Re: [ozmidwifery] Routine Observations in labour
I agree with Tania and in my private practice I do the same. Documenting the info needs to be done in the same manner. Instead of writing that BP as a number write all the things that you found. Skin, cool to touch, pulse regular, and BP. Then at appropriate intervals note that nothing has changed to indicate a need for doing so again. The dilemma comes when working for an organisation who claims to have evidence based practices but has policies that fail to reflect the same. The care of the woman in labour policy in the organisation I work for states the intervals at which observations should be done. But I decided long ago that the policies were guidelines and were not meant to over ride my duty of care to the client to provide the best care for her. I make sure that my notes reflect my constant presence with the woman and statements that reflect her well being much better than numbers. I find I have much to keep me occupied close to birth that gives me little time record numbers and much of what is recorded is done so retrospectively and should be noted as such. (As I have said before the most common use of medical records is for coding purposes and they love notes that let them know what went on which obs do not.) People worring about not following written policies should either get on the committee to rewrite them or challenge those who are to defend them as tI have never seen any evidence to support the frequency that most people seem to think they need to be done other than that is the way they have always done it here or wherever they used to work. New team members can be great when they bring new ideas but a drag when they bring an old attitude. Andrea Quanchi On Wednesday, December 8, 2004, at 06:09 , Tania Smallwood wrote: I am finding this whole thread really interesting, and quite horrifying all at once! If I were a labouring woman, I'd be blowed if I'd be standing still to let someone monitor my pulse and resps every 1/2 an hour! And for what? I can't believe that all of us don't truthfully expect a pulse rate to be higher than normal when in active labour, or that a woman labouring well in a warm pool might have a slightly raised temp. The way I see it, there are plenty of women having babies who manage to stay at home until labour is well established, before they enter a hospital or birth centre, or call their midwife to attend them at home, and these women are not having any of that damaging neo-cortex stimulation from someone wanting to observe and document their vital signs. Whilst I know a baseline is important, should we not be assuming that in the absence of any other signs, a healthy woman in labour is just that? Is it just the fear of litigation that drives us to do half hourly obs? Or is it truly justified from a research based perspective? I like to think that as a midwife, I approach the whole idea of pregnancy and birth from a wellness perspective, that a woman is healthy and well, and has the ability to gestate and birth under her own steam until I'm proven otherwise. This philosophy carries on in labour too, so why are so many of us suddenly treating women like they are an accident waiting to happen when they are in labour? Maybe there's that thought that a birth is safe and successful only in retrospect, I dunno... Working independently with normal healthy women, who expect to be treated as such, we do a baseline bp in labour when we arrive, or when the opportunity arises, (feeling their skin to do the bp gives you a good indication of whether they are hot or not, and pulse is heard through the steth during the bp reading) and if all's well, and their pregnancy has been uneventful from that point of view (no hx of raised bp for example) then it doesn't factor into it again, unless labour becomes prolonged, or we're thinking about transfer into hospital. I don't feel that I'm taking any chances in not doing these obs constantly, and the vast majority of the women we birth with get on with it and birth, undisturbed by us clanking around with a sphygmo etc. We check the water temp regularly, but this is non invasive, and also listen to baby quite frequently, depending on what the mum is comfortable with. Those who don't want any doppler are always most obliging to let us know that baby is moving frequently. Stretches the comfort level a bit I know, but when it all comes down to it, it's their birth. Anyway, just my 2 bob's worth... Tania - Original Message - From: Ken WArd To: [EMAIL PROTECTED] Sent: Wednesday, December 08, 2004 5:53 PM Subject: RE: [ozmidwifery] Routine Observations in labour All these obs in labour.distracting for the woman and annoying for the midwife. We do 15/60 fhr, although I do it 30/60 early labour, and when I can in active labour, 15-30/60 if all has been well. Any concerns I'll listen from cont. to cont. If I'm really worried I'd do a ctg. 2nd stage 5/60 until hov then following every cont. I try
