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Re: VBACFrom: Kathi Wilson (wilsonk@gtn.on.ca)Sun Oct 29 09:22:43 2000
jkulkin wrote:
> We rank 18th in the world in perinatal mortality and I think 8th in maternal Jay, one of the interesting things that has come out of this entire, free-wheeling discussion has been the responses I got to my continuous EFM question. What seemed apparent was that it was done for the majority of women, not because there was a clinical indication, but because there was a shortage of trained staff to provide 1-to-1 care for labouring women. The evidence certainly indicates that supportive care during labour reduces the need for operative intervention, and although that's a sort of "soft" intervention that often gets pooh-poohed, it certainly needs to be carefully considered. The Society of Obstetricians and Gynecologists of Canada has a document on Fetal Health Surveillance in Labour (on their website, if you're interested in wading through it -- it's lengthy) which strongly endorses intermittent auscultation with one-to-one care as the method of choice, with continuous EFM being used only when an indication arises (and that doesn't, however, mean that one-to-one care is abandoned...). In part, this is to help ensure an appropriate rate of Caesarean section. Recently, the Women's Health Council of the Ontario Ministry of Health published a report on "Attaining and Maintaining Best Practices in the Use of Caesarean Sections", which analysed the practices in 4 Ontario hospitals with low section rates (one of which was St. Joseph's Health Centre in London, where I am credentialled -- a level III hosp w/ a 17.4% C/S rate, and we have only 5 true level III hospitals in the province). One of the recommendations was that "all women in Ontario should receive one-to-one supportive nursing care" (or midwifery care...). I think, in providing the best care we can to women, that we can't underestimate the absolute importance of women receiving the human touch during labour in optimizing the outcomes. It's something that the obstetrician leaders at my hospital fight for and we, in large part, manage to do. If you'd like to see the sites I've mentioned, go to: Ontario Women's Health Council: http://www.womenshealthcouncil.com/E/prof_centre/index.html Society of Obstetricians and Gynecologists of Canada: http://www.sogc.org/SOGCnet/index_e.shtml You can go to the "Clinical Practice Guidelines" section without having to be a member (unlike with AGOG...) -- Kathi Wilson, RM Ilderton, Ontario, Canada mailto:wilsonk@gtn.on.ca ********************** Thames Valley Midwives 346 Platts Lane,
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