Brenda, you (&Sally & Pete)know I have practiced intuitive midwifery in homebirth for the last 22yrs. This is not my wish, but under a microscope in the particular fishbowl we are practicing in at the moment. This is the background which Sally is making this search. We are having to justify why our practice is not based on the NICE trial. That is why we have to find a realm of practice that "proves" we are right in not doing 5 minutely FH in 2nd stge. There is no logic. Homebirth midwives compliant? I don't think so, just trying to survive in the particular position we are in at the moment. We are trying hard to comply with the woman's wishes, the employers wishes and our knowledge of the importance of not disturbing the 2nd stge. We are doing the best we can. If any one can help us now you know the background, please do so. MM
Brenda wrote: Whist I agree with you & know you are right....there are no 'large scale retrospetelctive studies' to back up half of what the average medico does & how often is s/he called in to question? Where's the logic ? Sometimes I just think Midwives are by nature too compliant. Imagine the response if you queried the OBs practice ? Well you know what it is because we do it all the time ! It's ................off, or translated "get back in your box, I am the one with the appropriate training here". The 'somebodies' who make the decisions aren't at the coalface are they ? GRRRRRRRRRRRRR 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. >> >> >> >> >> >> > -- > 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.
