Re: [ozmidwifery] CTG

[Jackie Kitschke]

Kelly,
My daughter had seizures after she was born (at term at 
home) and spent 3 days in NICU sedated. It was the longest and 
darkest weekend of my life (not to mention my husband's, family's and work 
collegues). She is nearly 3 and a very happy, bright and healthy young girl. She 
has just had her 3 year check with the NICU follow up team and is completely 
normal and where she should be at. I just checked with Enkin et al and the 
incidence of seizures is reduced with CTG but the long term outcomes of babies 
with or without are the same. I don't know the figure for the frequency for 
this. There were other factors involved both with her and me and I am glad I had 
her at home with my hsuband and midwife and then the great support we both 
recieved from my collegues at the WCH. 
Jackie

  - Original Message - 
  From: 
  Kelly @ 
  BellyBelly 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Thursday, October 19, 2006 8:53 
  PM
  Subject: RE: [ozmidwifery] CTG
  
  
  We were actually 
  discussing this on my website and I was wondering, as were some others, what 
  the real figures are for infant seizures – I have personally never heard of a 
  woman around me who has been through that. Does it happen often at all? I just 
  want to reassure them with some wise words J
   
  
  Best 
  Regards,
   
  Kelly 
  Zantey 
  
  
  
  
  
  From: [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] On Behalf Of Mary MurphySent: Thursday, October 19, 2006 7:55 
  PMTo: 
  ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] 
  CTG
   
  This is the most recent review of 
  the value of CTG.  It is convincing and has the power of numbers, but… no 
  one take any notice of it.  MM
  “Continuous cardiotocography (CTG) 
  as a form of electronic fetal monitoring (EFM) for fetal assessment during 
  labour.”
  Alfirevic Z, Devane D, Gyte 
  GML
  This is a Cochrane review abstract 
  and plain language summary, prepared and maintained by The Cochrane 
  Collaboration. The full text of the review is available in The Cochrane Library 
  (ISSN 1464-780X). 
  The Cochrane Database of 
  Systematic Reviews 2006 Issue 3Copyright © 2006 
  The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 
  
  Plain language summary: Authors' 
  conclusions
  Continuous cardiotocography during 
  labour is associated with a reduction in neonatal seizures, but no significant 
  differences in cerebral palsy, infant mortality or other standard measures of 
  neonatal well-being. However, continuous cardiotocography was associated with 
  an increase in caesarean sections and instrumental vaginal births. The real 
  challenge is how best to convey this uncertainty to women to enable them to 
  make an informed choice without compromising the normality of 
  labour.
   

RE: [ozmidwifery] CTG

[Kelly @ BellyBelly]

We were actually discussing this on my
website and I was wondering, as were some others, what the real figures are for
infant seizures – I have personally never heard of a woman around me who
has been through that. Does it happen often at all? I just want to reassure
them with some wise words J

 



Best Regards,

 

Kelly Zantey 











From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On
Behalf Of Mary Murphy
Sent: Thursday, October 19, 2006
7:55 PM
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] CTG



 

This
is the most recent review of the value of CTG.  It is convincing and has
the power of numbers, but… no one take any notice of it.  MM

“Continuous
cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal
assessment during labour.”

Alfirevic
Z, Devane D, Gyte GML

This
is a Cochrane review abstract and plain language summary, prepared and
maintained by The Cochrane Collaboration. The full text of the review is
available in The Cochrane Library (ISSN
1464-780X). 

The Cochrane Database of Systematic Reviews 2006 Issue
3
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley &
Sons, Ltd. 

Plain
language summary: Authors' conclusions

Continuous
cardiotocography during labour is associated with a reduction in neonatal
seizures, but no significant differences in cerebral palsy, infant mortality or
other standard measures of neonatal well-being. However, continuous
cardiotocography was associated with an increase in caesarean sections and
instrumental vaginal births. The real challenge is how best to convey this
uncertainty to women to enable them to make an informed choice without
compromising the normality of labour.

 

Re: Re: [ozmidwifery] ctg stuff

[sally @ home]

Well said, Sue. There are 2 sides to the face of 
the choice coin...we may not agree with some women's choices, but if they are 
adamant and they have been given all the pros and cons then, really, who are we 
to dictate to them about what they choose?
 
Sally

  - Original Message - 
  From: 
  Susan 
  Cudlipp 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, June 17, 2006 2:20 
  PM
  Subject: Re: Re: [ozmidwifery] ctg 
  stuff
  
  
Choice is an interesting concept: if we 
truly support choice then surely even 'bad' choices should be 
respected?  One of our obs has joked about having a sign made for the 
ANC saying 'please do not ask for an induction as a refusal often offends' 
because the request comes so often.
However, the other obs will often agree to a 
woman's request without too much argument.  I have seen instances where 
the Ob has told the woman - you are not ready to birth, there is no reason 
to induce and if we try you will have a lengthy and horrible labour.  
The reply was "I DONT CARE- I WANT TO BE INDUCED" How can the ob refuse in 
this instance?  The reverse is not true - if a woman reaches T+10 she 
is booked for IOL - there is little 'choice' within our policy for anyone 
who wishes to wait longer - despite the evidence or the individual 
circumstances.   Occasionally requests for 'social' induction 
can be for very valid personal reasons and such instances should also be 
respected.
 I have discussed with some of 
our obs the mentality of agreeing to elective C/S for no other reason 
than maternal request, given that we are a public hospital - should we 
be wasting taxpayers money on non-essential surgery etc etc.  
Again the question of choice. If a woman demands an elective C/S despite 
discussion of the pros and cons, the usual route is to go with her wishes - 
presumably for fear of litigation if the birth does not go well.  I did 
challenge one ob who agreed without hesitation to a woman's request for 
repeat C/S and asked him what his attitude would have been if she had asked 
for VBAC - did not get much in the way of response!
Not saying that I agree with this you 
understand but it does cause some tricky moral dilemmas.
I feel the key issue is one of respect and 
honest discussion - ah but that is all too often missing within the medical 
model of care. That and education - women don't know that they have choices 
to challenge the usual practice of whoever their care provider happens to 
be, sadly those who do challenge are often seen as 'troublesome radicals' if 
their challenge is against 'routine' interventions. (Of course they are not 
seen the same way if their challenge is to request unecessary interventions! 
:-))
Sue
- Original Message - 
From: 
Emily 

To: ozmidwifery@acegraphics.com.au 

Sent: Saturday, June 17, 2006 8:49 
AM
Subject: Re: Re: [ozmidwifery] ctg 
stuff
hi all i have just finished the 'obstetrics' term of my 
course and over the 9 weeks i repetitively brought up my disgust with the 
use of CTGs against all the very high quality evidence that is out there 
against them, that noone refutes they just ignore. the wonderful 
obstetrician who was my supervisor (only one ive ever met that i like) 
agreed and said it is only collective inertia and fear that has led to 
everyone still using it. the fact that it has sneakily become the best 
practice standard. in the big cochrane review on the subject the only 
benefit seen was a reduction in neonatal seizures seen in the CTG group. 
this was used as evidence that it may reduce the incidence of cerebral palsy 
in this group also. actually, there was follow up studies done on all the 
studies included in the review some years later and it actually showed no 
difference in cerebral palsy rates in most studies. one study amazingly 
actually showed a higher rate of cerebral palsy in the CTG group !! this has 
been conveniently forgotten. CTGs are still sold to women as being a safety 
net to prevent cerebral palsy despite the fact that there is absolutely no 
evidence whatesoever of this being the caseall that remains to be the 
benefit of CTGs is for care providers. it makes many people feel safe to 
have a neat little print off documenting what has been happening. the other 
thing is that apparently in the court system, parents can only be 
'compensated' if a no fault verdict is made and that requires a CTG. 
anyway i wrote a huge article about this titled 'the irony of obstetric 
risk analysis'  and handed it in with my end of term work. i am waiting 
with bated breath to hear the f

Re: Re: [ozmidwifery] ctg stuff

[Janet Fraser]

Joyous Birth, the Australian 
home bith network. We have the world's only forums solely devoted to hb, we have 
meetings in 5 capital cities, libraries, birth pools and lots more!
J
http://www.joyousbirth.info/

  - Original Message - 
  From: 
  Susan 
  Cudlipp 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, June 17, 2006 2:20 
  PM
  Subject: Re: Re: [ozmidwifery] ctg 
  stuff
  
  What is the JB website please?
  Sue
  "The only thing necessary for the triumph of evil is for good men to do 
  nothing"Edmund Burke
  
- Original Message - 
From: 
Janet 
Fraser 
To: ozmidwifery@acegraphics.com.au 

Sent: Saturday, June 17, 2006 10:26 
AM
    Subject: Re: Re: [ozmidwifery] ctg 
stuff

I'd love a copy of that 
for the JB website, Emily, if you'd like to share and I'd love all your 
refs
 