Re: [ozmidwifery] Routine Observations in labour
I am finding this whole thread really interesting, and quite horrifying all at once! If I were a labouring woman, I'd be blowed if I'd be standing still to let someone monitor my pulse and resps every 1/2 an hour! And for what? I can't believe that all of us don't truthfully expect a pulse rate to be higher than normal when in active labour, or that a woman labouring well in a warm pool might have a slightly raised temp. The way I see it, there are plenty of women having babies who manage to stay at home until labour is well established, before they enter a hospital or birth centre, or call their midwife to attend them at home, and these women are not having any of that damaging neo-cortex stimulation from someone wanting to observe and document their vital signs. Whilst I know a baseline is important, should we not be assuming that in the absence of any other signs, a healthy woman in labour is just that? Is it just the fear of litigation that drives us to do half hourly obs? Or is it truly justified from a research based perspective? I like to think that as a midwife, I approach the whole idea of pregnancy and birth from a wellness perspective, that a woman is healthy and well, and has the ability to gestate and birth under her own steam until I'm proven otherwise. This philosophy carries on in labour too, so why are so many of us suddenly treating women like they are an accident waiting to happen when they are in labour? Maybe there's that thought that a birth is safe and successful only in retrospect, I dunno... Working independently with normal healthy women, who expect to be treated as such, we do a baseline bp in labour when we arrive, or when the opportunity arises, (feeling their skin to do the bp gives you a good indication of whether they are hot or not, and pulse is heard through the steth during the bp reading) and if all's well, and their pregnancy has been uneventful from that point of view (no hx of raised bp for example) then it doesn't factor into it again, unless labour becomes prolonged, or we're thinking about transfer into hospital. I don't feel that I'm taking any chances in not doing these obs constantly, and the vast majority of the women we birth with get on with it and birth, undisturbed by us clanking around with a sphygmo etc. We check the water temp regularly, but this is non invasive, and also listen to baby quite frequently, depending on what the mum is comfortable with. Those who don't want any doppler are always most obliging to let us know that baby is moving frequently. Stretches the comfort level a bit I know, but when it all comes down to it, it's their birth. Anyway, just my 2 bob's worth... Tania - Original Message - From: Ken WArd To: [EMAIL PROTECTED] Sent: Wednesday, December 08, 2004 5:53 PM Subject: RE: [ozmidwifery] Routine Observations in labour All these obs in labour. distracting for the woman and annoying for the midwife. We do 15/60 fhr, although I do it 30/60 early labour, and when I can in active labour, 15-30/60 if all has been well. Any concerns I'll listen from cont. to cont. If I'm really worried I'd do a ctg.2nd stage 5/60 until hov then following every cont.I try and slip obs in as I can. Temp 4/60, bp2-4/24conts continuously, pulse 30/60. Ve's I don't tend to do on multis unless they ask. Primips 6/24 from active labour., no real hard and fast rules on ve's. As long as abdom. descent can be detected and mum and bub ok there is no pressure.Observation of iquor, what the woman is saying, how she is managing the conts, fluid intake and output. If all has been well I do not interfere or interrupt the woman, but take my chance as it comes. MS -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Anglodutch NTL AccountSent: Tuesday, 7 December 2004 5:22 PMTo: [EMAIL PROTECTED]Subject: RE: [ozmidwifery] Routine Observations in labour Oops, BP should be hourly of course, not 4 hourly! Claudia -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Anne ClarkeSent: 06 December 2004 23:35To: OZMIDWIFERYSubject: [ozmidwifery] Routine Observations in labour Dear All, Talking about observations. Please take time to reply to this query. What observations - how often, what type of observations e.g. temp, pulse, BP, FHR, PV assessment etc.do you do routinely on a normally progressing singleton labour? With thanks, Anne Clarke
