Sunday, October 22, 2006

Midwives campaign against routine 20 minute foetal monitoring

From Scotland on Sunday

Scrap routine scans say midwives

ROUTINE scans given to women in labour should be scrapped, midwives have claimed in a move that has sparked fears for the safety of mothers and babies.
Gillian Smith, Scottish national officer of the Royal College of Midwives, believes the move would prevent medical staff interfering with the process of natural birth and increase women's chances of delivering their babies without forceps or Caesareans.

But doctors say the scans give them the best opportunity to see if there are problems with a baby during labour.
Around 95% of women who give birth in a Scottish hospital undergo a routine admission cardiotocograph when they arrive on the ward. The scan, also known as electronic foetal monitoring, requires the woman to lie still for at least 20 minutes. A belt strapped to the abdomen records the foetal heartbeat, alerting staff to signs of distress.
Smith says evidence suggests that healthy women with uncomplicated pregnancies do not need to undergo this examination and says it could lead to further unnecessary medical interventions, which damage the natural childbirth process.
The alternative would involve the midwife intermittently listening to the baby's heart through a hand-held device and judging herself whether it was satisfactory - a move some doctors dismiss as not being thorough enough.
Smith is heading a campaign by the RCM Scotland to reduce the number of unnecessary interventions women in labour are subjected to. She said: "Is routine electronic foetal monitoring required in every single woman? Perhaps they do not need it. Does that then start a string of interventions because the woman is strapped down and can't move about?
"There is research to prove that a woman who is up and about will labour better.
Our campaign is about trying to encourage midwives not to give in too quickly. Research tells us that women who receive one-to-one care are less likely to need analgesia and Caesareans. There is a tendency to perhaps intervene a little earlier than is actually required."
The number of Caesarean births has doubled over the past two decades. Now almost one-quarter of women have the procedure.
Forceps deliveries accounted for more than 7% of births, while ventouse, where a vacuum is used to assist birth, accounted for more than 5% of 51,803 children born in Scotland in 2004, the most recent figures available.
There is no specific Scottish guidance on the use of the scan. A report by the Royal College of Obstetricians and Gynaecologists found that it did not improve outcomes for women with normal pregnancies.
But doctors expressed concern, saying the scan is necessary in case of complications.
Dr David Farquharson, clinical director for women's reproductive health at the Edinburgh Royal Infirmary, said the practice of electronic foetal monitoring was standard in his hospital to reassure doctors and patients.
He said: "This is a very controversial area. A lot of obstetricians do not feel comfortable not having a record of foetal heart rate when the woman comes into hospital.
"The alternative is the midwife listening with a hand-held device, and that depends on her being confident on hearing it.
"The problem with that is knowing what they are listening to, then counting the beats with a watch. There is always the risk you could be taking the mother's pulse. That's a worry to obstetricians.
"That's why, from a medical point of view, they feel that recording the foetal heart rate is useful. Obstetricians like the reassurance of a normal foetal heart rate and the printout, which gives documentary evidence of foetal wellbeing.
"We are checking for the character of the foetal heart. There may be an underlying problem not picked up during pregnancy. You can check how well the placenta is working.
"When women go into labour, the baby is put under a degree of stress. If the placenta is not working as well as it should be, the additional stress of labour may cause the baby to be starved of oxygen."
Dorothy Maitland, manager of the Stillbirth and Neonatal Death Society, also backed the practice of routine scans:
"We are all for monitoring. A lot of women say they would go through the whole nine months of their pregnancy attached to a scan machine if they had to. I am not medically minded, but I think it's reassuring to know your baby's heart is beating.
"Many of the people who come to us after suffering a stillbirth say they wish they had been monitored more so they would have picked up something sooner."
Sarah Montagu, spokeswoman for the Association of Radical Midwives, said home birth has been shown in many studies to be as safe or safer than hospital for a healthy woman in a normal pregnancy.
She said: "Hospital is often presented as being safer, but many procedures routinely used in hospital have not been shown to improve safety and may indeed cause more problems than they solve. They are important if problems become evident, but the vast majority of women do not need them.
"We are fortunate that we live in a time and place when medical and technological help is available to women who genuinely need it. But it is sad when the same technology is applied to women who would be better off giving birth in a more natural environment."
'It's up to women to decide'
TESSA Rundell, a 33-year-old university administrator from Edinburgh, is thankful that doctors at Edinburgh Royal Infirmary were able to detect that her baby's heart was beating faster than normal during a routine cardiotograph.
Rundell was given close monitoring during her labour and baby Sam was born healthy and well on June 13 last year. Staff were able to keep an eye on how Sam was coping with the stress of the birth.
Rundell said: "They picked up that the baby's heartbeat had become quite rapid but they lost the signal from the belt so they put an electrode into the baby's scalp so they could monitor him during the delivery. When he was born he was fine. I didn't have any pain relief or any other intervention.
"I think it's up to women whether they want to be monitored during labour. I am glad I was monitored when Sam was born. You do worry about whether everything is going to be OK. If I was to have another baby I would take medical advice about whether I needed to be monitored again, but I do think it should be an option for women. You can say what you would like from your birth in your birth plan, so if you feel very strongly about something you can say it. But I think it should be an option available for medical staff."
Lucy Burns (pictured left with daughter Orla) chose to stay at home for the birth of her three children because she read research that it was safer for many mothers with uncomplicated pregnancies rather than going into hospital where there is a higher risk of interventions.
Burns, 34, who lives in East Lothian, has two boys and a girl. Her youngest, daughter Orla, was born in March.
Burns said: "When I speak to friends who have had hospital births it is very different. They talk about doctors and about being controlled, it seems very negative. At home I made my own decisions.
"It was up to me when I called the midwife and when I got into the pool.
"I didn't want to go to hospital and have an epidural - the thought of a needle in my spine terrifies me."

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