What you're describing in 
terms of "maternal choice" really needs a feminist critique to allow us to 
manage those "choices" in ways which are not harmful to women. Since 
induction and elec. c-secs are innately harmful, causing physical and 
emotional trauma to previously healthy women, we need to stop ranking all 
these "choices" as somehow equal. Surgery for no reason is no more healthy 
than formula feeding for no reason yet most of us struggle to work out what 
to do with cases where women request interventions with no medical need. I 
cannot support choices which are at heart harmful to women and babies in 
exactly the same way as I cannot support women to lie down in the middle of 
the highway despite it being their "choice" so to do. If surgeons weren't 
setting the agenda, we wouldn't perceive these interventions as normal and 
healthy. (The crap that so many Obs talk to make VB sound like a risky, 
dangerous, illinformed choice!) Lots of work to do there! You'd really 
benefit in this from the recent MASSIVE discussions on JB around choice and 
what many of us feel is more important still - maternal 
control.
J



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16/06/2006

Re: [ozmidwifery] ctg stuff

[Judy Chapman]

So true Andrea. 
Many years ago a woman consented to be admitted with a
transverse lie at term but rejected any treatment. She was a
mulipara. Many times over the next week the dangers were
explained (such explanation was well documented) and she
declined CS. Finally she consented and it was scheduled for the
next day. That evening SROM and thick mec. Emergency CS and a
beautiful boy around 9 lbs was born. Died next day of Mec
aspiration pneumonia. She blamed the hospital. That left us
feeling bad but eventually she came to realise just what
happened and when she came an gave us a potted plant for the
ward we knew she had done a lot of work with her grief and was
starting to come out the other side. 
Cheers
Judy 

--- Andrea Robertson <[EMAIL PROTECTED]> wrote:

> One aspect of "choice" that needs to be considered is that
> even when 
> all the pros and cons are weighted carefully and a very
> "informed" 
> choice is made, there is no guarantee that the option chosen
> will 
> prove to be the best in the final analysis. Mistakes can still
> be 
> made and decisions thought to be the best can turn out to be
> the 
> worst.  This may result in an unexpected outcomes, but is part
> of 
> life and often leads to rapid and useful learning.
> 
> However, often when a poor choice leads to a bad outcome, the
> blame 
> starts flying and scapegoats are sought (part of the grieving 
> process). It can often be the mother who is blamed (for
> example in a 
> home birth) or the doctor, if the birth takes place in
> hospital.
> 
> For example, if a woman decided, after being told all the
> advantages 
> and disadvantages of an induction and is counselled on likely 
> outcomes, then still choose this option then I belive she must
> be 
> supported in her decision.  It still may turn out OK (Sally
> Tracy's 
> work showed that if a perfectly healthy mother chooses an
> induction 
> for no medical reason she has a 40% chance of coming through
> without 
> further intervention). If things do turn out unexpectedly and 
> complications arise, then this women needs support postnatally
> so 
> that she learns from the event.  However, she may be blamed or
> left 
> feeling guilty or depressed without supportive counselling
> with no 
> opportunity to learn how her decision, even though taken
> carefully, 
> was in the event not the best one she could have made.
> 
> I am all for choice and better options being made available. I
> also 
> believe that women will try and make the best decisions they
> can 
> given a chance, and even though they may decide to do things 
> differently than we would, they have a right to make those 
> choices.  Circumstances change too, and these may affect the
> decision 
> making process - labour can be much harder than anticipated
> and help 
> may be sought. This is where the options are really needed so
> that an 
> epidural is not the only option available, but baths, showers
> etc etc 
> are also at hand (and a lot of this will come down to
> midwifery 
> attitudes and skills).
> 
> This is a tricky area - "informed choice" is really a myth, as
> so 
> many vested interests come into play, but we must support
> women once 
> they have made a considered decision. To do less would be to 
> undermine her further and to miss the opportunity for
> learning, even 
> of some of those lessons are unpalatable at the time.
> 
> Not really expressing this well this morning.
> 
> Regards
> 
> Andrea
> 
> 
> 
> 
> At 03:29 PM 17/06/2006, you wrote:
> >Dear Sue and all
> >
> >What an amazing thread!!
> >
> >Choice is the key.  The choices that are respected and funded
> are 
> >those that prop up the medical monopoly of the big business
> of birth.
> >
> >So all you wonderful midwives out there, start/keep saying 
> >it.  There are no rules or protocols for women, there is
> evidence 
> >and advice and a duty of care for midwives but at the end of
> the day 
> >a woman must be making the decision.  It is not until we have
> a full 
> >complement of choice from homebirth to elec c/s can we say
> that 
> >women are really making a choice.  Now it is choice within a
> vacuum 
> >of medical dominance.
> >
> >I heard an interesting thing re ADHD on the radio the other 
> >day.  The researcher said "if we only ask Drs we will only
> ever get 
> >a medical response".  Nothing new but nicely put.  By
> continuing to 
> >defer to medicos when the majority of us have no medical
> condition 
> >we will never make lasting change.
> >
> >I believe some midwifery stars were recently at a conference 
> >espousing the benefits of managed 3rd stage and justified by
> saying 
> >physiological could only ever be considered when things were
> totally 
> >natural so there was no real point etc.  Whilst I understand
> the 
> >pragmatics of that comment and the reality of the current
> system.  I 
> >find this a real sell-out and on par with the CTG argument
> and many others.
> >
> >Just because something is the majority d

Re: [ozmidwifery] ctg stuff

[MH]

I agree... so often women in early labour present over and over, demanding 
intervention. The reasons for non intervention are explained very clearly, 
there is no ambiguity of information from midwives or medical staff... the 
risks of undesirable outcomes- forceps, c/s, fetal distress etc, being 
hooked up to drips and monitors (yes, policy for Syntocinon use at our 
place) but women still want it in the majority of cases. Once they make sure 
they can have an EDB and so 'won't feel' whatever intervention happens... 
bring it on.

Very dispiriting.
And if you try to hold out, the next thing that happens is that you're 
answering a complaint from the PAtient Representative as to why you cruelly 
withheld legitimate treatment. No wonder midwives and doctors get worn down.

Monica
- Original Message - 
From: "Susan Cudlipp" <[EMAIL PROTECTED]>

To: 
Sent: Saturday, June 17, 2006 11:46 PM
Subject: Re: [ozmidwifery] ctg stuff


Re: [ozmidwifery] ctg stuffMy point here was that this woman DID have this 
explained very carefully by a patient ob who did not want to induce her, and 
still she wanted it done.  And we see so often those who come in time and 
time again trying very hard to get induced - some women will resort to all 
kinds of subterfuge, truly, and I have no idea why they are so keen to put 
themselves through the induction process, but they just want the pregnancy 
OVER.   Sad

Sue

- Original Message - 
 From: Roberta Quinn

 To: ozmidwifery@acegraphics.com.au
 Sent: Saturday, June 17, 2006 4:24 PM
 Subject: RE: [ozmidwifery] ctg stuff


 From: Susan Cudlipp
 "The reply was 'I DONT CARE- I WANT TO BE INDUCED' How can the ob refuse 
in this instance?"


 In my experience, many women don't understand that being induced can 
result in a very different birthing experience for themselves and their 
babies. Perhaps rather than simply being told yes or no, a woman would 
change her mind about wanting to be induced (or the way she is induced) if 
she had all the facts.


 I also think "due dates" (particularly the dates calculated at early 
ultrasounds) can have a hugely negative psychological effect on a woman's 
willingness to wait for labour to start spontaneously.


 From: Justine Canes
 "It is not until we have a full complement of choice from homebirth to 
elec c/s can we say that women are really making a choice. "


 And that women are fully informed when making those choices.


--


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RE: [ozmidwifery] ctg stuff

[Roberta Quinn]

On the contrary, very well said.

-Original Message-
From: Andrea Robertson

This is a tricky area - "informed choice" is really a myth, as so many
vested interests come into play, but we must support women once they have
made a considered decision. To do less would be to undermine her further and
to miss the opportunity for learning, even of some of those lessons are
unpalatable at the time.

Not really expressing this well this morning.

Regards

Andrea
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Visit  to subscribe or unsubscribe.

