Re: [ozmidwifery] Intermittent auscultation
Hi Sally do you know when it was published?? I have access to the journal but if you have the dates it narrows it down a lot Katrina x-tad-smallerDoes anyone have access to this guideline??/x-tad-smaller x-tad-smaller /x-tad-smaller x-tad-smallerThe AWHONN (/x-tad-smallerunknown.gif>x-tad-smaller) guidelines which accept q10 minutes for low risk situations/x-tad-smaller x-tad-smaller /x-tad-smaller Sally Westbury Homebirth Midwife Learn from mothers and babies; every one of them has a unique story to tell. Look for wisdom in the humblest places - that's usually where you'll find it. — Lois Wilson
RE: [ozmidwifery] intermittent auscultation
Hi Sue, I think you have missed the point. The alternative is not continuous fetal monitoring. As the research shows this is not best practice. The alternative is perhaps guidelines that say 15 minutely in second stage for low risk women. As these guidelines say: The American College of Obstetricians and Gynecologists (ACOG) states that with specific intervals, intermittent auscultation of the FHR is equivalent to continuous EFM in detecting fetal compromise.4 ACOG has recommended a 1:1 nurse-patient ratio if intermittent auscultation is used as the primary technique of FHR surveillance.4 The recommended intermittent auscultation protocol calls for auscultation every 30 minutes for low-risk patients in the active phase of labor and every 15 minutes in the second stage of labor.4 Continuous EFM is indicated when abnormalities occur with intermittent auscultation and for use in high-risk patients. Table 1 lists examples of the criteria that have been used to categorize patients as high risk. http://www.aafp.org/afp/990501ap/2487.html -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
Sally, I think you have a very valid point could argue it effectively. Good luck ! Brenda - Original Message - From: Sue Cookson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 3:03 PM Subject: Re: [ozmidwifery] intermittent auscultation Interesting line on intermittent auscultation. If mws aren't given the OK to listen intermittently, then every woman would be strapped to a CTG machine with its accompanying restrictions of time and position. Having done a placement recently where CTG's were the norm because of the hospital's tight risk guidelines - VBACs, PROM, anyone with oxytocin up for induction or aumentation, any mec (even if it was only thought to be mec), slow progress, and then the more real risks with unhealthy moms or babes; there were so few women who were in the category for intermittent listening. I totally agree that listening every 5 minutes would be disturbing to any woman's sacred space and time, and have had the luxury of self regulating how and when I listen in second stage by working independently. With today's dialogue around evidence based practice etc, mws are going to have to get their research hats on quickly to add to our unique body of knowledge, otherwise these crazy guidelines will stay in place. There may not be good evidence to support 5 minutely monitoring in low risk women, but we're in a world where the alternative is continuous monitoring and the benefits of this are not well supported either, just preferred by too many. The NICE guidelines also suggest continuous monitoring for 15 minutes every hour as an alternative to totally continuous monitoring thus allowing some change of position and ambulation. ??? My radical nature says unplug all the machines and get back to truly supporting women -high or low risk by giving them proper continuity of care by midwives working as midwives not technicians. The taste of high tech land I'm getting is very sour. Anyone know what the guidelines are in The Netherlands, where midwife supported homebirths abound and their PMR, c/section rates, epidural rates are all so much lower than ours?? Sue Just a thought Sally - the real argument would become whether abnormal states in labour, in this case in second stage, can be detected by other means - such as observation or mother's intuition etc etc. I would suggest they can but again our research hats need to be applied to support the things we do know. I would like to go further with today’s radical thought. I believe there is not evidence to support the 5 minutely interval of intermittent monitoring in a low risk population in second stage of labour. What do people think about this. Do you think I could argue this point effectively?? Sally Westbury __ NOD32 1.1176 (20050722) Information __ This message was checked by NOD32 antivirus system. http://www.nod32.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] intermittent auscultation
I certainly have never seen any evidence. All one gets is textbooks and protocol manuals telling you that you must but not referencing the reason. Cheers Judy --- Sally Westbury [EMAIL PROTECTED] wrote: I would like to go further with today's radical thought. I believe there is not evidence to support the 5 minutely interval of intermittent monitoring in a low risk population in second stage of labour. What do people think about this. Do you think I could argue this point effectively?? Sally Westbury Send instant messages to your online friends http://au.messenger.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
