RE: [ozmidwifery] Foetal positioning

[Dean & Jo]

I am beginning to see a fundamental flaw in research these days….in particular the maternity research.  The segregation of midwifery research and OB research is amazing.  Both look at the same scenarios and both come out with very different reasoning, findings and recommendations.   Almost all research in this area has a hidden (or perhaps not hidden) agenda of proving that particular professionals expertise on the matter –never considering the other professionals input or experience.  As a consumer it is frustrating as we are presented with information based on research that is biased and flawed due to the lack of the alternative.  I am more so directing this at the OBs of course but it can still apply to midwives also.  Research can be a very powerful tool to manipulate change (usually for the detriment of women’s choices).     I feel that is should be considered unethical to not actually acknowledge the other professions opinions, experience and expertise when discussing a topic.  For a woman to make an informed decision she needs to read current research from both midwifery and Ob perspectives….if they are available….then try to decipher what is relevant and what is not….no mean feat for even the seasoned informed consumer.  Perhaps someone should look at the depth of diversity of similar topics researched from both professional’s perspectives?   My brain hurts!   Jo :o)   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Dove, Shona Elizabeth - DOVSE001 Sent: Thursday, April 14, 2005 8:31 AM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Foetal positioning   Thanks Sally.  I also read this article but wondered at the paucity of information regarding the position of the birthing woman, certainly not difficult to establish given the retrospective nature of the study. Considering most midwives and most women would already know of the effects of different foetal positions on length of labour (and I really dislike the use of mal as a way of describing foetal position, such a threatening word, and I noticed that the problem of such positions remains an “obstetric challenge” and never mind the woman).   I suggest a more useful study would be to forget about determining times ad nauseam and look at the effects of maternal position when the foetus is lying less favourably, but perhaps that’s coming…!  Certainly enough Midwives have looked at the issue from a research perspective.   Apologies for the negative note to this post, but I am feeling slightly cynical today,   Shona Dove   From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Sally Westbury Sent: Wednesday, 13 April 2005 7:59 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Foetal positioning   Foetal malposition lengthens labour and poses maternal risks Source: Obstetrics & Gynaecology 2005; 105: 763-72 Assessing the impact of foetal position at full dilatation on labour duration and indicators of maternal morbidity. Pregnant women with occiput posterior or transverse position at full dilatation are at increased risk of a prolonged second stage of labour and of maternal morbidity, research shows. "Since Mauriceau's classical work was published in 1681, the occiput posterior and transverse malpositions have remained an obstetric challenge," write Julie Senecal (Laval University, Canada) and colleagues. For the current study, the team assessed the effect of such foetal positions on the duration of the second stage of labour and on indicators of maternal morbidity, using retrospective data for 210 women whose foetus was in the posterior position, 200 with it in a transverse position, and 1198 with an anteriorly positioned foetus. This revealed that foetal malposition at full dilatation was associated with significant maternal morbidity, including increased risks of instrumental delivery, caesarean delivery, oxytocin administration, episiotomy, and blood loss exceeding 500 ml. In addition, the duration of the second stage of labour with early or delayed pushing was higher for transverse (3.6 hours and 2.5 hours, respectively) and posterior (3.8 hours and 3.0 hours, respectively) positions than for the anteriorly positioned group (3.1 hours and 2.2 hours, respectively). "Guidelines that propose norms for expected labour duration should take into consideration position of the foetal head at full dilatation and the strategy of pushing," conclude the researchers. Posted: 12 April 2005     Sally Westbury Homebirth Midwife   "It takes courage to remain a true advocate for women, challenging authority and sacrificing social and professional acceptance. It takes courage for a woman to choose a caregiver who will truly advocate for and empower her."    -Judy Slome Cohain   -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.308 / Virus Database: 266.9.7 - Release Date: 4/12/2005 -- No virus found in this outgoing message. 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