Re: Re: [ozmidwifery] ctg stuff
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 trulysupport 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 obsthe mentality of agreeing to elective C/S for no other reason than maternal request, given that we are a public hospital -should we bewasting 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 t
Re: [ozmidwifery] ctg stuff
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 lets ask ourselves where the womans rights are in our anger, upset et etc and lets continue to shout it loudly to Obs cause they have no argument. JC
Re: Re: [ozmidwifery] ctg stuff
"if we
trulysupport 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 safelyas
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
trulysupport 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 obsthe mentality of agreeing to elective C/S for no other reason
than maternal request, given that we are a public hospital -should we
bewasting 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
ob
RE: [ozmidwifery] ctg stuff
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 hadall 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 informedwhen making those choices.
RE: Re: [ozmidwifery] ctg stuff
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
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 http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: Re: [ozmidwifery] ctg stuff
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 choicesaffectbabies 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 offendanyone, 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 trulysupport 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 safelyas
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
trulysupport 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 ou
Re: [ozmidwifery] ctg stuff
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 hadall 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 informedwhen 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: [ozmidwifery] ctg stuff
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 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: Re: [ozmidwifery] ctg stuff
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
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 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] ctg stuff
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: ozmidwifery@acegraphics.com.au 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. -- 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 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] ctg stuff
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 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
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 onelove emily Do you Yahoo!? Everyone is raving about the all-new Yahoo! Mail Beta.
RE: Re: [ozmidwifery] ctg stuff
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 safethe path most traveledmust 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 speakchanging the common assumption that hospital birthing with its 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 timewomen will still want to birth in a multitude of ways... It just seems strange that it is easier to persuade the docs 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 Do you Yahoo!? Everyone is raving about the all-new Yahoo! Mail Beta.
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. (Thecrap 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
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 AMSubject: 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 refsWhat 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. (Thecrap 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!