This is so true. We constantly have to justify our belief in the natural process of birth and should a mishap happen in midwifery care, the midwife is all but burnt at the stake. By contrast, most hospitals have regular mortality meetings to discuss medical mishaps, these are in house and only for the purpose of medicos discussing amongst themselves. The results are not for sharing with midwives or any other interested parties. I often wonder why it is that so much utter stupidity becomes common practice - not only in medical circles - and yet the common sense approach is ignored, riduculed or just not taken seriously. Sue The only thing necessary for the triumph of evil is for good men to do nothing Edmund Burke - Original Message - From: brendamanning [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 9:33 AM Subject: Re: [ozmidwifery] intermittent auscultation I notice that it is expected that Midwives base their practice on evidence research. It would appear on the other hand that the medical profession are able to practice on whatever they believe. They do not feel obliged to justify their preference or practice. Why is this so? Why are midwives always feeling they must justify themselves? Why do you allow it ? Who in fact are we accountable to in real life? Our clients, ourselves our peers only ? Or ..?? Brenda - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the somebodies, in positions of power, have set a standard that a reasonable midwife has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to. There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrly to continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.9.7/60 - Release Date: 28/07/2005 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
Once a month, where I work, we have a Practice Improvement Committee Meeting. Here midwivesand obstetricians gather to discuss the ongoing direction of our unit, (low risk, mainly midwife led). We also discuss any adverse outcomes together, no finger pointing, no laying of blame, to make sure that in that same situation next time we can all work better as a team for the greater good of the woman, her baby, and her family. So far, this has worked very well. Sally ---Original Message--- From: Susan Cudlipp Date: 07/30/05 21:25:46 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] intermittent auscultation This is so true. We constantly have to justify our belief in the natural process of birth and should a mishap happen in midwifery care, the midwife is all but burnt at the stake. By contrast, most hospitals have regular mortality meetings to discuss medical mishaps, these are "in house" and only for the purpose of medicos discussing amongst themselves. The results are not for sharing with midwives or any other interested parties. I often wonder why it is that so much utter stupidity becomes common practice - not only in medical circles - and yet the common sense approach is ignored, riduculed or just not taken seriously. Sue "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke - Original Message - From: "brendamanning" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 9:33 AM Subject: Re: [ozmidwifery] intermittent auscultation I notice that it is expected that Midwives base their practice on evidence research. It would appear on the other hand that the medical profession are able to practice on whatever they believe. They do not feel obliged to justify their preference or practice. Why is this so? Why are midwives always feeling they must justify themselves? Why do you allow it ? Who in fact are we accountable to in real life? Our clients, ourselves our peers only ? Or ..?? Brenda - Original Message - From: "Mary Murphy" [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the "somebodies", in positions of power, have set a standard that "a reasonable midwife" has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to.There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrlyto continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention.Surely as professionals we can use our skills to make the call on whether auscultation is needed or not.I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, "Sally Westbury" [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. "A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation." Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or gr
Re: [ozmidwifery] intermittent auscultation
That would be wonderful Sally, I wish more places had that
attitude. I have attended some of our monthly morbidity meetings but
midwives are not generally included.
Sue
"The only thing necessary for the triumph of evil is for good
men to do nothing"Edmund Burke
- Original Message -
From:
sally
williams
To: ozmidwifery@acegraphics.com.au
Sent: Saturday, July 30, 2005 7:31
PM
Subject: Re: [ozmidwifery] intermittent
auscultation
Once a month, where I work, we have a Practice Improvement
Committee Meeting. Here midwivesand obstetricians gather to
discuss the ongoing direction of our unit, (low risk, mainly midwife
led). We also discuss any adverse outcomes together, no finger pointing,
no laying of blame, to make sure that in that same situation next time
we can all work better as a team for the greater good of the woman, her
baby, and her family.
So far, this has worked very well.
Sally
---Original
Message---
From: Susan Cudlipp
Date: 07/30/05
21:25:46
To: ozmidwifery@acegraphics.com.au
Subject: Re:
[ozmidwifery] intermittent auscultation
This is so true.
We constantly have to justify our belief in the natural process of
birth and
should a mishap happen in midwifery care, the midwife is all but
burnt at
the stake.
By contrast, most hospitals have regular mortality meetings to
discuss
medical mishaps, these are "in house" and only for the purpose of
medicos
discussing amongst themselves. The results are not for sharing with
midwives
or any other interested parties.
I often wonder why it is that so much utter stupidity becomes
common
practice - not only in medical circles - and yet the common sense
approach
is ignored, riduculed or just not taken seriously.
Sue
"The only thing necessary for the triumph of evil is for good men
to do
nothing"
Edmund Burke
- Original Message -
From: "brendamanning" [EMAIL PROTECTED]
To: ozmidwifery@acegraphics.com.au
Sent: Saturday, July 30, 2005 9:33 AM
Subject: Re: [ozmidwifery] intermittent auscultation
I notice that it is expected that Midwives base their practice
on evidence
research.
It would appear on the other hand that the medical profession
are able to
practice on whatever they believe. They do not feel obliged to
justify
their preference or practice.
Why is this so?
Why are midwives always feeling they must justify
themselves?
