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Tuesday, 25 June 2013

Intermittent auscultation

Intermittent auscultation: the practice of listening to the baby's heartbeat at intervals either by a handheld ultrasonographic device (aka a Sonicaid) or a wooden or plastic fetal stethoscope known as a Pinard's stethoscope.  Current NICE guidelines state that this should be done EVERY 15 MINUTES during established labour.  The alternative is continuous monitoring of the baby's heart via a cardiotocograph (CTG machine).

A very interesting article by Ruth Martis in "Essentially MIDIRS" (Vol 4, no 5, May 2013) about the intrusiveness of intermittent auscultation and the lack of evidence regarding the efficacy of listening to baby's heartbeat in an otherwise normal labour/healthy woman.  A woman quoted describes the experience of intermittent auscultation as being intermittently "ripped away from my peaceful place".

The level of evidence for NICE's 15 minute guideline is C, effectively nothing more than personal opinion.  As obstetricians dominate the NICE maternity guidelines, this means obstetric opinion, and not scientific evidence.  It is actually as near to continuously monitoring as they could get without actually opting for continuous monitoring by CTG machine, undoubtedly their favoured option if not for the presence of lay members and midwifery representatives pointing out that the evidence pointed against that.  (Someone in the know told me this was the situation shortly after the intrapartum guideline was published.)

If some women (and of course many will want their midwife to listen to the baby's heart, whether at 15 minute or longer intervals) find it obtrusive, it also interferes with watchful midwifery.  Having to fiddle around with a sonicaid or Pinard every 15 minutes, changing the woman's position to get a clear reading, interfering with clothing, having to talk to or touch her, as well as the noise of the sonicaid which is intrusive even at low volume.  So called low-intervention care contains many interventions - pulse, blood pressure, palpations, FH auscultation, temperature-taking, asking questions, making records, noting times, offering drinks, massaging backs, even being in the same room ......they can all be intrusive and some women do not want or benefit from any of it.  Especially those who are using hypnobirthing techniques or who are most emotionally and therefore physiologically comfortable in private peace and quiet, who need a deeply mammalian experience and environment.  And there are far more women who need and want this than currently get it.

The Essentially MIDIRS article isn't available online but here is a link to Ruth Martis' proposal to undertake a review of auscultation and the frequency it may or may not be efficacious.

and a link to her other work which includes the use of music during caesarean section:

I am quite sure the questions Ruth is asking are important for women and midwives as she is asking questions about the nature of intervention itself in low-risk labour or where women do not want it regardless of risk.  Undercover Midwife looks forward to reading more when she and her colleagues publish their review.

Monday, 17 June 2013

Induction of labour and the risk of Caesarean section in low risk parous women.

A Swedish study has looked at the risk of CS in low risk PAROUS women who are induced (women who have had a baby before).  The Caesarean section rate in this group is doubled following elective induction of labour and tripled if a cervical ripening method (eg Propess or prostaglandin gel) is used.

This research is very significant and urgently requires to be replicated to make sure its highly significant findings are confirmed in other settings.  Any low-risk parous woman faced with elective induction should be made aware of the findings if she is to make an informed choice.

The paper can be found here:

Friday, 14 June 2013

Bounty (sic) and the child benefit form

Update 26.9.13
Good old Jane Martinson in The Guardian, she does seem to "get it"!

Update 18.6.13
This appeared in the Telegraph today!

Boom boom!


One of the most irritating things about being in a maternity unit is being accosted by Bounty (sic) "ladies" (salespersons) and being given numerous plastic bags full of advertising and samples of various toxic substances.  Even hand-held maternity notes come in plastic "Bounty" envelopes.  In fact, if you are left in any doubt as to the value of your pregnancy to global commerce at the beginning of pregnancy, even the most ardent advocate of free enterprise must be pig-sick of the rubbish being thrown at them by the time they qualify for the final samples which are usually waiting for them by their postnatal bed or in the baby's cot!!  Of course, it doesn't end there.  Once you are on the Bounty mailing list, a small forest of snail-mailings will be sent and your inbox will be full of junk from Bounty every time you manage to find a few minutes to sit at your computer in the first year of motherhood.   And this barrage of crap is justified on the grounds of "information-giving".  As far as maternity units are concerned, the dosh they get for allowing this rampant commercialisation of birth is all that interests them.  They even have to constantly check that the stuff in the packs doesn't run counter to evidence-based maternity care, especially as regards breastfeeding, and have said reps in to remonstrate with them when it doesn't. 

Why does the NHS allow such access to its clients?  It doesn't allow it for other groups, just pregnant women.  It justifies it, or allows Bounty to justify it, on the grounds that the Bounty Packs contain the child benefit claim form and this charade is therefore providing a public service.  Utter tosh.  You do not need to fill your recycling bin with rubbish just to get your child benefit form.  Here it is:

Instructions for completion are here:

and the link to the petition trying to get this sorry state of affairs changed is here!!

As I write, over 14,500 people have already signed!