There is a basic principle that I think is often overlooked when we look
for rules and set procedures. In my mind, any test or investigation should
be done with the intention of taking action on its result. Listening to FH
(using a doppler or a pinnard or anything) is such a test.
In homebirth practice I have found that there are times when I have
listened to a FH every 30 minutes, but usually not, unless I'm concerned
about something. This has been particularly in situations like Jan
describes - sometimes out in the bush, a long way from any emergency
medical facility, and sometimes in town. Just because I am in proximity to
a labouring woman does not give me the right or need to take over in a
sense of monitoring the baby's heart rate. Heart rate is only one of the
points that we take note of, and much of a midwife's work can be done
quietly and unobtrusively, while the woman gets on with the work of giving
birth.
Looking at observations as potential points of intervention, or points of
decision, the times I like to hear the baby's heartbeat are
* When I arrive to attend a labouring woman. Not usually immediately, but
after I have observed her activity and response to the labour
* When the membranes rupture
* At any time when we (she or I or both) is/am/are concerned about
progress.
There is a very important distinction in this between spontaneous birth in
the woman's own place, and birth that is complicated by induction, pain
killers, or even unfamiliar environments and people. Regular recording of
FH makes much more sense in those situations, as the woman's own power in
birth is probably compromised.
This principle of decision points in pregnancy and birth is discussed well
in the NZCOM MIDWIVES HANDBOOK FOR PRACTICE.
Joy Johnston
-Original Message-
From: [EMAIL PROTECTED] [SMTP:[EMAIL PROTECTED]]
Sent: Sunday, May 26, 2002 9:28 AM
To: [EMAIL PROTECTED]
Subject:Re: FHM
File: ATT00026.htm Dear list
Point IS WE DO HAVE RESEARCH THAT SAYS CONTINUOS MONITORING WITHOUT
IMMEDIATE ACCESS TO SCALP pH DOES NOT IMPROVE OUTCOMES FOR WOMEN OR
NEWBORNS [in healthy populations ]
Once again there should be no rules but partnership with families around
theirs, yours and the babies needs Another slant on picture before taking
FH is what is your action to be if the FH is whatever.
IE IF THE WOMAN IS CLOSE TO BIRTH AND YOUR DEEP IN THE BUSH,
OR THE 2ND STAGE IS PROGRESSING REALLY QUICKLY .
It is distressing to see a lovely birth marred by the MW trying to get a
fetal heart on a crowning baby with a healthy coloured scalp.
I listen to baby around 1/2 hrly then closer in 2nd stage but would not
disturb the momentum of the birth process to be totally prescriptive on
this issue.
I noticed in the German book [Runa's birth] the MW did a CTG.AT HOME ARE
WE HEADING IN THAT DIRECTION?
jan
- Original Message -
From: S.J.F.ELECTRICAL.
To: [EMAIL PROTECTED] ; [EMAIL PROTECTED] ; [EMAIL PROTECTED]
Sent: Sunday, May 26, 2002 8:42 AM
Subject: Re: FHM
Dear All
It sounds to me there is a thin line between fear and trust here?
Trust in the total picture the woman baby and process?
I know it is easier for me to say this because I have been with women I
have known through their pregnancy!
But also the question arises for me as the discussion sounds like
talking about what is required by research protocols, our fear of loosing a
baby etc (can we really save all babies and whilst we are trying to do that
what else are we doing??
Rather than what is needed for this baby and woman to feel safe and be
able to let go and birth!
Adrenaline is contagious it does affect the birth , the woman and the
babies!
For me it is this that is most often what I as a midwife feel neds to be
cleared out of the way of the births I have attended both at home and in
Hospital!
Denise
- Original Message -
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED] ; [EMAIL PROTECTED]
Sent: Saturday, May 25, 2002 9:03 PM
Subject: Re: FHM
Deb
I think Ann was asking about non electronic monitoring ie doppler/
fetascope/pinard during labor. Do you have any research on that? One of my
classmates at Seattle Midwifery School did her Senior paper on this topic,
however I don't have her paper with me and it is unpublished. I generally
have listened to FHt's every 30 minutes (before, during and after a ctx) in
active labor, and then every 5 minutes during second stage/ after every
contraction. Obviously we are listening for decels and it is contentious
as to if we can differentiate late, early, or variable decels with a
doppler (probably not with a pinard/fetascope). I think there is great
practitioner variability with the use of intermitent auscultation. I am
interested to here what others do at home and at birth centers/ hospital.
marilyn
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