Midwives campaign against routine 20 minute foetal monitoring

From Scotland on Sunday


Scrap routine scans say midwives
KATE FOSTER CHIEF REPORTER

kfoster@scotlandonsunday.com)

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."

A cause to consider

Robert Mugabe has reduced Zimbabwe to a state where women cannot even obtain sanitary towels. This woman is trying to get help:

http://www.itv-thismorning.co.uk/NewsAndFeaturesArticle.aspx?fid=1496&tid=2

Good for Kerry

From the tabloids:

15 October 2006
TV KERRY'S HOMING IN
Debbie Manley & Alice Walker
KERRY KATONA aims to give birth at home.
The pregnant ex-Atomic Kitten has revealed she will have her third child in her new £400,000 house in Warrington, Cheshire.
Kerry, 26, says she and her cabbie partner MARK CROFT want to name the baby Maggie or Peggy if a girl or Alfie if a boy.
The baby is due in April and Kerry has been rushed to hospital twice - once after collapsing and again after a car crash.
She said: "I'm having a home birth so I can say the child was born here in our new house."

Baby born in Richmond Park

This is a lovely birth story and shows how easy birth CAN be. I like the rowan tree idea!

The headline is a scream. Of course the tree surgeons did not deliver the baby. The mum delivered the baby herself.

Baby delivered in park by tree surgeons

04.10.06

Giving
birth was no walk in the park for Carmel Ohrwall.
As she went into labour
there were no midwives, sterilised surfaces or hot towels. Instead, she found
herself kneeling on grass being tended to by surgeons - tree surgeons.
Peter
Carlyon and Ed Campbell-White stopped to help after they saw the woman in
Richmond Park as they passed in their Land Rover.
Mrs Ohrwall, 43, from East
Sheen, told how her husband Fredrik had been trying to call an ambulance but the
operator kept demanding a postcode. "Fredrik was saying, 'Look, we're in the
middle of Richmond Park - are you going to send an ambulance or not?'" she said.
The 7lb baby was born while his father was on the phone. There were no
complications and the couple are now back home with a brother for James, three.
"We haven't chosen a name yet. We're calling him Parkie," said Mrs Ohrwall.
She told how when her contractions began she phoned her husband, who rushed
home from work in the City, and they set off for Kingston Hospital. "As we drove
through the park the urge to push was just so great I had to say to Fredrik,
'Can you pull over'," said Mrs Ohrwall. "There was nothing I could do. I jumped
on to the grass verge and he was out within a few pushes.
"A few seconds
after he started crying. I was just so relieved. Anything could have happened.
What a place to be introduced to the world."
Mr Carlyon, 29, said: "We were
driving past and saw a woman on the ground so we spun the Land Rover round. As
we got out, the mother delivered her own baby in her own hands. We got our
jumpers and wrapped them round the baby and mother. I called my friend who is a
midwife who told us what to do."
Paramedics arrived, cut the umbilical cord
and took them to hospital.
Sara Lom, director of the Royal Parks Foundation,
said: "The hospital phoned to congratulate the tree surgeons.
"Apparently,
most babies born outside get hypothermia but this one was fine. We'll be
planting a rowan tree on the spot."

At last - a sensible guide to birth in a newspaper

This article in the Mirror this week is pretty good. Except when you get to the end, and they suggest contacting British Doulas if you want a doula...Yuck! contact Doula UK please! BD are just a nanny agency, Doula UK is a network of independent doulas.

http://www.mirror.co.uk/yourlife/kidsandfamily/tm_objectid=17860083&method=full&siteid=94762&headline=have-a-happy-birth-day-on-the-nhs-name_page.html

Birth in Thailand

I've just discovered this depressing of birthing trends in Thailand. It seems every society has to go through a stupid phase of thinking birth is better if it's medicalised.

