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I am finding this whole thread really interesting, and quite
horrifying all at once! If I were a labouring woman, I'd be blowed if I'd
be standing still to let someone monitor my pulse and resps every 1/2 an
hour! And for what? I can't believe that all of us don't truthfully
expect a pulse rate to be higher than normal when in active labour, or that a
woman labouring well in a warm pool might have a slightly raised
temp.
The way I see it, there are plenty of women having babies who
manage to stay at home until labour is well established, before they enter a
hospital or birth centre, or call their midwife to attend them at home, and
these women are not having any of that damaging neo-cortex stimulation from
someone wanting to observe and document their vital signs. Whilst I know a
baseline is important, should we not be assuming that in the absence of any
other signs, a healthy woman in labour is just that? Is it just the fear
of litigation that drives us to do half hourly obs? Or is it truly
justified from a research based perspective? I like to think that as a
midwife, I approach the whole idea of pregnancy and birth from a wellness
perspective, that a woman is healthy and well, and has the ability to gestate
and birth under her own steam until I'm proven otherwise. This philosophy
carries on in labour too, so why are so many of us suddenly treating women like
they are an accident waiting to happen when they are in labour? Maybe
there's that thought that a birth is safe and successful only in retrospect, I
dunno...
Working independently with normal healthy women, who expect to
be treated as such, we do a baseline bp in labour when we arrive, or when the
opportunity arises, (feeling their skin to do the bp gives you a good indication
of whether they are hot or not, and pulse is heard through the steth during the
bp reading) and if all's well, and their pregnancy has been uneventful from that
point of view (no hx of raised bp for example) then it doesn't factor into it
again, unless labour becomes prolonged, or we're thinking about transfer into
hospital. I don't feel that I'm taking any chances in not doing
these obs constantly, and the vast majority of the women we birth with get on
with it and birth, undisturbed by us clanking around with a sphygmo etc.
We check the water temp regularly, but this is non invasive, and also listen to
baby quite frequently, depending on what the mum is comfortable with.
Those who don't want any doppler are always most obliging to let us know that
baby is moving frequently. Stretches the comfort level a bit I know, but
when it all comes down to it, it's their birth.
Anyway, just my 2 bob's worth...
Tania
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- Re: [ozmidwifery] Routine Observations in labour Tania Smallwood