Re: [ozmidwifery] Routine Observations in labour
Dear Tania Your care is also supportive of progressing labour as the hormonal flow requires the woman to be allowed to enter an altered state of consciousness for optimal oxytocinon!! Denise Hynd "Let us support one another, not just in philosophy but in action, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled." Linda Hes - Original Message - From: Tania Smallwood To: [EMAIL PROTECTED] Sent: Wednesday, December 08, 2004 3:09 PM Subject: Re: [ozmidwifery] Routine Observations in labour I am finding this whole thread really interesting, and quite horrifying all at once! If I were a labouring woman, I'd be blowed if I'd be standing still to let someone monitor my pulse and resps every 1/2 an hour! And for what? I can't believe that all of us don't truthfully expect a pulse rate to be higher than normal when in active labour, or that a woman labouring well in a warm pool might have a slightly raised temp. The way I see it, there are plenty of women having babies who manage to stay at home until labour is well established, before they enter a hospital or birth centre, or call their midwife to attend them at home, and these women are not having any of that damaging neo-cortex stimulation from someone wanting to observe and document their vital signs. Whilst I know a baseline is important, should we not be assuming that in the absence of any other signs, a healthy woman in labour is just that? Is it just the fear of litigation that drives us to do half hourly obs? Or is it truly justified from a research based perspective? I like to think that as a midwife, I approach the whole idea of pregnancy and birth from a wellness perspective, that a woman is healthy and well, and has the ability to gestate and birth under her own steam until I'm proven otherwise. This philosophy carries on in labour too, so why are so many of us suddenly treating women like they are an accident waiting to happen when they are in labour? Maybe there's that thought that a birth is safe and successful only in retrospect, I dunno... Working independently with normal healthy women, who expect to be treated as such, we do a baseline bp in labour when we arrive, or when the opportunity arises, (feeling their skin to do the bp gives you a good indication of whether they are hot or not, and pulse is heard through the steth during the bp reading) and if all's well, and their pregnancy has been uneventful from that point of view (no hx of raised bp for example) then it doesn't factor into it again, unless labour becomes prolonged, or we're thinking about transfer into hospital. I don't feel that I'm taking any chances in not doing these obs constantly, and the vast majority of the women we birth with get on with it and birth, undisturbed by us clanking around with a sphygmo etc. We check the water temp regularly, but this is non invasive, and also listen to baby quite frequently, depending on what the mum is comfortable with. Those who don't want any doppler are always most obliging to let us know that baby is moving frequently. Stretches the comfort level a bit I know, but when it all comes down to it, it's their birth. Anyway, just my 2 bob's worth... Tania - Original Message - From: Ken WArd To: [EMAIL PROTECTED] Sent: Wednesday, December 08, 2004 5:53 PM Subject: RE: [ozmidwifery] Routine Observations in labour All these obs in labour. distracting for the woman and annoying for the midwife. We do 15/60 fhr, although I do it 30/60 early labour, and when I can in active labour, 15-30/60 if all has been well. Any concerns I'll listen from cont. to cont. If I'm really worried I'd do a ctg.2nd stage 5/60 until hov then following every cont.I try and slip obs in as I can. Temp 4/60, bp2-4/24conts continuously, pulse 30/60. Ve's I don't tend to do on multis unless they ask. Primips 6/24 from active labour., no real hard and fast rules on ve's. As long as abdom. descent can be detected and mum and bub ok there is no pressure.Observation of iquor, what the woman is saying, how she is managing the conts, fluid intake and output. If all has been well I do not interfere or interrupt the woman, but take my chance as it comes. MS -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Anglodutch NTL AccountSent: Tuesday, 7 December 2004 5:22 PMTo: [EMAIL PROTECTED]Subject: RE: [ozmidwifery] Routine Observations in labour Oops, BP should be hourly of course, not 4 hourly! Claudia -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Beha
Re: [ozmidwifery] Routine Observations in labour and post partum