More and more Thai women shun natural birth in favour of caesareans

Elayne Clift Women’s Feature Service

Imagine a woman in a rural South Asian village labouring to give birth. She is at home, surrounded by her extended family. She walks and rests intermittently; the choice is hers. Her birth attendants place a flower near her, telling her softly that as the petals unfold, so will her cervix open. The atmosphere is one of quiet ceremony and celebration. When she is fully dilated, she squats, supported from behind by another woman. The midwife encourages her to push when the time is right. There is no cutting into her body. She is neither medicated nor monitored. She trusts herself to bring her child into the world.
Now look at what is happening to another woman - a more educated, sophisticated woman who is giving birth in a city in Thailand. She is admitted to the hospital, where her clothes and personal belongings are removed. She is immediately hooked up to an intravenous drip for hydration (and the possible administration of medication). Her genitals are partially shaved and an enema is administered. She will most likely be hooked up to a foetal heart monitor. She will be offered drugs "to take the edge off". Perhaps she will be given the stimulant Pitocin to speed things up. If she delivers vaginally, her perineum will be cut, then stitched. But if her cervix does not dilate as quickly as her doctor thinks it should (or if he grows impatient waiting), she may well be subjected to a Caesarean section (C-section)
The contrast between these two births could not be more profound. In the first case, the birth environment is one of confidence and natural forces at work. In the second, a medical atmosphere suggests that something is - or may be - amiss, something that technology can fix or prevent. In fact, that technology is quite likely to be unnecessary in most cases and could be harmful in others.
For example, a C-section is a major surgery and carries with it the attendant risks, including infection, pulmonary embolism (blood clot in the lung), and anaesthesia complications. Foetal monitoring can provide erroneous information, which leads to unnecessary interventions, such as surgery or forceps delivery. Drugs are often administered prematurely, slowing down the progress of labour, another justification for performing C-sections, which are known to carry a risk two to four times higher than vaginal delivery. (The World Health Organisation - WHO - estimates that maternal mortality after C-section is two to 11 times higher than that after vaginal birth.)
So how did the medicalisation of childbirth occur, and why are Asian women increasingly buying into it?
The highly respected Boston Women's Health Book Collective and other women's health advocacy groups internationally have long documented the medical establishment's cooptation of childbirth. In the US, it began in the 19th century, when surgeons realised there was money to be made by treating birth as a debilitating medical event. As one nurse-midwife put it in the Collective's classic book 'Our Bodies, Ourselves' (OBOS) (Simon & Shuster, 1992), "There was no longer any place for most of the natural aspects of birth, like blood, sweat, faeces, movement and sound."
Women began to be encouraged "for your own good" or "for the good of the baby" to accept medical intervention and something of a factory approach to birth ensued. That approach focused on efficiency and practitioner profit rather than individual experience and preference.
Over time, women in America and Europe themselves began to internalise the medical model of childbirth. Frightened, they were no longer confident of their ability to give birth. This is how one mother put it in OBOS: "It was like our confidence was a big piece of material. When little holes of fear and doubt began to appear, the medical mentality made them larger and larger until the once-beautiful cloth was nothing but gaping holes."
That lack of confidence is one big reason that urban, affluent women in many Asian countries are choosing C-section births at an astounding rate. In a Thai urban hospital, 30 per cent of first births - and 40 to 50 per cent of subsequent births - are C-section.
The overall C-section rate in the country rose from 15.2 per cent in 1990 to 22.4 per cent in 1996, according to the WHO Regional Office for Southeast Asia. In 1996, private hospitals in Thailand were found to have a C-section rate of 51.5 per cent. The WHO says that, under normal circumstances, C-sections should not make up more than 15 per cent of births.
Several women in Thailand interviewed for this article, all of them pregnant for the first time, reported that they had already informed their doctors they wanted a Caesarean birth because they didn't want to experience any pain. Other women elect to have C-sections so that their child will be born on an auspicious or convenient day. Some think it will help them to "keep a honeymoon vagina".
Physicians are only too happy to comply, often for reasons of convenience or economic gain. For example, when asked why epidurals are overshadowed by C-sections in her hospital, one delivery nurse in Thailand reported that anaesthesiologists and obstetricians "don't like to hang around waiting".
The conventional wisdom among the medical establishment is "once a section, always a section", although objectively there is no reason, in most cases, why subsequent births cannot be vaginal. What's more, foetal monitoring, IVs, 'prepping' (shaves and enemas), episiotomies, and drugs are all part of the arsenal of medicalised childbirth. Dr Frederick LeBoyer captured this arsenal and mindset in his 1975 classic book 'Birth Without Violence': "The orthodoxy reflects an anxious view of birth...as a treacherous course mined with sudden unexpected disasters requiring the medical equivalent of a military alert."
The issues related to participatory and woman-centred childbirth go beyond medical intervention at delivery. For example, Asian women are foregoing breast-feeding or are nursing only for short periods in an attempt to retain their figures or to resume daily activities without the demands of nursing an infant. Only a fraction of them take advantage of prenatal classes offered by hospitals. They willingly defer to their doctors for decisions that many advocates feel are rightfully theirs.
Such practices suggest that the wholesale adoption by mothers as well as medical personnel of western, medicalised standards for labour, delivery and post-partum care increases as women become more educated, affluent and urban. Time will tell whether or not those practices are useful in Asia, even as statistics and patient preferences in the West suggest otherwise.
Elayne Clift, a writer and women's studies professor in Vermont, USA, is a doula - or birth
attendant - at her local hospital. She recently spent a year teaching in Thailand.