Re: Re: [ozmidwifery] ctg stuff

[Lynne Staff]

Hi Emily, Could you please email me off list? Re 
your supervisor's request.
Regards, Lynne

  - Original Message - 
  From: 
  Emily 
  
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, June 17, 2006 10:49 
  AM
  Subject: Re: Re: [ozmidwifery] ctg 
  stuff
  hi all i have just finished the 'obstetrics' term of my 
  course and over the 9 weeks i repetitively brought up my disgust with the use 
  of CTGs against all the very high quality evidence that is out there against 
  them, that noone refutes they just ignore. the wonderful obstetrician who was 
  my supervisor (only one ive ever met that i like) agreed and said it is only 
  collective inertia and fear that has led to everyone still using it. the fact 
  that it has sneakily become the best practice standard. in the big cochrane 
  review on the subject the only benefit seen was a reduction in neonatal 
  seizures seen in the CTG group. this was used as evidence that it may reduce 
  the incidence of cerebral palsy in this group also. actually, there was follow 
  up studies done on all the studies included in the review some years later and 
  it actually showed no difference in cerebral palsy rates in most studies. one 
  study amazingly actually showed a higher rate of cerebral palsy in the CTG 
  group !! this has been conveniently forgotten. CTGs are still sold to women as 
  being a safety net to prevent cerebral palsy despite the fact that there is 
  absolutely no evidence whatesoever of this being the caseall that remains 
  to be the benefit of CTGs is for care providers. it makes many people feel 
  safe to have a neat little print off documenting what has been happening. the 
  other thing is that apparently in the court system, parents can only be 
  'compensated' if a no fault verdict is made and that requires a CTG. 
  anyway i wrote a huge article about this titled 'the irony of obstetric 
  risk analysis'  and handed it in with my end of term work. i am waiting 
  with bated breath to hear the feedback and whether i will fail for being so 
  blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres 
  less harm saying it all now, on my way out :)the reason im writing this is 
  that the (good) obstetrician wants me to put together my views on social 
  inductions and social elective caesars and how we should respond to women who 
  sometimes demand these things and whether it is ethical to refuse. im really 
  struggling with it because if we all always say inform and then follow the 
  mothers wishes, what right do we have to refuse this? it is often for what i 
  see as ridiculous reasons (ie the woman recently who demanded an induction so 
  she wouldnt birth on 6/6/06 and threatened to kill herself if we didnt) but 
  who am i to judge women's choices like others judge non-interventionalist 
  choices?id love to know everyones thoughts on this one love emily
  
  
  Do you Yahoo!?Everyone is raving about the all-new 
  Yahoo! Mail Beta.

Re: [ozmidwifery] ctg stuff

[Andrea Robertson]

One aspect of "choice" that needs to be considered is that even when 
all the pros and cons are weighted carefully and a very "informed" 
choice is made, there is no guarantee that the option chosen will 
prove to be the best in the final analysis. Mistakes can still be 
made and decisions thought to be the best can turn out to be the 
worst.  This may result in an unexpected outcomes, but is part of 
life and often leads to rapid and useful learning.


However, often when a poor choice leads to a bad outcome, the blame 
starts flying and scapegoats are sought (part of the grieving 
process). It can often be the mother who is blamed (for example in a 
home birth) or the doctor, if the birth takes place in hospital.


For example, if a woman decided, after being told all the advantages 
and disadvantages of an induction and is counselled on likely 
outcomes, then still choose this option then I belive she must be 
supported in her decision.  It still may turn out OK (Sally Tracy's 
work showed that if a perfectly healthy mother chooses an induction 
for no medical reason she has a 40% chance of coming through without 
further intervention). If things do turn out unexpectedly and 
complications arise, then this women needs support postnatally so 
that she learns from the event.  However, she may be blamed or left 
feeling guilty or depressed without supportive counselling with no 
opportunity to learn how her decision, even though taken carefully, 
was in the event not the best one she could have made.


I am all for choice and better options being made available. I also 
believe that women will try and make the best decisions they can 
given a chance, and even though they may decide to do things 
differently than we would, they have a right to make those 
choices.  Circumstances change too, and these may affect the decision 
making process - labour can be much harder than anticipated and help 
may be sought. This is where the options are really needed so that an 
epidural is not the only option available, but baths, showers etc etc 
are also at hand (and a lot of this will come down to midwifery 
attitudes and skills).


This is a tricky area - "informed choice" is really a myth, as so 
many vested interests come into play, but we must support women once 
they have made a considered decision. To do less would be to 
undermine her further and to miss the opportunity for learning, even 
of some of those lessons are unpalatable at the time.


Not really expressing this well this morning.

Regards

Andrea




At 03:29 PM 17/06/2006, you wrote:

Dear Sue and all

What an amazing thread!!

Choice is the key.  The choices that are respected and funded are 
those that prop up the medical monopoly of the big business of birth.


So all you wonderful midwives out there, start/keep saying 
it.  There are no rules or protocols for women, there is evidence 
and advice and a duty of care for midwives but at the end of the day 
a woman must be making the decision.  It is not until we have a full 
complement of choice from homebirth to elec c/s can we say that 
women are really making a choice.  Now it is choice within a vacuum 
of medical dominance.


I heard an interesting thing re ADHD on the radio the other 
day.  The researcher said "if we only ask Drs we will only ever get 
a medical response".  Nothing new but nicely put.  By continuing to 
defer to medicos when the majority of us have no medical condition 
we will never make lasting change.


I believe some midwifery stars were recently at a conference 
espousing the benefits of managed 3rd stage and justified by saying 
physiological could only ever be considered when things were totally 
natural so there was no real point etc.  Whilst I understand the 
pragmatics of that comment and the reality of the current system.  I 
find this a real sell-out and on par with the CTG argument and many others.


Just because something is the majority does not mean it is 
right.  Sometimes all the fools are simply on the same side, rich 
and very powerful ones I know.


Recently I was told midwives greeted my news of twins at home with 
reasonable upset saying it was one thing to do it but I should have 
done it quietly!!  Oh dear.  It would have been so much nicer to 
have prem babies with respiratory distress (saved by Obstetrics) or 
a "vaginal birth" in lithotomy with a forceps for twin 2.


Lets get real.  Innocent until proven guilty and  Healthy until proven sick!!

They key to change is in the unity.  If enough midwives and women 
said No more it would change very quickly.


When we disagree and are challenged let's ask ourselves where the 
woman's rights are in our anger, upset et etc and let's continue to 
shout it loudly to Obs 'cause they have no argument.



JC





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Re: [ozmidwifery] ctg stuff

[Susan Cudlipp]

Title: Re: [ozmidwifery] ctg stuff



My point here was that this woman DID have this 
explained very carefully by a patient ob who did not want to induce her, and 
still she wanted it done.  And we see so often those who come in time and 
time again trying very hard to get induced - some women will resort to all kinds 
of subterfuge, truly, and I have no idea why they are so keen to put themselves 
through the induction process, but they just want the pregnancy 
OVER.   Sad
Sue
 
- Original Message - 

  From: 
  Roberta Quinn 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, June 17, 2006 4:24 
  PM
  Subject: RE: [ozmidwifery] ctg 
stuff
  
  From: Susan 
  Cudlipp
  "The reply was 'I DONT CARE- I WANT TO BE INDUCED' How can 
  the ob refuse in this instance?"
   
  In my experience, many women don't understand 
  that being induced can result in a very different birthing experience for 
  themselves and their babies. Perhaps rather than simply being told yes or no, 
  a woman would change her mind about wanting to be induced (or the way she is 
  induced) if she had all the facts.
   
  I also think 
  "due dates" (particularly the dates calculated at early ultrasounds) can have 
  a hugely negative psychological effect on a woman's willingness to wait for 
  labour to start spontaneously.
   
  From: Justine 
  Canes
  "It is not until we have a full complement of 
  choice from homebirth to elec c/s can we say that women are really making a 
  choice. "
   
  And that women are fully informed when 
  making those choices.
  
  

  No virus found in this incoming message.Checked by AVG Free 
  Edition.Version: 7.1.394 / Virus Database: 268.9.0/368 - Release Date: 
  16/06/2006

Re: Re: [ozmidwifery] ctg stuff

[Susan Cudlipp]

By 'bad' I meant -choices that I or most midwives 
would disagree with - such as social (non-medically indicated) induction or 
elective C/S.
They might be 'bad' choices in my view but there 
are plenty of intelligent women out there whose views are opposite to 
mine.  I may disagree, I may attempt to inform (and I do, often), I may 
even avoid caring for them, but I cannot ultimately make their choice for 
them.  They are making choices regarding what happens to their own bodies, 
not anyone else's, so it cannot be put in the same context as rape or child 
beating - I know  that these choices affect babies too, but 
because they are so commonplace it is hard to convince women that their choice 
to intervene unecessarily might also impact negatively on the baby.

An example was on front of me recently: a mum had a 
child with Leukaemia, was due to birth the second one. Life was getting very 
hard with the care of sick child and increasing pregnancy, she asked to be 
induced early to make this time easier, for all sorts of personal reasons as 
well as medical ones.  This was not the best option for babe-to-come, not 
the best birthing option for mum-to-be but it was the best option for the family 
unit as a whole.  Who would deny this woman's choice in this 
situation?
Have you ever tried to talk a smoker into 
quitting?  The evidence is undisputably in their face but the choice to 
continue or not is theirs to make.
Yes, misinformation must be fought. Yes, women must 
have good support and advocacy. Yes, to all those things but do we want to be 
accused of forcing 'our' beliefs on women?Because our truth is not necessarily 
their truth.
 
Love this stimulating discussion - and please know 
that I am in no way trying to offend anyone, just playing Devil's 
advocate  :-)
Sue

  - Original Message - 
  From: 
  Stephen & 
  Felicity 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, June 17, 2006 3:21 
  PM
  Subject: Re: Re: [ozmidwifery] ctg 
  stuff
  
  "if 
  we truly support choice then surely even 'bad' choices should be 
  respected?"
   