Title: Re: [ozmidwifery] Routine Observations in labour and post partum Hi Tania, Have to agree with you - I don't 'routinely' do much except listen to baby's heart rate, more so in 2nd stage or if any worrying fluctuations in 1st stage. I don't do BP's unless there has been a problem during the pregnancy and I guess my main belief is in trusting the woman as I know her. to tell me of any physical deviations. I have worked now for over 20 years following this philosophy, and have not had any problems. There seems to be a huge gap between normal physiological birth and medicalised management of birth. Forgive me if I am wrong... This also follows for postnatal care - I only do BP's or temps if I or or the mother think there is a problem ... I would tend to do more maternal pulses whilst waiting for third stage but this and other worries would translate to maybe 5 % of the births I attend, and mostly there are no problems... healthy mums and healthy babes... Sue I am finding this whole thread really interesting, and quite horrifying all at once! If I were a labouring woman, I'd be blowed if I'd be standing still to let someone monitor my pulse and resps every 1/2 an hour! And for what? I can't believe that all of us don't truthfully expect a pulse rate to be higher than normal when in active labour, or that a woman labouring well in a warm pool might have a slightly raised temp. The way I see it, there are plenty of women having babies who manage to stay at home until labour is well established, before they enter a hospital or birth centre, or call their midwife to attend them at home, and these women are not having any of that damaging neo-cortex stimulation from someone wanting to observe and document their vital signs. Whilst I know a baseline is important, should we not be assuming that in the absence of any other signs, a healthy woman in labour is just that? Is it just the fear of litigation that drives us to do half hourly obs? Or is it truly justified from a research based perspective? I like to think that as a midwife, I approach the whole idea of pregnancy and birth from a wellness perspective, that a woman is healthy and well, and has the ability to gestate and birth under her own steam until I'm proven otherwise. This philosophy carries on in labour too, so why are so many of us suddenly treating women like they are an accident waiting to happen when they are in labour? Maybe there's that thought that a birth is safe and successful only in retrospect, I dunno... Working independently with normal healthy women, who expect to be treated as such, we do a baseline bp in labour when we arrive, or when the opportunity arises, (feeling their skin to do the bp gives you a good indication of whether they are hot or not, and pulse is heard through the steth during the bp reading) and if all's well, and their pregnancy has been uneventful from that point of view (no hx of raised bp for example) then it doesn't factor into it again, unless labour becomes prolonged, or we're thinking about transfer into hospital. I don't feel that I'm taking any chances in not doing these obs constantly, and the vast majority of the women we birth with get on with it and birth, undisturbed by us clanking around with a sphygmo etc. We check the water temp regularly, but this is non invasive, and also listen to baby quite frequently, depending on what the mum is comfortable with. Those who don't want any doppler are always most obliging to let us know that baby is moving frequently. Stretches the comfort level a bit I know, but when it all comes down to it, it's their birth. Anyway, just my 2 bob's worth... Tania - Original Message - From: Ken WArd mailto:[EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, December 08, 2004 5:53 PM Subject: RE: [ozmidwifery] Routine Observations in labour All these obs in labour. distracting for the woman and annoying for the midwife. We do 15/60 fhr, although I do it 30/60 early labour, and when I can in active labour, 15-30/60 if all has been well. Any concerns I'll listen from cont. to cont. If I'm really worried I'd do a ctg. 2nd stage 5/60 until hov then following every cont. I try and slip obs in as I can. Temp 4/60, bp2-4/24conts continuously, pulse 30/60. Ve's I don't tend to do on multis unless they ask. Primips 6/24 from active labour., no real hard and fast rules on ve's. As long as abdom. descent can be detected and mum and bub ok there is no pressure.Observation of iquor, what the woman is saying, how she is managing the conts, fluid intake and output. If all has been well I do not interfere or interrupt the woman, but take my chance as it comes. MS -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Anglodutch NTL Account Sent: Tuesday, 7 December 2004 5:22 PM To: [EMAIL PROTECTED] Subject: RE: [ozmidwifery] Routine Observations in labour Oops, BP should be hourly of course, not 4 hourly! Claudia
