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Re: OB:Home Births in AustraliaFrom: Kathi Wilson, BHSc, RM (wilsonk@gtn.net)Sat Aug 29 09:58:26 1998
At Fri, 28 Aug 1998, Peter Wein wrote: > >The point I was trying to make is that "non-reassuring" is a specific CTG >term, usually implying decreased variability or some variable decelerations >(in the FIGO intrapartum classification as "suspicious"). AN abnormality on >auscultation would only usually be a major baseline bradycardia or >tachycardia - which is a little more than "non-reassuring". Actually, I beg to differ. We make a practice of listening through a contraction and just after, so with the combination of the read-out on the doppler and a trained ear, we can "hear" early's and late's and variables. Not as precise, for sure, as a printout, but does tell us more than just "baseline" tachys and bradys.
>>I would hope that you're not routinely using electronic fetal monitoring This is from the Society of Obstetricians and Gynecologists of Canada statement on Fetal Health Surveillance during Labour: "The results of the meta-analyses suggest no benefit from EFM (alone or with access to fetal scalp blood sampling) on neonatal outcome, as measured by low or very low Apgar scores, admission to the special care nursery and perinatal death. The one measure of fetal outcome affected by EFM, with access to fetal blood sampling, was neonatal seizures. The reduced risk of seizures was limited, in the Dublin trial, to labours that were induced and/or that were prolonged. Children in this trial who had seizures were reassessed at age four, and it was found that the seizures which might have been considered to be potentially preventable by more intensive monitoring were not associated with long term problems." Journal SOGC, Sept 1995, 859 - 901. This also from Banta and Thacker and the Cochrane Collaboration: "The benefits once claimed for EFM are clearly more modest than once believed and appear to be primarily in the prevention of neonatal seizures. However, the long-term implications of this outcome appear less serious than once believed. Abnormal neurologic consequences were not consistently higher among children monitored by auscultation relative to those monitored electronically. At the same time, the risks associated with the use of EFM, especially the risk of cesarean delivery, appear to have been reduced but not eliminated." Sorry, I don't have the ref in front of me, but it is the review entitled "Continuous electronic fetal monitoring" from the online cochrane review.
> I didn't say that *my* figures were high; this has nothing to do with my clients. This is in our neck of the woods in general. Babies born in cars, is a relatively common event, in general. And it happens in downtown Toronto as well as in the boonies. Last notable one here was a few months ago, woman had her baby on the lawn in front of the hospital, under the emergency sign.
>I was clearly and specifically referring to the Australian situation where
Sorry, Peter, it was not clear to me in your post that you were
referring specifically to Australia. I thought that you were referring
to obstetrical services in general. In Ontario, not all level 2
hospitals, by any means, have in-house pediatricians.
> The law, I should expect. Doesn't mean that people won't do it, but it is against the law to practice midwifery if one is not a registered midwife and there are penalties. The only exception to this is First Nations midwives practicing on reserves, and that is a self-governance issue.
-- Kathi Wilson BHSc RM Thames Valley Midwives London, Ontario, Canada mailto:wilsonk@gtn.net
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