[ozmidwifery] Postnatal observations
Dear List Sorry to go back over old ground (message sent by Mel Dunstan 17/11/04), but I really need your help in a Obs V Midwives battle against doing postnatal observations. About 4 years ago we ceased doing postnatal observations on all 'normal birth' postnatal women. Our postnatal unit hasrun perfectly since this time without incident relating to the postnatal care of wellbeing of the women we care for. We use a pathway for signing off the education and the wellbeing of mother and child. Recently we have had a visiting registrar who required postnatal observations on women. This request has gone to our DON whodemanded that our practice be immediately updated and that we do at least one set of obs per day on every woman. In our unit,we do not gain a numerical value from any machine, however, we ask the woman how she is feeling, we observe behaviour, we listen to the woman, we educate and spend time with mother and baby,we are 'with woman'!! and if there is anything deviating from the normal then we investigate further, often by doing observations, however, if there is no indication to do the observations, then I do not believe that they need to be done. Four years ago, our unit progressed from being task orientated and medicalised, to caring for the individual and empowering the woman to care for herself. A woman with child is not a medical emergency and removing routine observations is normalising this situation. I have no doubt the woman I cared for last night (day3, engorged breasts, tears, etc) would have an elevated temp, high heart rate and probably an elevated BP but I was already dealing with the problems and a set of obs would have proven NOTHING. I am so very angry and frustrated that I am now faced with a situation where I need to find some recent evidence based practice to support the fact that we do not do routine observations. We are having to re-invent a wheel that has been rolling perfectly well for so many years (until it ran over an obstetric nail). If there is anyone out there who can help, please alert me to web sites, publications, anything!! Thanks in advance Felicity
Re: [ozmidwifery] Postnatal observations
Enkin et al. in A Guide to Effective Care in Pregnancy Childbirth state: Routine [postnatal] Observations: Making recording regular measurements of Temp, pulse, bp, fundal height, lochia the various wounds that a woman may sustain during birth, is still common practice in the days following birth. The intensity of this screening activity varies arbitrarily and depnds more on the hospital in which a mother happens to give birth, and on the legnth of time she spends in it, than on her individual needs. While it is prudent to observe women in this way when they are known to be at increased risk of either infection or hemorrhage, it is difficult to justifythis as a routine for all women. Chapter 45, p.432 This book is available online, free, in PDF format from www.maternitywise.org/guide Also, have a look at WHO: Care in Normal Labour Birth online http://www.who.int/reproductive-health/publications/MSM_96_24/MSM_96_24_table_of_contents.en.html Has the OB that wants the change provided any evidence to support his/her demands? Jen --- cummins [EMAIL PROTECTED] wrote: Dear List Sorry to go back over old ground (message sent by Mel Dunstan 17/11/04), but I really need your help in a Obs V Midwives battle against doing postnatal observations. About 4 years ago we ceased doing postnatal observations on all 'normal birth' postnatal women. Our postnatal unit has run perfectly since this time without incident relating to the postnatal care of wellbeing of the women we care for. We use a pathway for signing off the education and the wellbeing of mother and child. Recently we have had a visiting registrar who required postnatal observations on women. This request has gone to our DON who demanded that our practice be immediately updated and that we do at least one set of obs per day on every woman. In our unit,we do not gain a numerical value from any machine, however, we ask the woman how she is feeling, we observe behaviour, we listen to the woman, we educate and spend time with mother and baby, we are 'with woman'!! and if there is anything deviating from the normal then we investigate further, often by doing observations, however, if there is no indication to do the observations, then I do not believe that they need to be done. Four years ago, our unit progressed from being task orientated and medicalised, to caring for the individual and empowering the woman to care for herself. A woman with child is not a medical emergency and removing routine observations is normalising this situation. I have no doubt the woman I cared for last night (day3, engorged breasts, tears, etc) would have an elevated temp, high heart rate and probably an elevated BP but I was already dealing with the problems and a set of obs would have proven NOTHING. I am so very angry and frustrated that I am now faced with a situation where I need to find some recent evidence based practice to support the fact that we do not do routine observations. We are having to re-invent a wheel that has been rolling perfectly well for so many years (until it ran over an obstetric nail). If there is anyone out there who can help, please alert me to web sites, publications, anything!! Thanks in advance Felicity Find local movie times and trailers on Yahoo! Movies. http://au.movies.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Postnatal observations
Dear Jen No, the Ob has not provided anything, only that this was the practice at the tertiary hospital from where she came from, so it MUST be right! And where I work, in the eyes of management, Obs are right until proven wrong and Midwives wrong until accepted after lots of fighting. Felicity -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Postnatal observations
Hi Felicity Try this one.. x-tad-biggerGilmour, C. Twining, S. (2002). Postnatal care in hospitals: Ritual, routine, or individualised. Australian Journal of Midwifery 15, (2)11-15. Katrina :-) (I had this for an assignment for uni and found it quite good) /x-tad-bigger On 07/12/2004, at 11:53 AM, cummins wrote: Dear Jen No, the Ob has not provided anything, only that this was the practice at the tertiary hospital from where she came from, so it MUST be right! And where I work, in the eyes of management, Obs are right until proven wrong and Midwives wrong until accepted after lots of fighting. Felicity -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au> to subscribe or unsubscribe.