RE: [ozmidwifery] Routine Observations in labour
All these obs in labour. distracting for the woman and annoying for the midwife. We do 15/60 fhr, although I do it 30/60 early labour, and when I can in active labour, 15-30/60 if all has been well. Any concerns I'll listen from cont. to cont. If I'm really worried I'd do a ctg.2nd stage 5/60 until hov then following every cont.I try and slip obs in as I can. Temp 4/60, bp2-4/24conts continuously, pulse 30/60. Ve's I don't tend to do on multis unless they ask. Primips 6/24 from active labour., no real hard and fast rules on ve's. As long as abdom. descent can be detected and mum and bub ok there is no pressure.Observation of iquor, what the woman is saying, how she is managing the conts, fluid intake and output. If all has been well I do not interfere or interrupt the woman, but take my chance as it comes. MS -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Anglodutch NTL AccountSent: Tuesday, 7 December 2004 5:22 PMTo: [EMAIL PROTECTED]Subject: RE: [ozmidwifery] Routine Observations in labour Oops, BP should be hourly of course, not 4 hourly! Claudia -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Anne ClarkeSent: 06 December 2004 23:35To: OZMIDWIFERYSubject: [ozmidwifery] Routine Observations in labour Dear All, Talking about observations. Please take time to reply to this query. What observations - how often, what type of observations e.g. temp, pulse, BP, FHR, PV assessment etc.do you do routinely on a normally progressing singleton labour? With thanks, Anne Clarke
[ozmidwifery] Routine Observations in labour
Dear All, Talking about observations. Please take time to reply to this query. What observations - how often, what type of observations e.g. temp, pulse, BP, FHR, PV assessment etc.do you do routinely on a normally progressing singleton labour? With thanks, Anne Clarke
Re: [ozmidwifery] Routine Observations in labour
at wch post natal ward the obs are 4/24 for the first day then bd if all is ok then daily. in labour it is protocol to do fhr very 15 min, temp 4/24, bp 1/2 hly, pulse 15 min and contractions every1/2 hr and mark on the partogram. - Original Message - From: Anne Clarke To: OZMIDWIFERY Sent: Tuesday, December 07, 2004 10:05 AM Subject: [ozmidwifery] Routine Observations in labour Dear All, Talking about observations. Please take time to reply to this query. What observations - how often, what type of observations e.g. temp, pulse, BP, FHR, PV assessment etc.do you do routinely on a normally progressing singleton labour? With thanks, Anne Clarke
RE: [ozmidwifery] Routine Observations in labour
Hi Anne, BP: 4 hourly Temp: 4 hourly FHR: intermittently every 15 minutes for at least one minute during and after contractions in first stagealong with maternal pulse, to distinguish between the two. In second stage, FHR every 5 minutes for at least one minute after contractions. Assessing the frequency and strength of contractions throughout labour. Abdominal palpation prior to every vaginal examination. Vaginal examination: 4 hourly Urinalysis: on admission, and keeping an eye on urine output throughout labour. In addition, you are observing continuously for any deviations from the normal progress of labour, by talking to and being with the woman. That's the bare bones of the care we are expected to provide on Delivery Suite. What makes the job so rewarding to me is all that we do around it: being 'with woman'. Getting to know her and supporting her through the process, providing encouragement and reassurance, providing informationto help her make the decisionsthat are right for her; the list goes on. Hope that helps, Claudia. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Anne ClarkeSent: 06 December 2004 23:35To: OZMIDWIFERYSubject: [ozmidwifery] Routine Observations in labour Dear All, Talking about observations. Please take time to reply to this query. What observations - how often, what type of observations e.g. temp, pulse, BP, FHR, PV assessment etc.do you do routinely on a normally progressing singleton labour? With thanks, Anne Clarke
RE: [ozmidwifery] Routine Observations in labour
Oops, BP should be hourly of course, not 4 hourly! Claudia -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Anne ClarkeSent: 06 December 2004 23:35To: OZMIDWIFERYSubject: [ozmidwifery] Routine Observations in labour Dear All, Talking about observations. Please take time to reply to this query. What observations - how often, what type of observations e.g. temp, pulse, BP, FHR, PV assessment etc.do you do routinely on a normally progressing singleton labour? With thanks, Anne Clarke
