Re: [ozmidwifery] fetal heart in labour

[Elissa and David]

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