  Why? Solely in the name 
  of blindly supporting "choice" as a concept? How does this benefit Mothers and 
  babes? We also have the choice to beat our children, men have the choice 
  to rape women, and we can also choose to be cruel to helpless animals if we 
  like.  Should we respect these "choices" so as to indiscriminately uphold 
  the paradigm of choice? Of course not.  Why are innately harmful birthing 
  choices (that affect not only the birthing woman but also her child) any 
  different? If a Mother has made the decision to bring her child to birth, then 
  shouldn't the Mother and babe be able to do so as optimally and safely as 
  possible - why is the "choice" to do so by mutilation and trauma even 
  available, where it is not optimal practice?
   
  Besides which, do women 
  birthing truly have "choice"? Or are the options they are TOLD they have 
  presented to them by a patriarchal system directed at pacifying and 
  controlling them in order to maintain the status quo and secure the balance of 
  power; rewarding "good" (compliant) behaviour and brutally punishing "bad" 
  (well-informed and assertive) behaviour? Women aren't making their "choices" 
  in a vacuum and the incredible external pressures and aggressive campaign of 
  misinformation they face strongly influences any directions they may 
  take.  We're far too focused on the choice and not focused enough on the 
  Mothers and babes at the mercy of those choices.
   
  We need to stop singing 
  about "choice" and focus on the facts; change the system, squash the 
  misinformation, advocate for safety of Mother and baby, place the power 
  back in their hands, and not be afraid to get REAL.  Political 
  correctness has no place in birth and nor does beauracracy. 
  
- Original Message ----- 
    From: 
Susan 
Cudlipp 
To: ozmidwifery@acegraphics.com.au 

Sent: Saturday, June 17, 2006 2:20 
PM
Subject: Re: Re: [ozmidwifery] ctg 
stuff


  Choice is an interesting concept: if we 
  truly support choice then surely even 'bad' choices should be 
  respected?  One of our obs has joked about having a sign made for the 
  ANC saying 'please do not ask for an induction as a refusal often offends' 
  because the request comes so often.
  However, the other obs will often agree to a 
  woman's request without too much argument.  I have seen instances 
  where the Ob has told the woman - you are not ready to birth, there is no 
  reason to induce and if we try you will have a lengthy and horrible 
  labour.  The reply was "I DONT CARE- I WANT TO BE INDUCED" How can 
  the ob refuse i

Re: [ozmidwifery] ctg stuff

[Jennifairy]

Susan Cudlipp wrote:


Choice is an interesting concept: if we truly support choice then
surely even 'bad' choices should be respected?

Yeah see this is where a persons rights as a medical consumer gets 
tricky. How do we define 'bad' choices whilst being 
culturally/theologically/spiritually/ etc sensitive? Look I think that 
the woman who wanted to be induced before the 6/6/06 has just seen too 
many Exorcist movies, but who are we to deny her the right to hold a 
totally different world view? Yes we could argue that her choices can 
potentially cause harm to herself & her baby, we can attempt to 'inform' 
her of her rights and responsibilities as we see them, but at the end of 
the day if she is willing to make that decision then it is hers to make. 
If we are going to be 'real' about supporting womens rights to choose, 
then we also have to be real about where the responsibility ultimately 
lies, & until this is sorted in a cultural, political & legal sense, its 
going to keep going around in these same circles.
The bottom line is that we are arguing about the choices human beings 
have in our culture around birthing, when we cant even choose the way we 
die, that also is a choice that is proscribed (by law even). In the 
situation of dying, one has to consider that you can do it yourself 
quietly (or not) at home (ie 'commit' suicide - notice the allusion to a 
criminal activity in that statement), but you cant expect the help of 
the medical establishment to do so (ie euthanasia). That is one very 
obvious 'boundary' to what medical science can 'ethically' provide. 
Maybe if more women understood that the same boundaries exist in the 
birthing scene, we may see some changes take place! Because of the fear 
of litigation (ie, where the ultimate responsibility lies), you cannot 
expect the medical establishment to sanction or support any behaviour 
that it defines as 'life-threatening'. The fact that the information the 
establishments use to create those definitions is not always evidence 
based just adds to the frustration!
With all due respect to those who work in hospitals, please can we all 
just admit that as soon as you become a 'patient', your choices (and 
therefore your responsibilities) are potentially (depending on what you 
want) over-ridden by hospital policy (ie, there are boundaries to the 
support you can expect)? We can argue that 'it is her body, her baby', 
but if she cant (is not allowed or supported to) make choices that the 
institution sees as inherently 'dangerous' (by thier definition) to 
herself or her baby, then its all just bullshit.

Call me naive (go on, I dont mind), but -
What we want as consumers is to be able to access medical help *on our 
terms*.
What we want as midwives is to know we are working with people (women 
mostly but not only women) that are willing & able to take 
responsibility for their choices & decisions.


--

Jennifairy Gillett RM

Midwife in Private Practice

Women’s Health Teaching Associate

ITShare volunteer – Santos Project Co-ordinator
ITShare SA Inc - http://itshare.org.au/
ITShare SA provides computer systems to individuals & groups, created 
from donated hardware and opensource software


--
This mailing list is sponsored by ACE Graphics.
Visit  to subscribe or unsubscribe.

RE: Re: [ozmidwifery] ctg stuff

[Nicole Carver]

Hi 
Emily,
Good 
on you! As far as induction and c/s on demand the rule of weighing up the 
benefits vs risks still applies. Some women's emotional state may make it 
sensible although regrettable, to concur with their wishes. However, if you have 
been caring for a woman throughout her pregnancy, and have build up a good 
trusting relationship, I think this situation would be rare. Women don't feel 
safe in our disjointed system, where they can see up to 25 health professionals 
in one childbearing experience.
Warm 
regards,Nicole Carver.

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of 
  EmilySent: Saturday, June 17, 2006 10:49 AMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: Re: [ozmidwifery] ctg 
  stuffhi all i have just finished the 'obstetrics' 
  term of my course and over the 9 weeks i repetitively brought up my disgust 
  with the use of CTGs against all the very high quality evidence that is out 
  there against them, that noone refutes they just ignore. the wonderful 
  obstetrician who was my supervisor (only one ive ever met that i like) agreed 
  and said it is only collective inertia and fear that has led to everyone still 
  using it. the fact that it has sneakily become the best practice standard. in 
  the big cochrane review on the subject the only benefit seen was a reduction 
  in neonatal seizures seen in the CTG group. this was used as evidence that it 
  may reduce the incidence of cerebral palsy in this group also. actually, there 
  was follow up studies done on all the studies included in the review some 
  years later and it actually showed no difference in cerebral palsy rates in 
  most studies. one study amazingly actually showed a higher rate of cerebral 
  palsy in the CTG group !! this has been conveniently forgotten. CTGs are still 
  sold to women as being a safety net to prevent cerebral palsy despite the fact 
  that there is absolutely no evidence whatesoever of this being the caseall 
  that remains to be the benefit of CTGs is for care providers. it makes many 
  people feel safe to have a neat little print off documenting what has been 
  happening. the other thing is that apparently in the court system, parents can 
  only be 'compensated' if a no fault verdict is made and that requires a CTG. 
  anyway i wrote a huge article about this titled 'the irony of obstetric 
  risk analysis'  and handed it in with my end of term work. i am waiting 
  with bated breath to hear the feedback and whether i will fail for being so 
  blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres 
  less harm saying it all now, on my way out :)the reason im writing this is 
  that the (good) obstetrician wants me to put together my views on social 
  inductions and social elective caesars and how we should respond to women who 
  sometimes demand these things and whether it is ethical to refuse. im really 
  struggling with it because if we all always say inform and then follow the 
  mothers wishes, what right do we have to refuse this? it is often for what i 
  see as ridiculous reasons (ie the woman recently who demanded an induction so 
  she wouldnt birth on 6/6/06 and threatened to kill herself if we didnt) but 
  who am i to judge women's choices like others judge non-interventionalist 
  choices?id love to know everyones thoughts on this one love emily
  
  
  Do you Yahoo!?Everyone is raving about the all-new 
  Yahoo! Mail Beta.

RE: [ozmidwifery] ctg stuff

[Roberta Quinn]

Title: Re: [ozmidwifery] ctg stuff



From: Susan 
Cudlipp
"The reply was 'I DONT CARE- I WANT TO BE INDUCED' How can the 
ob refuse in this instance?"
 
In my experience, many women don't understand 
that being induced can result in a very different birthing experience for 
themselves and their babies. Perhaps rather than simply being told yes or no, a 
woman would change her mind about wanting to be induced (or the way she is 
induced) if she had all the facts.
 
I also think "due 
dates" (particularly the dates calculated at early ultrasounds) can have a 
hugely negative psychological effect on a woman's willingness to wait for labour 
to start spontaneously.
 
From: Justine 
Canes
"It is not until we have a full complement of 
choice from homebirth to elec c/s can we say that women are really making a 
choice. "
 
And that women are fully informed when 
making those choices.

Re: Re: [ozmidwifery] ctg stuff

[Stephen & Felicity]

"if we 
truly support choice then surely even 'bad' choices should be 
respected?"
 
