Hi Jo and all: This timing of listening to fetal hearts keeps coming up and I find it concerning. Having worked and studied in the USA in homebirths and been to workshops with Ina May Gaskin et al., I do not recall any of my mentors there even debating whether to listen to the FH or not during labour and birth. I want to make it clear I am talking about studying in the heartland of homebirth in the USA not some obstetric hospital there. Now we have all been to births where the last thing you have time for is getting an obligatory fetal heart before the baby is born but that is a no-brainer and a quite different situation from a midwife in attendance at a birth not listening to the baby to avoid disturbing the ambience/mood of the mother. On our very first interview with our mothers to be we discussed how mother and baby would be monitored in labour the frequency etc., our transfer policies, there were no surprises in store for the women. Our women were happy to have their BP, pulse and temp monitored in labour and understood why and how often we would do this, they were also happy for us to listen to the baby at 30 min, 15 min, and between ctx intervals we would discuss doing this with headphones if using a doppler, or using a pinards or a fetoscope if they didn't want the u/s technology used. As I think Lesley said, there are many births that the neighbour lady could have popped in to catch in which these monitorings are nothing more than reassuring and they could lull you into believing they aren't necessary, what we are there for is to catch the anomolous birth where things aren't quite right and decisions need to be made. Also as has been said things can appear normal if you aren't monitoring when in fact they aren't, sometimes mothers become aware that something is amiss and other times they don't. Particularly when you have prolonged first or second stage I believe you need to be listening for fetal well being.
In the practices I worked in our transfer rate was low (between 10 to 20 % depending on the proportion of primips in the practice at any point in time) as was the c/s rate (5%). I have to say that I have never been present at a homebirth where the monitoring appeared to have a negative effect by increasing fear/angst, adrenaline etc, though theoretically I can see and understand the argument. Quite honestly I had never even heard intermittent auscultation as being a problem until I read it on this list. I know that studies have linked efm and ctg's with increased intervention and so we do need to be aware of the misuse and misunderstanding of technology (it is my understanding that it is not the trace so often that is wrong as the interpretation of the trace as could be the interpretation of decels heard by doppler). I do think we need to be cautious about what we discard or want discarded and I don't think mothers or fathers need to fear their midwife listening to the fetal heart: it should be reassuring. marilyn ----- Original Message ----- From: "jo hunter" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Friday, December 05, 2003 12:23 AM Subject: Re: [ozmidwifery] Fwd: response from Pat and Nicky > Hi Nicole, > Great to see you the other day - even though brief. > About the hospital run homebirth service, I think that alot of the comments > that are seen as negative are a reflection of the lack of faith consumers as > well as midwives have in the hospital system. I think we all agree that Pat > and Nicky are wonderful women centred midwives with alot of experience. The > 'negative' comments, although may appear to be directed at them, actually > are not, they are directed at the 'system'. > We have a hospital system in this country that can't even serve the women > who want to use them, with the majority of women (unless really strong and > educated and well supported) suffering unnecessary intervention at the hands > of overzealous obstetricians. Midwives hands are tied because of the > hospital protocols under which they must operate or they fear losing their > jobs. This has been described by some midwives on this list as a reality. > I was ignorant to this for some time, having had homebirths myself and only > knowing what other women had told me of their experience and treatment in > the 'system'. Now as I support more and more women as their doula in > hospitals I am appalled at what goes on. It must be the most > incredibly frustrating job working as a hospital midwife and I applaud all > who soldier on regardless. > The reason a hospital run homebirth service concerns me is for the very > reason that it is hospital run. I don't doubt that the midwives operating > and working in the service all have the very best intentions and all > advocate women centred care, however I have to question whether, to some > extent their hands will also be tied with the fear of losing their jobs > should a