Why do you allow it ?
Who in fact are we accountable to in real life?
Our clients, ourselves our peers only ? Or
..??
Brenda
- Original Message -
From: "Mary Murphy" [EMAIL PROTECTED]
To: ozmidwifery@acegraphics.com.au
Sent: Saturday, July 30, 2005 11:15 AM
Subject: RE: [ozmidwifery] intermittent auscultation
Pete, the only problem is that the "somebodies", in
positions of power,
have
set a standard that "a reasonable midwife" has to adhere
to, or suffer
the
consequences if there is an adverse outcome, ie, a dead or
compromised
baby.
Also, when one is employed by the Govt. there is an
expectation that the
standard will be adhered to.There was not
extensive trials or even
large
scale retrospective research to compare 1/2 hrly or 1/4
hrlyto
continuous
EFM. Unfortunately, common sense does not
prevail.When we don't have
the
midwifery research knowledge to back it up, we have no
other choice. I
wish
it were otherwise, MM
se- d-oes -n--Original Message-
Sally I agree with what both you and Gloria are saying,
with a low risk
women term and all progressing well in labour where is the
evidence to
support any auscultation, I also believe that it can he
horribly
invasive and could easily be construed as
intervention.Surely as
professionals we can use our skills to make the call on
whether
auscultation is needed or not.I also believe
that there can be a lot
of angst built up over listening too often in what in most
situations is
the normal physi
Re: [ozmidwifery] intermittent auscultation
So true Sue!! - hung out to dry then burnt at the stake! - Original Message - From: Susan Cudlipp [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 7:23 PM Subject: Re: [ozmidwifery] intermittent auscultation This is so true. We constantly have to justify our belief in the natural process of birth and should a mishap happen in midwifery care, the midwife is all but burnt at the stake. By contrast, most hospitals have regular mortality meetings to discuss medical mishaps, these are in house and only for the purpose of medicos discussing amongst themselves. The results are not for sharing with midwives or any other interested parties. I often wonder why it is that so much utter stupidity becomes common practice - not only in medical circles - and yet the common sense approach is ignored, riduculed or just not taken seriously. Sue The only thing necessary for the triumph of evil is for good men to do nothing Edmund Burke - Original Message - From: brendamanning [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 9:33 AM Subject: Re: [ozmidwifery] intermittent auscultation I notice that it is expected that Midwives base their practice on evidence research. It would appear on the other hand that the medical profession are able to practice on whatever they believe. They do not feel obliged to justify their preference or practice. Why is this so? Why are midwives always feeling they must justify themselves? Why do you allow it ? Who in fact are we accountable to in real life? Our clients, ourselves our peers only ? Or ..?? Brenda - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the somebodies, in positions of power, have set a standard that a reasonable midwife has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to. There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrly to continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http
Re: [ozmidwifery] intermittent auscultation
Hi listers I will check our policies at work when I am there next, but all our policies have research that is referenced to it! So I will check our monitoring policy and let you know :-) Katrina attachment: smallnps2.jpg www.niagaraparkshow.com.au
RE: [ozmidwifery] intermittent auscultation
I would like to go further with todays radical thought. I believe there is not evidence to support the 5 minutely interval of intermittent monitoring in a low risk population in second stage of labour. What do people think about this. Do you think I could argue this point effectively?? Sally Westbury
RE: [ozmidwifery] intermittent auscultation
I remember asking Anne Frye what she thought about this and she said Second stage heart tones are the insanity of N. American midwives. It is completely disruptive of the trance state in second stage to be poking at the mother with a fetoscope. In a woman with normal BP, cephalic presentation of a full term infant and clear amniotic fluid (or intact membranes), the mw can relax. That baby got conceived, grew to 9 mos gestation without constant monitoring, and can now push it's little self out without being listened to q 5 min. Gloria Quoting Sally Westbury [EMAIL PROTECTED]: I would like to go further with today's radical thought. I believe there is not evidence to support the 5 minutely interval of intermittent monitoring in a low risk population in second stage of labour. What do people think about this. Do you think I could argue this point effectively?? Sally Westbury -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] intermittent auscultation
Pete, the only problem is that the somebodies, in positions of power, have set a standard that a reasonable midwife has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to. There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrly to continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
Good Grief ! Who in the real world does this anyway with a normal labour? What woman in her right mind would LET a midwife do this without a very good reason? Sounds like text book mid doesn't it? Where's the common sense here? I agree with Sally, leave the poor woman baby alone to do their job ! Dear Lord Brenda - Original Message - From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 9:34 AM Subject: Re: [ozmidwifery] intermittent auscultation Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
I notice that it is expected that Midwives base their practice on evidence research. It would appear on the other hand that the medical profession are able to practice on whatever they believe. They do not feel obliged to justify their preference or practice. Why is this so? Why are midwives always feeling they must justify themselves? Why do you allow it ? Who in fact are we accountable to in real life? Our clients, ourselves our peers only ? Or ..?? Brenda - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the somebodies, in positions of power, have set a standard that a reasonable midwife has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to. There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrly to continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