Why? Solely in the name of 
blindly supporting "choice" as a concept? How does this benefit Mothers and 
babes? We also have the choice to beat our children, men have the choice to 
rape women, and we can also choose to be cruel to helpless animals if we 
like.  Should we respect these "choices" so as to indiscriminately uphold 
the paradigm of choice? Of course not.  Why are innately harmful birthing 
choices (that affect not only the birthing woman but also her child) any 
different? If a Mother has made the decision to bring her child to birth, then 
shouldn't the Mother and babe be able to do so as optimally and safely as 
possible - why is the "choice" to do so by mutilation and trauma even available, 
where it is not optimal practice?
 
Besides which, do women 
birthing truly have "choice"? Or are the options they are TOLD they have 
presented to them by a patriarchal system directed at pacifying and controlling 
them in order to maintain the status quo and secure the balance of power; 
rewarding "good" (compliant) behaviour and brutally punishing "bad" 
(well-informed and assertive) behaviour? Women aren't making their "choices" in 
a vacuum and the incredible external pressures and aggressive campaign of 
misinformation they face strongly influences any directions they may take.  
We're far too focused on the choice and not focused enough on the Mothers and 
babes at the mercy of those choices.
 
We need to stop singing 
about "choice" and focus on the facts; change the system, squash the 
misinformation, advocate for safety of Mother and baby, place the power 
back in their hands, and not be afraid to get REAL.  Political correctness 
has no place in birth and nor does beauracracy. 

  - Original Message - 
  From: 
  Susan 
  Cudlipp 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, June 17, 2006 2:20 
  PM
  Subject: Re: Re: [ozmidwifery] ctg 
  stuff
  
  
Choice is an interesting concept: if we 
truly support choice then surely even 'bad' choices should be 
respected?  One of our obs has joked about having a sign made for the 
ANC saying 'please do not ask for an induction as a refusal often offends' 
because the request comes so often.
However, the other obs will often agree to a 
woman's request without too much argument.  I have seen instances where 
the Ob has told the woman - you are not ready to birth, there is no reason 
to induce and if we try you will have a lengthy and horrible labour.  
The reply was "I DONT CARE- I WANT TO BE INDUCED" How can the ob refuse in 
this instance?  The reverse is not true - if a woman reaches T+10 she 
is booked for IOL - there is little 'choice' within our policy for anyone 
who wishes to wait longer - despite the evidence or the individual 
circumstances.   Occasionally requests for 'social' induction 
can be for very valid personal reasons and such instances should also be 
respected.
 I have discussed with some of 
our obs the mentality of agreeing to elective C/S for no other reason 
than maternal request, given that we are a public hospital - should we 
be wasting taxpayers money on non-essential surgery etc etc.  
Again the question of choice. If a woman demands an elective C/S despite 
discussion of the pros and cons, the usual route is to go with her wishes - 
presumably for fear of litigation if the birth does not go well.  I did 
challenge one ob who agreed without hesitation to a woman's request for 
repeat C/S and asked him what his attitude would have been if she had asked 
for VBAC - did not get much in the way of response!
Not saying that I agree with this you 
understand but it does cause some tricky moral dilemmas.
I feel the key issue is one of respect and 
honest discussion - ah but that is all too often missing within the medical 
model of care. That and education - women don't know that they have choices 
to challenge the usual practice of whoever their care provider happens to 
be, sadly those who do challenge are often seen as 'troublesome radicals' if 
their challenge is against 'routine' interventions. (Of course they are not 
seen the same way if their challenge is to request unecessary interventions! 
    :-))
Sue
- Original Message - 
From: 
Emily 

To: ozmidwifery@acegraphics.com.au 

Sent: Saturday, June 17, 2006 8:49 
AM
Subject: Re: Re: [ozmidwifery] ctg 
stuff
hi all i have just finished the 'obstetrics' term of my 
course and over the 9 weeks i repetitively brought up my disgust with the 
use of CTGs against 

Re: [ozmidwifery] ctg stuff

[Justine Caines]

Title: Re: [ozmidwifery] ctg stuff



Dear Sue and all

What an amazing thread!!

Choice is the key.  The choices that are respected and funded are those that prop up the medical monopoly of the big business of birth.

So all you wonderful midwives out there, start/keep saying it.  There are no rules or protocols for women, there is evidence and advice and a duty of care for midwives but at the end of the day a woman must be making the decision.  It is not until we have a full complement of choice from homebirth to elec c/s can we say that women are really making a choice.  Now it is choice within a vacuum of medical dominance.

I heard an interesting thing re ADHD on the radio the other day.  The researcher said “if we only ask Drs we will only ever get a medical response”.  Nothing new but nicely put.  By continuing to defer to medicos when the majority of us have no medical condition we will never make lasting change.

I believe some midwifery stars were recently at a conference espousing the benefits of managed 3rd stage and justified by saying physiological could only ever be considered when things were totally natural so there was no real point etc.  Whilst I understand the pragmatics of that comment and the reality of the current system.  I find this a real sell-out and on par with the CTG argument and many others.

Just because something is the majority does not mean it is right.  Sometimes all the fools are simply on the same side, rich and very powerful ones I know.  

Recently I was told midwives greeted my news of twins at home with reasonable upset saying it was one thing to do it but I should have done it quietly!!  Oh dear.  It would have been so much nicer to have prem babies with respiratory distress (saved by Obstetrics) or a “vaginal birth” in lithotomy with a forceps for twin 2.

Lets get real.  Innocent until proven guilty and  Healthy until proven sick!!

They key to change is in the unity.  If enough midwives and women said No more it would change very quickly.

When we disagree and are challenged let’s ask ourselves where the woman’s rights are in our anger, upset et etc and let’s continue to shout it loudly to Obs ‘cause they have no argument.


JC

Re: Re: [ozmidwifery] ctg stuff

[Emily]

www.joyousbirth.info Susan Cudlipp <[EMAIL PROTECTED]> wrote:  What is the JB website please?  Sue  "The only thing necessary for the triumph of evil is for good men to do   nothing"Edmund Burke  - Original Message - From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Saturday, June 17, 2006 10:26
 AM    Subject: Re: Re: [ozmidwifery] ctg stuffI'd love a copy of that for the JB website, Emily, if you'd like to share and I'd love all your refs What you're describing in terms of "maternal choice" really needs a feminist critique to allow us to manage those "choices" in ways which are not harmful to women. Since induction and elec. c-secs are innately harmful, causing physical and emotional trauma to previously healthy women, we need to stop ranking all these "choices" as somehow equal. Surgery for no reason is no more
 healthy than formula feeding for no reason yet most of us struggle to work out what to do with cases where women request interventions with no medical need. I cannot support choices which are at heart harmful to women and babies in exactly the same way as I cannot support women to lie down in the middle of the highway despite it being their "choice" so to do. If surgeons weren't setting the agenda, we wouldn't perceive these interventions as normal and healthy. (The crap that so many Obs talk to make VB sound like a risky, dangerous, illinformed choice!) Lots of work to do there! You'd really benefit in this from the recent MASSIVE discussions on JB around choice and what many of us feel is more important still - maternal control.J  No virus found in this incoming message.Checked by AVG Free
 Edition.Version: 7.1.394 / Virus Database: 268.9.0/368 - Release Date: 16/06/2006 
		Yahoo! Sports Fantasy Football ’06 - Go with the leader. 
Start your league today! 

Re: Re: [ozmidwifery] ctg stuff

[Susan Cudlipp]

What is the JB website please?
Sue
"The only thing necessary for the triumph of evil is for good men to do 
nothing"Edmund Burke

  - Original Message - 
  From: 
  Janet 
  Fraser 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, June 17, 2006 10:26 
  AM
  Subject: Re: Re: [ozmidwifery] ctg 
  stuff
  
  I'd love a copy of that for 
  the JB website, Emily, if you'd like to share and I'd love all your 
  refs
   
  What you're describing in 
  terms of "maternal choice" really needs a feminist critique to allow us to 
  manage those "choices" in ways which are not harmful to women. Since induction 
  and elec. c-secs are innately harmful, causing physical and emotional trauma 
  to previously healthy women, we need to stop ranking all these "choices" as 
  somehow equal. Surgery for no reason is no more healthy than formula feeding 
  for no reason yet most of us struggle to work out what to do with cases where 
  women request interventions with no medical need. I cannot support choices 
  which are at heart harmful to women and babies in exactly the same way as I 
  cannot support women to lie down in the middle of the highway despite it being 
  their "choice" so to do. If surgeons weren't setting the agenda, we wouldn't 
  perceive these interventions as normal and healthy. (The crap that so 
  many Obs talk to make VB sound like a risky, dangerous, illinformed 
  choice!) Lots of work to do there! You'd really benefit in this from the 
  recent MASSIVE discussions on JB around choice and what many of us feel is 
  more important still - maternal control.
  J
  
  

  No virus found in this incoming message.Checked by AVG Free 
  Edition.Version: 7.1.394 / Virus Database: 268.9.0/368 - Release Date: 
  16/06/2006

Re: Re: [ozmidwifery] ctg stuff

[Susan Cudlipp]

