I totally agree Maureen, I rarely if ever encourage active pushing, by active 2nd stage I actually meant there is no ambiguity about it and mum can push when and how she wants too.
I have to say I went back to my guidelines, policies and procedures manual and discovered much to my embarrassment that we are actually discussing procedures for labour and birth here. Guidelines are usually much less explicit such as indicating that we would be monitoring FH not necessarily how often or even with what. Umm! I am in the middle of night duty. I should learn to be quiet on-line. However, after muddling around in my head thoughts on Maggie Banks article kept resurfacing. And I agree with her even more in that truly much of what we now do re monitoring of women and babies is medical in tradition and we have coopted it to our use. I am not sure this invalidates it. I should also acknowledge that the founding mothers, if you will, of lay midwifery in the USA of the 1960's-1970's (such as Ina May and the founders of Seattle Midwifery school) were actually taught by rather radical medical practitioners many of whom were still conducting homebirths themselves at the time, thus the origins of their practice were more medical than midwifery- as some of you who may have seen early videos from the Farm or even Seattle would attest to. As the re-emerging profession matured and we have all travelled so much we have learned from women in other parts of the world and so we bump up against other traditions and other borrowings. My daughter witnessed midwives in Africa with their ears plastered to the labouring woman's stomach taping out the FHR with their fingers, but is this tradition or a habit passed on from observers of colonial doctors/nurses? However, I don't think we will see, nor do i wish to see, a randomised controlled trial of intermittent auscultation vs no monitoring of healthy women during labour, personally I don't think this would be ethical, but maybe I am misguided. I do think retrospective studies could be done comparing healthy pregnant women with minimal surveillance/monitoring (those who show up at hospital with head on view, birth before arrival, or birth shortly after the midwife sets up at their home) to those with other levels of monitoring(by midwives) in labour at home or hospital. I think this would be quite expensive because one would need to look at thousands of data sheets and your results would be dependent upon the accuracy of the data entered. Anyway, I think it is a study waiting to be done even though I am predicting it just might show there is no significant difference in outcome and I am not sure if this would or even should change our practice. I also think we need to be mindful that the reason midwives often practiced without instruments of any kind or medicines was because they were forbidden by law to do so. Even today in many states of the USA (but not all thankfully) it is illegal for a midwife to carry syntocinon or oxygen (she would be practicing medicine without a licence if she did), so you learn to practice within those parameters not because it is midwifery but because it is what you are allowed to do. As midwives we should no longer allow ourselves to be regulated by another profession either by limitation or extension (does that make sense?) of practice. Surely it is up to us and the women we serve to describe our own profession with mindfulness and hopefully openess. marilyn marilyn ----- Original Message ----- From: "Ken Ward" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Sunday, December 07, 2003 5:34 PM Subject: RE: [ozmidwifery] Fwd: response from Pat and Nicky and fetal hearts > I listen 30 min inactive 1st stage, then 15 min 2nd stage, after each > contraction when pushing. I dont listen for long following conts, just > enough to reassure mum. FHR can be very variable when pushing, and a slow > rate needs checking. I am usually reluctant to encourage active pushing as I > have found this tends to play havoc with FHR. Maureen > > -----Original Message----- > From: [EMAIL PROTECTED] > [mailto:[EMAIL PROTECTED] Behalf Of Marilyn > Kleidon > Sent: Monday, 8 December 2003 12:51 PM > To: [EMAIL PROTECTED] > Subject: Re: [ozmidwifery] Fwd: response from Pat and Nicky and fetal > hearts > > > Hi Denise: > > I have now read Maggie Banks' article that you suggested and find myself > totally agreeing with her. I guess being educated in midwifery primarily in > an apprenticeship (called preceptorship for educational purposes) model in a > homebirth situation meant that I learned from the very first antenatal > appointment how to interpret guidelines for the individual woman. We also > learnt in the "school" part of our curriculum how to write our own > guidelines for our own practice and the future women who we would serve. It > was hammered into us the difference between guidelines, procedures and > protocols and how we should not write a guideline we ultimately couldn't > follow. > > When it came to listening to fetal hearts we had to demonstrate to our > preceptor that not only could we do this safely, accurately, and > meaningfully but that we could do it in a manner that was not distruptive to > the woman whose birth we were attending. If we could not do that not only > could the midwives precepting us ask us to leave but so of course could the > woman. And women did, not to me fortunately, I think I would have died on > the spot. Having been trained and practiced this way I do find it strange > when other midwives need to ask a woman to change position to hear a FHR or > do a VE, not that some positions aren't hard to accomplish this in. I had > not heard of listening every 15 minutes in first stage until arriving in > Australia, it was not our practice in the USA, but we did listen every 30 > minutes if we were in attendance at a labour as a midwife, and I would think > this was mainly for litigious reasons in early labour, but also because if > the woman was in early labour but felt she needed us in attendance perhaps > we needed to be sure all was in fact ok. We, like the dutch midwives, > encouraged our women to call us in time for us