[ozmidwifery] Postnatal Observations
Hello Everyone Wondering If I can tap into your minds of wisdom. We are currently fighting with a registrar at work regarding post natal observations. At present if a woman has had a normal vaginal birth with no complications either antenatally or during the birth we do not routinely take BP, P or Temps. The registrar does not quite like this idea and is trying to change our practice as she feels that things might be missed and that birth has a huge impact on a woman's health. We have argued the point that these women are well women and that if they feel unwell we would then take observations. I guess I am wondering what the practice elsewhere is and if there is any evidence to support our practice Thanks Melanie Dunstan -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Postnatal Observations
Iam currently on the postnatal ward at the wch in adelaide and the postnatal obs they do there are 4/24 for the first 24 hours then bd then daily of tpr and bp followed by ususal postnatal checks of the woman. you can find the protocol under the s a governements protocol. - Original Message - From: Melanie Jane Dunstan [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, November 17, 2004 4:02 PM Subject: [ozmidwifery] Postnatal Observations Hello Everyone Wondering If I can tap into your minds of wisdom. We are currently fighting with a registrar at work regarding post natal observations. At present if a woman has had a normal vaginal birth with no complications either antenatally or during the birth we do not routinely take BP, P or Temps. The registrar does not quite like this idea and is trying to change our practice as she feels that things might be missed and that birth has a huge impact on a woman's health. We have argued the point that these women are well women and that if they feel unwell we would then take observations. I guess I am wondering what the practice elsewhere is and if there is any evidence to support our practice Thanks Melanie Dunstan -- 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.
Re: [ozmidwifery] Postnatal Observations
I'm a BMid student at UniSA so I don't have any practice info to give you but I do know that routine measurement of temp, pulse, BP and fundal height are in table 5 of 'A guide to effective care in pregnancy and childbirth' - meaning it is a form of care unlikely to be beneficial. Tania - Original Message - From: Melanie Jane Dunstan [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, November 17, 2004 4:02 PM Subject: [ozmidwifery] Postnatal Observations Hello Everyone Wondering If I can tap into your minds of wisdom. We are currently fighting with a registrar at work regarding post natal observations. At present if a woman has had a normal vaginal birth with no complications either antenatally or during the birth we do not routinely take BP, P or Temps. The registrar does not quite like this idea and is trying to change our practice as she feels that things might be missed and that birth has a huge impact on a woman's health. We have argued the point that these women are well women and that if they feel unwell we would then take observations. I guess I am wondering what the practice elsewhere is and if there is any evidence to support our practice Thanks Melanie Dunstan -- 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.
RE: [ozmidwifery] Postnatal Observations
Are these healthy women actually woken up for obs during the night! That is ridiculous. We do daily T, P and only do the BP if elevated antenatally or in Birth Suite and then it may only be daily. If she required IOL for BP then she may be on TDS BP never at night. After the first 24 hours of a LSCS same obs. As for fundal heights we teach the women to monitor themselves and we record it daily, PV loss they tell us. If the woman expresses concern such as a sore peri we ask if they want us to look at it, if they do fine if they don't then that is fine too. After all these women are going home so soon they should know when they are well or unwell if they are empowered with some knowledge before they leave. Birth is not an illness! Cheers Barb -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of shaz42 Sent: Wednesday, 17 November 2004 4:44 PM To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] Postnatal Observations Iam currently on the postnatal ward at the wch in adelaide and the postnatal obs they do there are 4/24 for the first 24 hours then bd then daily of tpr and bp followed by ususal postnatal checks of the woman. you can find the protocol under the s a governements protocol. - Original Message - From: Melanie Jane Dunstan [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, November 17, 2004 4:02 PM Subject: [ozmidwifery] Postnatal Observations Hello Everyone Wondering If I can tap into your minds of wisdom. We are currently fighting with a registrar at work regarding post natal observations. At present if a woman has had a normal vaginal birth with no complications either antenatally or during the birth we do not routinely take BP, P or Temps. The registrar does not quite like this idea and is trying to change our practice as she feels that things might be missed and that birth has a huge impact on a woman's health. We have argued the point that these women are well women and that if they feel unwell we would then take observations. I guess I am wondering what the practice elsewhere is and if there is any evidence to support our practice Thanks Melanie Dunstan -- 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. --- Incoming mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.784 / Virus Database: 530 - Release Date: 10/27/2004 --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.784 / Virus Database: 530 - Release Date: 10/27/2004 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Postnatal Observations
Hi Melanie, At my workplace we do temperature and pulse twice a day, BP only if they have a history of hypertension in their pregnancy. I don't know if it is evidence based. Nicole C - Original Message - From: Melanie Jane Dunstan [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, November 17, 2004 4:32 PM Subject: [ozmidwifery] Postnatal Observations Hello Everyone Wondering If I can tap into your minds of wisdom. We are currently fighting with a registrar at work regarding post natal observations. At present if a woman has had a normal vaginal birth with no complications either antenatally or during the birth we do not routinely take BP, P or Temps. The registrar does not quite like this idea and is trying to change our practice as she feels that things might be missed and that birth has a huge impact on a woman's health. We have argued the point that these women are well women and that if they feel unwell we would then take observations. I guess I am wondering what the practice elsewhere is and if there is any evidence to support our practice Thanks Melanie Dunstan -- 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.