  Choice is an interesting concept: if we 
  truly support choice then surely even 'bad' choices should be 
  respected?  One of our obs has joked about having a sign made for the ANC 
  saying 'please do not ask for an induction as a refusal often offends' because 
  the request comes so often.
  However, the other obs will often agree to a 
  woman's request without too much argument.  I have seen instances where 
  the Ob has told the woman - you are not ready to birth, there is no reason to 
  induce and if we try you will have a lengthy and horrible labour.  The 
  reply was "I DONT CARE- I WANT TO BE INDUCED" How can the ob refuse in this 
  instance?  The reverse is not true - if a woman reaches T+10 she is 
  booked for IOL - there is little 'choice' within our policy for anyone who 
  wishes to wait longer - despite the evidence or the individual 
  circumstances.   Occasionally requests for 'social' induction 
  can be for very valid personal reasons and such instances should also be 
  respected.
   I have discussed with some of our 
  obs the mentality of agreeing to elective C/S for no other reason than 
  maternal request, given that we are a public hospital - should we 
  be wasting taxpayers money on non-essential surgery etc etc.  Again 
  the question of choice. If a woman demands an elective C/S despite discussion 
  of the pros and cons, the usual route is to go with her wishes - presumably 
  for fear of litigation if the birth does not go well.  I did challenge 
  one ob who agreed without hesitation to a woman's request for repeat C/S and 
  asked him what his attitude would have been if she had asked for VBAC - did 
  not get much in the way of response!
  Not saying that I agree with this you understand 
  but it does cause some tricky moral dilemmas.
  I feel the key issue is one of respect and 
  honest discussion - ah but that is all too often missing within the medical 
  model of care. That and education - women don't know that they have choices to 
  challenge the usual practice of whoever their care provider happens to be, 
  sadly those who do challenge are often seen as 'troublesome radicals' if their 
  challenge is against 'routine' interventions. (Of course they are not seen the 
  same way if their challenge is to request unecessary interventions! :-))
  Sue
  - Original Message - 
  From: 
  Emily 
  
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, June 17, 2006 8:49 
  AM
  Subject: Re: Re: [ozmidwifery] ctg 
  stuff
  hi all i have just finished the 'obstetrics' term of my 
  course and over the 9 weeks i repetitively brought up my disgust with the use 
  of CTGs against all the very high quality evidence that is out there against 
  them, that noone refutes they just ignore. the wonderful obstetrician who was 
  my supervisor (only one ive ever met that i like) agreed and said it is only 
  collective inertia and fear that has led to everyone still using it. the fact 
  that it has sneakily become the best practice standard. in the big cochrane 
  review on the subject the only benefit seen was a reduction in neonatal 
  seizures seen in the CTG group. this was used as evidence that it may reduce 
  the incidence of cerebral palsy in this group also. actually, there was follow 
  up studies done on all the studies included in the review some years later and 
  it actually showed no difference in cerebral palsy rates in most studies. one 
  study amazingly actually showed a higher rate of cerebral palsy in the CTG 
  group !! this has been conveniently forgotten. CTGs are still sold to women as 
  being a safety net to prevent cerebral palsy despite the fact that there is 
  absolutely no evidence whatesoever of this being the caseall that remains 
  to be the benefit of CTGs is for care providers. it makes many people feel 
  safe to have a neat little print off documenting what has been happening. the 
  other thing is that apparently in the court system, parents can only be 
  'compensated' if a no fault verdict is made and that requires a CTG. 
  anyway i wrote a huge article about this titled 'the irony of obstetric 
  risk analysis'  and handed it in with my end of term work. i am waiting 
  with bated breath to hear the feedback and whether i will fail for being so 
  blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres 
  less harm saying it all now, on my way out :)the reason im writing this is 
  that the (good) obstetrician wants me to put together my views on social 
  inductions and social elective caesars and how we should respond to women who 
  sometimes demand these things and whether it is ethical to refuse. im really 
  struggling with it because if we all always say inform and then follow the 
  mothers wishes, what right do we have to refuse this? it is often for what i 
  see as ridi

Re: Re: [ozmidwifery] ctg stuff

[Janet Fraser]

I'd love a copy of that for 
the JB website, Emily, if you'd like to share and I'd love all your 
refs
 
What you're describing in 
terms of "maternal choice" really needs a feminist critique to allow us to 
manage those "choices" in ways which are not harmful to women. Since induction 
and elec. c-secs are innately harmful, causing physical and emotional trauma to 
previously healthy women, we need to stop ranking all these "choices" as somehow 
equal. Surgery for no reason is no more healthy than formula feeding for no 
reason yet most of us struggle to work out what to do with cases where women 
request interventions with no medical need. I cannot support choices which are 
at heart harmful to women and babies in exactly the same way as I cannot support 
women to lie down in the middle of the highway despite it being their "choice" 
so to do. If surgeons weren't setting the agenda, we wouldn't perceive these 
interventions as normal and healthy. (The crap that so many Obs talk to 
make VB sound like a risky, dangerous, illinformed choice!) Lots of work to 
do there! You'd really benefit in this from the recent MASSIVE discussions on JB 
around choice and what many of us feel is more important still - maternal 
control.
J

RE: Re: [ozmidwifery] ctg stuff

[adamnamy]

It would be good if we could change the ordinary
persons thinking from “intervention is necessary to save lives and
prevent bad outcomes- and that the trade- offs are minimal” to the truth
about how dangerous and ineffective they can be and how choosing one often
means setting yourself up for the whole gamut of intervention.    

 

I think women who choose such interventions
for “non medical” reasons in part do so because when they are done
for “medical” reasons we are told that they are safe and in fact
necessary to ensure a good outcome.  There is an attitude that because it
is so frighteningly common it must be safe…the path most traveled…must be safe!

 

We all know that it is not actually the
case, women and their babies fare so much better, emotionally and physically
when empowered to birth under their own steam.  It is not about judging
women but changing the climate so to speak…changing the common assumption
that hospital birthing with it’s vast array of “aids” and
interventions is the be all and end all of safe birthing, this is obviously a
harder task.

 

In the mean time…women will still
want to birth in a multitude of ways... It just seems strange that it is easier
to persuade the doc’s to intervene than to not interfere.

 

Amy

 









From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On
Behalf Of Emily
Sent: Saturday, June 17, 2006 8:49
AM
To: ozmidwifery@acegraphics.com.au
Subject: Re: Re: [ozmidwifery] ctg
stuff



 

hi all 
i have just finished the 'obstetrics' term of my course and over the 9 weeks i
repetitively brought up my disgust with the use of CTGs against all the very
high quality evidence that is out there against them, that noone refutes they
just ignore. the wonderful obstetrician who was my supervisor (only one ive
ever met that i like) agreed and said it is only collective inertia and fear
that has led to everyone still using it. the fact that it has sneakily become
the best practice standard. in the big cochrane review on the subject the only
benefit seen was a reduction in neonatal seizures seen in the CTG group. this
was used as evidence that it may reduce the incidence of cerebral palsy in this
group also. actually, there was follow up studies done on all the studies
included in the review some years later and it actually showed no difference in
cerebral palsy rates in most studies. one study amazingly actually showed a
higher rate of cerebral palsy in the CTG group !! this has been conveniently
forgotten. CTGs are still sold to women as being a safety net to prevent
cerebral palsy despite the fact that there is absolutely no evidence
whatesoever of this being the case
all that remains to be the benefit of CTGs is for care providers. it makes many
people feel safe to have a neat little print off documenting what has been
happening. the other thing is that apparently in the court system, parents can
only be 'compensated' if a no fault verdict is made and that requires a CTG. 
anyway i wrote a huge article about this titled 'the irony of obstetric risk
analysis'  and handed it in with my end of term work. i am waiting with
bated breath to hear the feedback and whether i will fail for being so
blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres
less harm saying it all now, on my way out :)
the reason im writing this is that the (good) obstetrician wants me to put
together my views on social inductions and social elective caesars and how we
should respond to women who sometimes demand these things and whether it is
ethical to refuse. im really struggling with it because if we all always say
inform and then follow the mothers wishes, what right do we have to refuse
this? it is often for what i see as ridiculous reasons (ie the woman recently
who demanded an induction so she wouldnt birth on 6/6/06 and threatened to kill
herself if we didnt) but who am i to judge women's choices like others judge
non-interventionalist choices?
id love to know everyones thoughts on this one 
love emily

  







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Everyone is raving about the all-new
Yahoo! Mail Beta.

