Interesting line on intermittent auscultation.
If mws aren't given the OK to listen intermittently, then every woman
would be strapped to a CTG machine with its accompanying restrictions of
time and position.
Having done a placement recently where CTG's were the norm because of
the hospital's tight risk guidelines - VBACs, PROM, anyone with oxytocin
up for induction or aumentation, any mec (even if it was only thought to
be mec), slow progress, and then the more real risks with unhealthy moms
or babes; there were so few women who were in the category for
intermittent listening.
I totally agree that listening every 5 minutes would be disturbing to
any woman's sacred space and time, and have had the luxury of self
regulating how and when I listen in second stage by working independently.
With today's dialogue around evidence based practice etc, mws are going
to have to get their research hats on quickly to add to our unique body
of knowledge, otherwise these crazy guidelines will stay in place.
There may not be good evidence to support 5 minutely monitoring in low
risk women, but we're in a world where the alternative is continuous
monitoring and the benefits of this are not well supported either, just
preferred by too many. The NICE guidelines also suggest continuous
monitoring for 15 minutes every hour as an alternative to totally
continuous monitoring thus allowing some change of position and
ambulation. ???
My radical nature says unplug all the machines and get back to truly
supporting women -high or low risk by giving them proper continuity of
care by midwives working as midwives not technicians. The taste of high
tech land I'm getting is very sour.
Anyone know what the guidelines are in The Netherlands, where midwife
supported homebirths abound and their PMR, c/section rates, epidural
rates are all so much lower than ours??
Sue
Just a thought Sally - the real argument would become whether abnormal
states in labour, in this case in second stage, can be detected by other
means - such as observation or mother's intuition etc etc. I would
suggest they can .... but again our research hats need to be applied to
support the things we do know.
I would like to go further with today’s radical thought.
I believe there is not evidence to support the 5 minutely interval of
intermittent monitoring in a low risk population in second stage of
labour.
What do people think about this.
Do you think I could argue this point effectively??
Sally Westbury
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