situation arise that an Independent midwife may see as within the > normal realm but the protocols and guidelines of the hospital system see as > abnormal. There are many many > 'situations' during labour and birth where this is evident (even down to how > often a midwife should > listen to a baby's heart during labour, whether this is necessary after > every contraction so the midwife has an idea of how the baby is coping or > whether it is yet another unnecessary intervention the women is subjected to > that may > interrupt the rhythm of her labour) > Of course we are all striving to achieve the same goal, real choices for > women, publicly funded homebirth and one to one midwifery care. It is > imperative that we get it right the first time round (for NSW) as this is > most likely our only chance. > So pleased you've joined the list Nicole - will catch you soon. > Jo Hunter > > ----- Original Message ----- > From: "Ron & Nicole Christensen" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Thursday, December 04, 2003 4:37 PM > Subject: Re: [ozmidwifery] Fwd: response from Pat and Nicky > > > > Hi everyone, > > As a newcomer to this mailing list, I haven't had the time to go through > all > > of the responses to the 'models of midwifery care' debate - but just > merely > > browsing through some of the e-mails - it perplexes me that there would be > > so much negativity - even more so - when we have two VERY experienced, > VERY > > wise, VERY respected; VERY intuitive; VERY woman centred and VERY > homebirth > > orientated midwives who are at the forefront of developing such a model > > inclusive of homebirth ..... that in itself will hold my faith, confidence > > and belief in this model. > > I would also have faith in the midwives who would be part of such a > model - > > to be woman/family centred and have a strong belief and love of birth as > a > > natural and normal family event ... I just cannot envisage a medically > > minded midwife (which is contradictory in itself!) to be interested in > being > > a part of this - nor do I see Pat or Nicky allowing such a midwife on the > > team. I do not believe that a homebirth midwife attached to a midwifery > > model at a hospital would be any less passionate and loving as an > > independent midwife - and yes, I too can see interest from independent > > midwives who haven't practised since the indemnity crisis or from those > who > > need a bit more security - great!!! > > Especially in the light of this ever increasing caesarean epidemic - I > > embrace and praise this attempt to provide homebirths as part of a new > > midwifery model. I know that it is something that I would absolutely use - > > especially when the cost of an independant midwife rules our little one > > income family out of that league (our recent homebirth was a loving gift). > > I see it as a positive and exciting step forward in what is a very bleak > and > > dismal maternity service that currently exists. > > I just hope that Pat and Nicky do not get so disheartened by the lack of > > support, that they would consider forgetting about setting up the > proposed > > model. > > We should all be saying Go Pat and Nicky!!! (I know I am!!!). > > > > kindest regards, > > Nicole > > > > > > > > ----- Original Message ----- > > From: Andrea Robertson <[EMAIL PROTECTED]> > > To: <[EMAIL PROTECTED]> > > Sent: Thursday, December 04, 2003 3:03 PM > > Subject: [ozmidwifery] Fwd: response from Pat and Nicky > > > > > > > > > > >Subject: response from Pat and Nicky > > > >Date: Thu, 4 Dec 2003 13:59:40 +1100 > > > > > > > >Dear Andrea > > > > > > > >Thank you for sending us the emails that have been circulating about > the > > > >proposed homebirth model at St George.We find much of the content > > > >insulting and grossly ill informed. > > > > > > > >It is hard to imagine where the information has been collected from and > > we > > > >find it very sad that so much can be said about what is not yet formed > in > > > >any way. > > > > > > > >There is a meeting in a few weeks time and these views will be well > > > >represented and discussed in a respectful and honourable manner. > > > > > > > >Please do not forward us any more emails. > > > > > > > >You may post this onto ozmidwifery > > > > > > > >Many thanks > > > > > > > >Pat Brodie & Nicky Leap > > > > > > > > > > > > > > > > > > > > > -------------------------------------------------------------------------- > -- > > ---- > > > > > > > > > > ----- > > > Andrea Robertson > > > Birth International * ACE Graphics * Associates in Childbirth Education > > > > > > e-mail: [EMAIL PROTECTED] > > > web: www.birthinternational.com > > > > > > > -- > > This mailing list is sponsored by ACE Graphics. > > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > > > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. 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