Re: Re: [ozmidwifery] ctg stuff

[Emily]

hi all   i have just finished the 'obstetrics' term of my course and over the 9  weeks i repetitively brought up my disgust with the use of CTGs against  all the very high quality evidence that is out there against them, that  noone refutes they just ignore. the wonderful obstetrician who was my  supervisor (only one ive ever met that i like) agreed and said it is  only collective inertia and fear that has led to everyone still using  it. the fact that it has sneakily become the best practice standard. in  the big cochrane review on the subject the only benefit seen was a  reduction in neonatal seizures seen in the CTG group. this was used as  evidence that it may reduce the incidence of cerebral palsy in this  group also. actually, there was follow up studies done on all the  studies included in the review some years later and it actually showed  no difference in cerebral palsy rates in most studies. one study  amazingly actually showed a higher rate of cerebral palsy
 in the CTG  group !! this has been conveniently forgotten. CTGs are still sold to  women as being a safety net to prevent cerebral palsy despite the fact  that there is absolutely no evidence whatesoever of this being the case  all that remains to be the benefit of CTGs is for care providers. it  makes many people feel safe to have a neat little print off documenting  what has been happening. the other thing is that apparently in the  court system, parents can only be 'compensated' if a no fault verdict  is made and that requires a CTG.   anyway i wrote a huge article about this titled 'the irony of obstetric  risk analysis'  and handed it in with my end of term work. i am  waiting with bated breath to hear the feedback and whether i will fail  for being so blatently anti-obstetrics to my obstetric supervisors!!!  but i figured theres less harm saying it all now, on my way out :)  the reason im writing this is that the (good) obstetrician wants me to  put
 together my views on social inductions and social elective caesars  and how we should respond to women who sometimes demand these things  and whether it is ethical to refuse. im really struggling with it  because if we all always say inform and then follow the mothers wishes,  what right do we have to refuse this? it is often for what i see as  ridiculous reasons (ie the woman recently who demanded an induction so  she wouldnt birth on 6/6/06 and threatened to kill herself if we didnt)  but who am i to judge women's choices like others judge  non-interventionalist choices?  id love to know everyones thoughts on this onelove emily 
		Do you Yahoo!? Everyone is raving about the  all-new Yahoo! Mail Beta.

Re: [ozmidwifery] CTG & stillbirth

[brendamanning]

Lieve,
 
I love your 
posts.
 
It is so reassuring to 
know that we are all in the same energy zone even when the outcomes are poor. It 
isn't just here in OZ, it must be some 
universal synergy !!
 
With kind regardsBrenda Manning www.themidwife.com.au

  - Original Message - 
  From: 
  Lieve Huybrechts 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, May 27, 2006 9:11 
PM
  Subject: RE: [ozmidwifery] CTG & 
  stillbirth
  
  
  Hello 
  Michelle
   
  Last week something 
  strange has happened. Two colleague midwives had a stillbirth at home. A very 
  normal labour, half an hour second stage, good heartbeats. When the baby’s 
  head was born they saw meconium in the mouth (the water was clear when it 
  broke minutes before). The baby was flat and gave no reaction. They tried to 
  reanimate and called urgency. The baby died later that day.
  Yesterday I spoke to 
  a colleague that works in a hospital. She told that they had on that same day 
  (17th of May) a similar story. A woman came a few days overdue for 
  a monitor. The monitor showed a non variable heartbeat. They controlled with 
  another monitor, even flatter tracé, than the STAN monitor and emergency 
  C-section. Baby had apgar 0 at birth. Clear fluid at the c-section, meconium 
  aspirated from the lungs!  After reanimation,  baby lives but has 
  very bad brain scans, so is severely damaged. The people of the tertiare 
  hospital were called and when they came to pick up the baby, they told that 
  they didn’t understand what was happening: they had the same day already five 
  similar cases.
   
  I think this is all 
  very strange. 
   
  Greetings from rainy 
  Belgium
  Lieve
   
  
  Lieve 
  Huybrechts
  vroedvrouw
  0477740853
   
  -Oorspronkelijk 
  bericht-Van: 
  owner-ozmidwifery@acegraphics.com.au 
  [mailto:owner-ozmidwifery@acegraphics.com.au] Namens Michelle WindsorVerzonden: zaterdag 27 mei 2006 
  11:16Aan: 
  OzmidwiferyOnderwerp: 
  [ozmidwifery] CTG & stillbirth
   
  
   
  
   
  
  Recently where I work a primip come in at 
  term plus 7 days in early labour about 11pm.  She had a CTG at 3pm which 
  was reactive, good variability etc.  (they do routine CTG's on post-dates 
  women).  The woman wasn't in established labour and the midwife 
  suggested she return home.  The woman wasn't keen for this so stayed and 
  the FHR was auscultated every couple of hours and was normal, with the woman 
  still not in active labour.  Apparently after change of shift the next 
  midwife couldn't find a FHR and USS confirmed the baby had died within the 
  last couple of hours.  I wasn't caring for this woman so don't know all 
  the details but apparently she had an uneventful pregnancy although she had 
  presented three times during pregnancy with decreased movements and the CTG's 
  were always normal.
  
   
  
  To me it just proves again the 
  unreliability of CTG's.  Just interested in what others 
  think.
  
   
  
  Cheers
  
  Michelle
  
  
  
  On Yahoo!7 360°: 
  Your own space to share what you want with who you 
  want!

Re: [ozmidwifery] CTG & stillbirth

[Sadie]

I think it shows one person's interpretation of 
a CTG...

  - Original Message - 
  From: 
  Michelle Windsor 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, May 27, 2006 9:39 
PM
  Subject: Re: [ozmidwifery] CTG & 
  stillbirth
  
  Hi Sadie,
   
  I guess the thing is that alot of people believe that a normal CTG (not 
  in labour) is reassuring for fetal well being for the next 24 hours.  
  Obviously this wasn't the case for this baby. 
   
  You said about doing emergency C/S for unressuring trace only to have the 
  baby come out screaming don't you think this shows CTG's are 
  unreliable?
   
  Cheers MichelleSadie 
  <[EMAIL PROTECTED]> wrote:
  



CTG's can only reveal what is happening at 
that moment and are subjective to interpretation. Often a CTG can look 
positively awful, and yet after FBS the pH is fine - and how often have many 
of us taken an emergency C/S to theatre because of a trace that was not 
reassuring - to have a screaming, healthy baby emerge (thank goodness, as 
you are on stand-by with resus). This is very sad Michelle, but you cannot 
say this has happened because CTG's are unreliable. The CTG at 3pm was 
probably reflecting accurately - and the poor midwife who was responsible 
for performing that CTG will be feeling bad enough as it is. 
Just my thoughts having been through a 
similar situation..
 
Sadie

  - Original Message - 
  From: 
  Michelle Windsor 
  To: Ozmidwifery 
  Sent: Saturday, May 27, 2006 5:15 
  PM
  Subject: [ozmidwifery] CTG & 
  stillbirth
  
   
   
  Recently where I work a primip come in at term plus 7 days in early 
  labour about 11pm.  She had a CTG at 3pm which was reactive, good 
  variability etc.  (they do routine CTG's on post-dates women).  
  The woman wasn't in established labour and the midwife suggested she 
  return home.  The woman wasn't keen for this so stayed and the FHR 
  was auscultated every couple of hours and was normal, with the woman still 
  not in active labour.  Apparently after change of shift the next 
  midwife couldn't find a FHR and USS confirmed the baby had died within the 
  last couple of hours.  I wasn't caring for this woman so don't know 
  all the details but apparently she had an uneventful pregnancy although 
  she had presented three times during pregnancy with decreased movements 
  and the CTG's were always normal.
   
  To me it just proves again the unreliability of CTG's.  Just 
  interested in what others think.
   
  Cheers
  Michelle
  
  
  On Yahoo!7 360°: 
  Your own space to share what you want with who you 
want!
  
  
  The 
  LOST Ninja blog: Exclusive clues, clips and gossip. 

Re: [ozmidwifery] CTG & stillbirth

[Michelle Windsor]

Hi Sadie,     I guess the thing is that alot of people believe that a normal CTG (not in labour) is reassuring for fetal well being for the next 24 hours.  Obviously this wasn't the case for this baby.      You said about doing emergency C/S for unressuring trace only to have the baby come out screaming don't you think this shows CTG's are unreliable?     Cheers MichelleSadie <[EMAIL PROTECTED]> wrote:  CTG's can only reveal what is happening at that moment and are subjective to interpretation. Often a CTG can look positively awful, and yet after FBS the pH is fine - and how often have many of us taken an emergency C/S to
 theatre because of a trace that was not reassuring - to have a screaming, healthy baby emerge (thank goodness, as you are on stand-by with resus). This is very sad Michelle, but you cannot say this has happened because CTG's are unreliable. The CTG at 3pm was probably reflecting accurately - and the poor midwife who was responsible for performing that CTG will be feeling bad enough as it is.   Just my thoughts having been through a similar situation..     Sadie- Original Message -   From: Michelle Windsor   To: Ozmidwifery   Sent: Saturday, May 27, 2006 5:15 PM  Subject: [ozmidwifery] CTG & stillbirth      Recently where I work a primip come in at term plus 7 days in early labour about 11pm.  She had a CTG at 3pm which was reactive, good variability etc.  (they do routine CTG's on post-dates women).  The woman wasn't in established labour and the midwife suggested she return home.  The woman wasn't keen for this so stayed and the FHR was auscultated every couple of hours and was normal, with the woman still not in active labour.  Apparently after change of shift the next midwife couldn't find a FHR and
 USS confirmed the baby had died within the last couple of hours.  I wasn't caring for this woman so don't know all the details but apparently she had an uneventful pregnancy although she had presented three times during pregnancy with decreased movements and the CTG's were always normal.     To me it just proves again the unreliability of CTG's.  Just interested in what others think.     Cheers  Michelle  On Yahoo!7 360°: Your own space to share what you want with who you want!
		 
 
The LOST Ninja blog: Exclusive clues, clips and gossip.  

