The physical
indicators are vast and varied and often the overviewing markers in the
partogram blinker one to the holistic nature of birth.
A crime so well exemplified by the Cardio-Toco Graph me thinks.
Yes criticsm abounds but to be with woman is that to sense to direct to
observe and to correlate. To act when one needs to and to allow nature
take its course when no risk is evident.
A partogram does not and cannot exist that holistically observes a
birthing woman and her child environment and support spiritually,
physically and emotionally.
Of course this is just my opinion, but whatever was the original force
behind the partogram it truly has been bastardised and is responsible
for the oppression of the natural birthing ability of many women.
yours with respect and love.
Nigel.
--- Mandy O'Reilly <[EMAIL PROTECTED]> wrote:
> The partogram was not created for the convenience of
> doctors. It was in
> fact created as a tool for all health professionals
> (by that read
> midwives & traditional birth attendants too) who
> care for the birthing
> women. The aim of the partogram was to provide a
> precise overview of the
> labouring women's situation and progress. It was
> introduced by WHO in
> 1993, as part of a program to decrease the very
> real and very tragic
> number of mothers and babies that die as a result of
> labour
> mismanagement and obstructed labour. To the best of
> my knowledge
> Indonesia was one of the major designated trial
> sites for the partogram
> and midwives were extensively involved in this
> process. (1994).
>
> The partogram was based on the work of Philpott &
> Castle (1972). I was
> introduced to and worked with the original version
> "The Philpott Chart"
> as a midwifery student 20 years ago. The chart is
> well research and
> based on normal labour. Research shows that a
> "fifth of primigravida
> crossed the action line and 10- 11% the alert
> line."
>
> In other words a great many women in established
> labour conform to the
> pattern predicted by the partogram. The purpose of
> the partogram as we
> now know it is to enable the person caring for the
> birthing women to
> critically analyse the situation and care for the
> women accordingly. It
> does not mean you HAVE to do 4 hourly vaginal exams.
> If you are able to
> judge the progress of labour by decent of head
> pelvically (is that not
> what we are all supposed to do before a vag exam)
> and by other means
> that's great and very women centred. It merely
> gives you a framework
> that can be used to confirm the normal or warn the
> midwife/ doctor of
> deviations. It is an evaluation and analysis tool.
>
>
> This may be vital in certain situations. As a
> homebirth midwife who may
> have been awake for over 20 hrs with a labouring
> women the ability to
> use a decision making tool might crucially aid the
> midwife to correctly
> assess the situation Certainly if one is a rural
> midwife 4 - 6 hrs by
> road away from any assistance the difference could
> be life or death.
>
> I do not believe that the use of a partogram impacts
> on our ability to
> give women centred midwifery care. The difference is
> in how you
> interpret and act on that information not on the
> tool used. If you
> assess that a women's contractions are the problem
> that definitely
> requires attention: in the medical model you use
> pitocin in the
> midwifery model you do other things, like reassuring
> the women,
> assisting her with natural methods of pain control,
> support, maybe even
> herbs before the pitocin.
>
> Yes, birth is a natural and physiological process
> and I absolutely vote
> for the midwifery model. But with that comes
> accountability and evidence
> based practice. As we all know that when things go
> wrong they can go
> very wrong. In this profession there are "guns and
> roses" and I am quite
> happy to use the partogram as a tool if it enables
> me to think
> critically regarding the care of a birthing women.
> In hospital or out.
>
> As a matter of interest I wonder how many of you are
> using the actual
> WHO partogram which has action and alert lines
> demarcated on it.
>
> Regards
>
> Mandy O'Reilly
>
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===
>From Cathy Bock and Nigel Duncan.
at
BIRTHING HANDS (Homebirth, ante/post natal care and hospital support)
[EMAIL PROTECTED]
0414 886827 or 0414 554840
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