Mary, Whist I agree with you know you are rightthere are no 'large scale retrospective studies' to back up half of what the average medico does how often is s/he called in to question? Where's the logic ? Sometimes I just think Midwives are by nature too compliant. Imagine the response if you queried the OBs practice ? Well you know what it is because we do it all the time ! It's off, or translated get back in your box, I am the one with the appropriate training here. The 'somebodies' who make the decisions aren't at the coalface are they ? GR Brenda - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the somebodies, in positions of power, have set a standard that a reasonable midwife has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to. There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrly to continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] intermittent auscultation
Brenda, you (Sally Pete)know I have practiced intuitive midwifery in homebirth for the last 22yrs. This is not my wish, but under a microscope in the particular fishbowl we are practicing in at the moment. This is the background which Sally is making this search. We are having to justify why our practice is not based on the NICE trial. That is why we have to find a realm of practice that proves we are right in not doing 5 minutely FH in 2nd stge. There is no logic. Homebirth midwives compliant? I don't think so, just trying to survive in the particular position we are in at the moment. We are trying hard to comply with the woman's wishes, the employers wishes and our knowledge of the importance of not disturbing the 2nd stge. We are doing the best we can. If any one can help us now you know the background, please do so. MM Brenda wrote: Whist I agree with you know you are rightthere are no 'large scale retrospetelctive studies' to back up half of what the average medico does how often is s/he called in to question? Where's the logic ? Sometimes I just think Midwives are by nature too compliant. Imagine the response if you queried the OBs practice ? Well you know what it is because we do it all the time ! It's off, or translated get back in your box, I am the one with the appropriate training here. The 'somebodies' who make the decisions aren't at the coalface are they ? GR Brenda - Original Message - From: Mary Murphy [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Saturday, July 30, 2005 11:15 AM Subject: RE: [ozmidwifery] intermittent auscultation Pete, the only problem is that the somebodies, in positions of power, have set a standard that a reasonable midwife has to adhere to, or suffer the consequences if there is an adverse outcome, ie, a dead or compromised baby. Also, when one is employed by the Govt. there is an expectation that the standard will be adhered to. There was not extensive trials or even large scale retrospective research to compare 1/2 hrly or 1/4 hrly to continuous EFM. Unfortunately, common sense does not prevail.When we don't have the midwifery research knowledge to back it up, we have no other choice. I wish it were otherwise, MM se- d-oes -n--Original Message- Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] intermittent auscultation
Interesting line on intermittent auscultation. If mws aren't given the OK to listen intermittently, then every woman would be strapped to a CTG machine with its accompanying restrictions of time and position. Having done a placement recently where CTG's were the norm because of the hospital's tight risk guidelines - VBACs, PROM, anyone with oxytocin up for induction or aumentation, any mec (even if it was only thought to be mec), slow progress, and then the more real risks with unhealthy moms or babes; there were so few women who were in the category for intermittent listening. I totally agree that listening every 5 minutes would be disturbing to any woman's sacred space and time, and have had the luxury of self regulating how and when I listen in second stage by working independently. With today's dialogue around evidence based practice etc, mws are going to have to get their research hats on quickly to add to our unique body of knowledge, otherwise these crazy guidelines will stay in place. There may not be good evidence to support 5 minutely monitoring in low risk women, but we're in a world where the alternative is continuous monitoring and the benefits of this are not well supported either, just preferred by too many. The NICE guidelines also suggest continuous monitoring for 15 minutes every hour as an alternative to totally continuous monitoring thus allowing some change of position and ambulation. ??? My radical nature says unplug all the machines and get back to truly supporting women -high or low risk by giving them proper continuity of care by midwives working as midwives not technicians. The taste of high tech land I'm getting is very sour. Anyone know what the guidelines are in The Netherlands, where midwife supported homebirths abound and their PMR, c/section rates, epidural rates are all so much lower than ours?? Sue Just a thought Sally - the real argument would become whether abnormal states in labour, in this case in second stage, can be detected by other means - such as observation or mother's intuition etc etc. I would suggest they can but again our research hats need to be applied to support the things we do know. I would like to go further with today’s radical thought. I believe there is not evidence to support the 5 minutely interval of intermittent monitoring in a low risk population in second stage of labour. What do people think about this. Do you think I could argue this point effectively?? Sally Westbury __ NOD32 1.1176 (20050722) Information __ This message was checked by NOD32 antivirus system. http://www.nod32.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
