New Beginnings Doula Training

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Wednesday, August 31, 2011

Intermittant Auscultation-a review

"The purpose of all intrapartum fetal surveillance techniques is to assess fetal well-being in an attempt to identify fetuses potentially at risk for poor outcomes, especially those related to hypoxic acidemia as a result of the labor process".-Fetal Heart Rate Auscultation from AWHONN

The question that we face now is, what is the best way to do this?  Electronic Fetal Monitors were put in the market with the intent of decreasing fetal deaths and cerebral palsy.  This was done without research to back it's use, and yet now most women use this form of monitoring. This wouldn't be too much of  big deal, except it leaves a woman laying in bed and attached to monitors and machines that may not be necessary and certainly don't have the woman's comfort in mind.

Studies since that time have shown that intermittent auscultation(which listens to the heart rate periodically, instead of continuously), has been found to be just as effective at assessing fetal status as the electronic fetal monitor.  It also has the benefit of allowing the woman more freedom of movement.

Many professional associations have stated that both intermittent monitoring and electronic fetal monitoring are acceptable standards of practice.  These organizations include the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists, AWHONN, the Royal College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canadea.

Even so, most women are not even offered the choice.  Some reasons for this include legal concerns, lack of medical or administrative support, lack of equipment needed, limited staff, and lack of education of the staff on how to use intermittent auscultation.  In some studies some midwives have felt like they would like to use intermittent monitoring, but don't feel confident in using it(which again goes back to my post on medical professionals not experiencing enough normal, unmedicated labors).

My solution:  educate doctors and nurses on how to do intermittent monitoring as well as it's benefits.  I really think that this should be what all women should have unless otherwise needed or requested, not the other way around.  That said, a discussion of the pros and cons of both modes of monitoring should be happening to allow the woman to make the choice.

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Birth is a Journey: Does it have to be life changing?

  • One woman might have to climb on an overfilled boat, risking her life and nearly dying as she escapes over the ocean to come to this land. This experience could certainly be life altering. It may very well color the rest of her life, positively or negatively. (I overcame this amazing struggle and here I am triumphant! OR Holy crap, that was SO hard I don’t know if I can go on! By the way, neither response is “right”. No one would judge the woman with the 2nd response.)
  • One woman may buy an airplane ticket, sit on a comfortable 747 and fly to America with a nice smooth flight and landing. She is happy to be in America. Those welcoming her are glad she is here safe and sound. She may only travel by plane 2-4 times in her life, so it is pretty memorable. But the journey itself probably wouldn’t be life changing; it would simply be a journey.
  • One woman may learn to fly an ultra-light plane to lead a flock of geese into America teaching them to migrate. This experience could certainly be empowering and life altering.