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Re: Chilliwack Journal Club - re Active Management of LabourFrom: Michael Klein (mklein@unixg.ubc.ca)Tue Apr 30 22:13:24 1996
Dear Mark et al: I thought the critical analysis by 2nd year family practice resident John Hamilton was well done. In point of fact, O"Driscoll did not study Active Management of Labour. He merely reported their very low cxion rates. It has been assumed that the AML is the responsible factor. Neglected, in my view, is the powerful effect of the experienced midwives who in Dublin never left the patient. O"Driscoll has always minimized this factor. Newly minted nurse-midwives in the Boston trial (trained specially for the Boston trial) can hardly be compared to their EXPERIENCED Dublin midwife sisters. I guess this points out how critical it is to know the context when evaluating RCTs or any study. If we in North America take away from the Dublin experience only the oxytocin effect i.e. a quick fix, we will likely get the no effect of Boston. Yet the SOCG Guidelines on EFM have made the point strongly based on a massive metaanalysis, that a supportive labor compagnion is what leads to the good result--no matter what else is going on. This means one-to-one nursing, which is now about to become the only acceptible standard. When this is available, EFM can be replaced by intermittent auscultation, with better results for babe and mom than with continuous EFM. I think that we now have to confront administrative types and demand that one to one nursing is the standard AND it will cost less in the end. I know I have gone beyond this study as reported from your excellent journal club but the links are there. Cheers. Michael PS anyone who needs the text of this jounal club conducted by rural family practice residents can ask and it can be forwarded. I should have included it.
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