Now I've heard everything

Young women are adept at coming up with excuses for smoking packet after packet of fags. "It stops me eating and I'm trying to lose weight" is the most common with "it's something to do wiv me hands... stops me biting my nails" coming in close behind.

Now I've heard everything: just read this...
Note that Caroline Flint pronounces that "pain relief is the answer". Please, not pain RELIEF. Pain management. You don't need drugs to cope with labour.
Also note that none of the papers picked this story up during the Labour Party conference. They picked it up from the Nursing Standard a week later. Just shows how many editors put a priority on sending reporters to fringe meetings organised by nurses on issues of maternity and women's health, doesn't it?

From the Guardian (all papers carried this story)

Pregnant teenagers are deliberately smoking in the hope of having smaller babies
so giving birth is easier, it has been reported.
Public health minister
Caroline Flint spoke at a Labour Party conference fringe meeting about
teenagers' attempts to reduce their labour pains, the Nursing Standard magazine
reported.
Smoking can lead to low birthweight babies, meaning some teenagers
smoke throughout pregnancy, the magazine said.
The Department of Health said
Ms Flint had heard about the issue anecdotally from health professionals and
young women she has met.
Ms Flint said: "It is important that we understand
what stops young women making healthy choices so we can provide the right
answers to their concerns.
"In this case, childbirth is no less painful if
your baby is low weight. So smoking is not the answer, pain relief
is."
Studies have shown that women who smoke during pregnancy are three times
more likely to have a low birthweight baby. Smoking can also cause other
problems, such as respiratory illness.
Women who smoke are less likely to
carry their babies to full term and there is a 26% increased risk that they will
miscarry or experience stillbirth.
Babies of smoking mothers are also an
average of 200g (7oz) lighter at birth.
Royal College of Midwives (RCM)
midwife Gail Johnson said there was no evidence that having a smaller baby
reduced pain in labour. She said: "It is vital that the risks associated with
smoking are highlighted and that women are then supported to make changes to
their lifestyle but the RCM is very clear that there is no evidence that the
size of the baby relates to the amount of pain the woman may experience."
©
Copyright Press Association Ltd 2006, All Rights Reserved

National Breastfeeding Week

It is National Breastfeeding Week and in Canada they've made it into a competitive sport!
Oh, well, if it promotes breastfeeding...

http://www.canada.com/montrealgazette/news/story.html?id=3f45e911-8569-44d9-a213-86f208c5fe48&k=1668

Meanwhile in the UK we are still - according to today's press - wondering whether or not breastfeeding is best for babies...oh for heaven's sake!

http://www.dailymail.co.uk/pages/live/articles/health/womenfamily.html?in_article_id=408327&in_page_id=1799&in_a_source=

Channel Five to show natural birth

Crucial viewing. Channel Five is to show some births including what they SAY will be a "natural" birth, beginning in October:

http://media.guardian.co.uk/site/story/0,,1872628,00.html