to get there and set up for > the birth, but if we could have ever come up with a formula for accurately > predicting that we would be very rich women. If we arrived in early labour > we would often leave if the woman was comfortable so as to let her get on > with it. Since i always try to do as few VE's as possible, the only time I > might have listened every 15 min was if I thought the woman was fully ( with > noVE confirming this) but I couldn't see the baby's head at all, again this > would depend on other factors. > > > marilyn > ----- Original Message ----- > From: "Denise Hynd" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Saturday, December 06, 2003 7:00 PM > Subject: Re: [ozmidwifery] Fwd: response from Pat and Nicky and fetal hearts > > > > Dear Marilyn > > As you said As you know there is an art to > > > being with woman in birth. > > I was wondering what is your response to Maggie Banks' article?? > > > > But Whose Art Frames the Questions? > > Midwives need to be vigilant to ensure the defining of appropriate > midwifery > > practice is not colonized by obstetric thought. Any guiding must reflect > the > > essential Midwifery Model of Care in the evidence amassed and the way in > > which it is applied ... Guildelines quickly become claimed as 'standard > > practice' - which is then passed on to students as midwifery knowledge ... > A > > great deal of power is given to Guidelines ... this impacts on how far a > > midwife can 'stray' from the dominant medicalised culture of birth ... (Go > > to full > > > > > > > > http://www.birthspirit.co.nz/ > > > > > > Denise > > ----- Original Message ----- > > From: "Marilyn Kleidon" <[EMAIL PROTECTED]> > > To: <[EMAIL PROTECTED]> > > Sent: Monday, December 08, 2003 1:01 AM > > Subject: Re: [ozmidwifery] Fwd: response from Pat and Nicky and fetal > hearts > > > > > > > Hi Jo: > > > > > > Because you were contracting so frequently and the FHR was fine is > > probably > > > why your midwife chose to listen after every other contraction. As I > said > > > earlier the guideline everywhere I have worked (home and hospital)has > > been > > > "after every ctx or every 5 minutes" obviously with the caveat 'unless > > there > > > is something concerning going on'. Some women really space out their > > second > > > stage contractions so listening after every other ctx might be listening > > > every 10 minutes or more, others have clusters of small but strong ctx's > > > where listening after every ctx would mean almost constant monitoring, > and > > > there is everything in between hence a guideline not a protocol, it is > > meant > > > to have flexibility along with understanding. As you know there is an > art > > to > > > being with woman in birth. > > > > > > marilyn > > > > > > ----- Original Message ----- > > > From: "Jo Bourne" <[EMAIL PROTECTED]> > > > To: <[EMAIL PROTECTED]> > > > Sent: Saturday, December 06, 2003 2:25 AM > > > Subject: Re: [ozmidwifery] Fwd: response from Pat and Nicky and fetal > > hearts > > > > > > > > > > I do actually recall my midwife listening to DDs fetal heart tones > being > > > either painful (because I had to change positions, even slightly was > > enough > > > to increase pain) or distracting, but I also recall being pleased to > hear > > > that all was ok, and being intellectually aware that it was part of my > > > midwife's job to know how the baby was and that I needed to let her do > her > > > job well so I could relax into mine. I think that she listened less > often > > > than hospital standards but I felt she was happy that she was listening > > > often enough to be telling me what a healthy baby she could hear and > that > > > was good for me on both counts. I actually got my notes out to check if > I > > > remember correctly and it does say that they were having difficulty > > getting > > > FHs when I arrived (DD was difficult about ultrasounds the whole > > pregnancy) > > > but what they heard was good and then later my midwife also noted that > she > > > was only listening every second contraction during second stage at my > > > request. I am certainly glad ! > > > > she listened as often as she did, or as often as she needed to, > however > > > you want to look at it. But I am equally glad that it was not every > > > contraction because I honestly think it would have made the second stage > > > much harder for me as there was no rest between contractions on the ones > > > where I had to move so she could listen. > > > > > > > > cheers > > > > Jo > > > > > > > > At 15:44 +1100 6/12/03, jo hunter wrote: > > > > >Hi Marilyn, > > > > >I personally don't and didn't have a problem with my fetal hearts > being > > > > >listened to at my own homebirths where there was a midwife present. > > > > >I think the argument is, correct me if I'm wrong, how often to listen > > in. > > > > >Thinking of my own labours I would consider after ever contraction to > > be > > > a > > > > >bit over the top and I could imagine getting annoyed should someone > be > > > > >trying to do that to me. I'm not a trained midwife so have no idea > what > > > the > > > > >standard of practice is regarding this - but every 2 minutes??? > > > > >I agree that hearing the heart when in labour is reassuring and > reminds > > > us > > > > >of why we are doing the whole labour thing and yes, mothers should > most > > > > >definately not fear the midwife listening in. > > > > >All the best > > > > >Jo > > > > >----- Original Message ----- > > > > >From: "Marilyn Kleidon" <[EMAIL PROTECTED]> > > > > >To: <[EMAIL PROTECTED]> > > > > >Sent: Sunday, December 07, 2003 1:35 AM > > > > >Subject: Re: [ozmidwifery] Fwd: response from Pat and Nicky and fetal > > > hearts > > > > > > > > > > > > > > >> 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. > > > > >> 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. > > > > > > > > > > > > -- > > > > Jo Bourne > > > > Virtual Artists Pty Ltd > > > > -- > > > > 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. > > 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. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. 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