I notice that it is expected that Midwives base their practice on evidence &
research.
It would appear on the other hand that the medical profession are able to
practice on whatever they believe. They do not feel obliged to justify their
preference or practice.
Why is this so?
Why are midwives always feeling they must justify themselves?
Why do you allow it ?
Who in fact are we accountable to in real life?
Our clients, ourselves & our peers only ? Or ..............??
Brenda
----- Original Message -----
From: "Mary Murphy" <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Saturday, July 30, 2005 11:15 AM
Subject: RE: [ozmidwifery] intermittent auscultation
Pete, the only problem is that the "somebodies", in positions of power,
have
set a standard that "a reasonable midwife" has to adhere to, or suffer the
consequences if there is an adverse outcome, ie, a dead or compromised
baby.
Also, when one is employed by the Govt. there is an expectation that the
standard will be adhered to. There was not extensive trials or even large
scale retrospective research to compare 1/2 hrly or 1/4 hrly to
continuous
EFM. Unfortunately, common sense does not prevail. When we don't have
the
midwifery research knowledge to back it up, we have no other choice. I
wish
it were otherwise, MM
se- d-oes -n--Original Message-----
Sally I agree with what both you and Gloria are saying, with a low risk
women term and all progressing well in labour where is the evidence to
support any auscultation, I also believe that it can he horribly
invasive and could easily be construed as intervention. Surely as
professionals we can use our skills to make the call on whether
auscultation is needed or not. I also believe that there can be a lot
of angst built up over listening too often in what in most situations is
the normal physiology of 2nd stage.
yours in midwifery pete malavisi
On Fri, 29 Jul 2005 16:24:32 +0800, "Sally Westbury"
<[EMAIL PROTECTED]> said:
OK. What the Nice Guideline have based the bulk of their guideline on
are the following three studies. All of these studies have randomized
high and low risk pregnancies.
I would like to propose that the auscultation intervals set are
reflective of a lack of risk screening.
I would like to us think about is whether it is appropriate to try to
translate these auscultation interval to a low risk client group??
What do other people thinks??
Efficacy and safety of intrapartum electronic fetal monitoring: an
update
SB Thacker, DF Stroup, and HB Peterson
STUDY SELECTION: Our search identified 12 published RCTs addressing the
efficacy and safety of EFM; no unpublished studies were found. The
studies included 58,855 pregnant women and their 59,324 infants in both
high- and low-risk pregnancies from ten clinical centers in the United
States, Europe, Australia, and Africa. DATA
Vintzileos, A. M. et al. 1993. "A randomized trial of intrapartum
electronic fetal heart rate monitoring versus intermittent
auscultation." Obstetrics & Gynecology 81:899-907.
METHODS: The study was conducted simultaneously at two university
hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from
October 1, 1990 to June 30, 1991. All patients with singleton living
fetuses and gestational ages of 26 weeks or greater were eligible for
inclusion. The participants were assigned to continuous EFM or
intermittent auscultation based on the flip of a coin.
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