RE: [ozmidwifery] CTG & stillbirth

[Lieve Huybrechts]

Hello Michelle

 

Last week something
strange has happened. Two colleague midwives had a stillbirth at home. A very
normal labour, half an hour second stage, good heartbeats. When the baby’s
head was born they saw meconium in the mouth (the water was clear when it broke
minutes before). The baby was flat and gave no reaction. They tried to
reanimate and called urgency. The baby died later that day.

Yesterday I spoke to a
colleague that works in a hospital. She told that they had on that same day (17th
of May) a similar story. A woman came a few days overdue for a monitor. The
monitor showed a non variable heartbeat. They controlled with another monitor,
even flatter tracé, than the STAN monitor and emergency C-section. Baby had
apgar 0 at birth. Clear fluid at the c-section, meconium aspirated from the
lungs!  After reanimation,  baby lives but has very bad brain scans, so is severely
damaged. The people of the tertiare hospital were called and when they came to
pick up the baby, they told that they didn’t understand what was
happening: they had the same day already five similar cases.

 

I think this is all very
strange. 

 

Greetings from rainy
Belgium

Lieve

 



Lieve Huybrechts

vroedvrouw

0477740853



 

-Oorspronkelijk
bericht-
Van: owner-ozmidwifery@acegraphics.com.au
[mailto:owner-ozmidwifery@acegraphics.com.au] Namens Michelle Windsor
Verzonden: zaterdag 27 mei 2006
11:16
Aan: Ozmidwifery
Onderwerp: [ozmidwifery] CTG &
stillbirth

 



 





 





Recently where I work a
primip come in at term plus 7 days in early labour about 11pm.  She had a
CTG at 3pm which was reactive, good variability etc.  (they do routine
CTG's on post-dates women).  The woman wasn't in established labour
and the midwife suggested she return home.  The woman wasn't keen for this
so stayed and the FHR was auscultated every couple of hours and was normal, with
the woman still not in active labour.  Apparently after change of shift
the next midwife couldn't find a FHR and USS confirmed the baby had died within
the last couple of hours.  I wasn't caring for this woman so don't know all
the details but apparently she had an uneventful pregnancy although she had
presented three times during pregnancy with decreased movements and the CTG's
were always normal.





 





To me it just proves
again the unreliability of CTG's.  Just interested in what others think.





 





Cheers





Michelle









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360°:
Your own space to share what you want with who you want!

Re: [ozmidwifery] CTG & stillbirth

[Melissa Singer]

Hi Michelle,
 

  CTG's have been proven to be very inaccurate, for 
  various reason such as interpretation etc.  In fact 80% of all CTG's will 
  show some abnormality, which is staggering considering  it is such a 
  widely spread and heavily relied on tool.  Why is it used?, because in 
  most hospital's it is the best available.  That is why some places are 
  moving from CTG alone towards biophysical profiles in birth suite which is far 
  more accurate.  Often a suspicious CTG will be shown ok with BPP and the 
  women is left alone without further interference and vice vera.
   
  Very sad..
   
   
   

  - Original Message - 
  From: 
  Sadie 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Saturday, May 27, 2006 5:38 
PM
  Subject: Re: [ozmidwifery] CTG & 
  stillbirth
  
  CTG's can only reveal what is happening at 
  that moment and are subjective to interpretation. Often a CTG can look 
  positively awful, and yet after FBS the pH is fine - and how often have many 
  of us taken an emergency C/S to theatre because of a trace that was not 
  reassuring - to have a screaming, healthy baby emerge (thank goodness, as you 
  are on stand-by with resus). This is very sad Michelle, but you cannot say 
  this has happened because CTG's are unreliable. The CTG at 3pm was probably 
  reflecting accurately - and the poor midwife who was responsible for 
  performing that CTG will be feeling bad enough as it is. 
  Just my thoughts having been through a similar 
  situation..
   
  Sadie
  
- Original Message - 
From: 
Michelle Windsor 
To: Ozmidwifery 
Sent: Saturday, May 27, 2006 5:15 
PM
Subject: [ozmidwifery] CTG & 
stillbirth

 
 
Recently where I work a primip come in at term plus 7 days in early 
labour about 11pm.  She had a CTG at 3pm which was reactive, good 
variability etc.  (they do routine CTG's on post-dates women).  
The woman wasn't in established labour and the midwife suggested she 
return home.  The woman wasn't keen for this so stayed and the FHR was 
auscultated every couple of hours and was normal, with the woman still not 
in active labour.  Apparently after change of shift the next midwife 
couldn't find a FHR and USS confirmed the baby had died within the last 
couple of hours.  I wasn't caring for this woman so don't know all the 
details but apparently she had an uneventful pregnancy although she had 
presented three times during pregnancy with decreased movements and the 
CTG's were always normal.
 
To me it just proves again the unreliability of CTG's.  Just 
interested in what others think.
 
Cheers
Michelle


On Yahoo!7 360°: 
Your own space to share what you want with who you 
want!

Re: [ozmidwifery] CTG & stillbirth

[Sadie]

CTG's can only reveal what is happening at that 
moment and are subjective to interpretation. Often a CTG can look 
positively awful, and yet after FBS the pH is fine - and how often have many of 
us taken an emergency C/S to theatre because of a trace that was not reassuring 
- to have a screaming, healthy baby emerge (thank goodness, as you are on 
stand-by with resus). This is very sad Michelle, but you cannot say this has 
happened because CTG's are unreliable. The CTG at 3pm was probably reflecting 
accurately - and the poor midwife who was responsible for performing that CTG 
will be feeling bad enough as it is. 
Just my thoughts having been through a similar 
situation..
 
Sadie

  - Original Message - 
  From: 
  Michelle Windsor 
  To: Ozmidwifery 
  Sent: Saturday, May 27, 2006 5:15 
PM
  Subject: [ozmidwifery] CTG & 
  stillbirth
  
   
   
  Recently where I work a primip come in at term plus 7 days in early 
  labour about 11pm.  She had a CTG at 3pm which was reactive, good 
  variability etc.  (they do routine CTG's on post-dates women).  The 
  woman wasn't in established labour and the midwife suggested she return 
  home.  The woman wasn't keen for this so stayed and the FHR was 
  auscultated every couple of hours and was normal, with the woman still not in 
  active labour.  Apparently after change of shift the next midwife 
  couldn't find a FHR and USS confirmed the baby had died within the last couple 
  of hours.  I wasn't caring for this woman so don't know all the details 
  but apparently she had an uneventful pregnancy although she had presented 
  three times during pregnancy with decreased movements and the CTG's were 
  always normal.
   
  To me it just proves again the unreliability of CTG's.  Just 
  interested in what others think.
   
  Cheers
  Michelle
  
  
  On Yahoo!7 360°: 
  Your own space to share what you want with who you 
want!

Re: [ozmidwifery] CTG Inservice

[Veronica]

David,
I have just downloaded the CTG Tutor, and have found it 
extremely useful.  Very user friendly, and very practical, although they do 
talk about Ph levels which we don't do where I work.  I am going to 
download it at work also and get some others that are interested to through 
it.  Thanks heaps.  
Veronica

  - Original Message - 
  From: 
  Elissa and 
  David 
  To: [EMAIL PROTECTED] 
  Sent: Wednesday, May 28, 2003 10:20 
  PM
  Subject: Re: [ozmidwifery] CTG 
  Inservice
  
  There is a programme called CTG Tutor which you 
  may find useful .It can be downloaded free at http://www.perinatal.org.uk/ctg/index_ctg.htm
  Cheers,
   David
  
- Original Message - 
From: 
ljg 
To: [EMAIL PROTECTED] 

Sent: Tuesday, May 27, 2003 2:10 
PM
Subject: [ozmidwifery] CTG 
Inservice

Hi all. 
Again need some help from hospital mdiwives. Our unit is implementing 
CTG inservice and am keen to hear how other units do it. Do you do workshops 
or learning packages? Anyone had any involvement in writing/putting together 
a CTG learning package? If anyone uses them am I able to get copies to 
assist with ours if we choose to go down that track? How often are you 
required to do CTG inservice?
Sorry about all the questions!!
regards
lisa g
PS thanks to all those who replied abut my Vitamin K enquiry 
  !

Re: [ozmidwifery] CTG Inservice

[Elissa and David]

There is a programme called CTG Tutor which you may 
find useful .It can be downloaded free at http://www.perinatal.org.uk/ctg/index_ctg.htm
Cheers,
 David

  - Original Message - 
  From: 
  ljg 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, May 27, 2003 2:10 PM
  Subject: [ozmidwifery] CTG 
Inservice
  
  Hi all. 
  Again need some help from hospital mdiwives. Our unit is implementing CTG 
  inservice and am keen to hear how other units do it. Do you do workshops or 
  learning packages? Anyone had any involvement in writing/putting together a 
  CTG learning package? If anyone uses them am I able to get copies to assist 
  with ours if we choose to go down that track? How often are you required to do 
  CTG inservice?
  Sorry about all the questions!!
  regards
  lisa g
  PS thanks to all those who replied abut my Vitamin K enquiry 
!