Something interesting (and sad) I found out...

[BellyBelly]

When I was at the birth this weekend, I found out from the midwives that the monitoring machines are being replaced with newer ones - some hospitals have started making the change already but many are planning to. They are having the new machines put in on a satellite system, so they only need to sit at their desks and can see the monitors without having to be in the room.

I know some will think this is great, as they can keep an eye on you all the time, but it's making one to one midwifery care even further away from women, and also does this make it more likely that they will sit you on machines and leave you there for longer?

Apparently they were having a joke about it, saying that they can imagine having loudspeakers at the desk where they could put thtough something like, "Excuse me Mr. xxx, can you please adjust your wife's monitor a little please as it's just moved out the right spot...?"

One step forward, two back...

[BellyBelly]

They have done that already - Frances Perry has them. They would cost a fortune I imagine. They are okay, but of course, movement still makes them move around a bit and drop out sometimes.

[Tigergirl1980]

I can see the good points I suppose but I don't like the sound of them. I loved the last midwife that was there when Jonah was born, she was so very lovely (so were the first 2) but I don't know what I would have done without her, or all of the midwives that I had throughout my whole hospital stay. They really put me at ease and made me feel really comfortable, I think it would have sucked to have not seen them very often.

[chelleg]

I can see the benefits in some situations. Unfortunately midwifery care isn't always one-to-one (in the public system at least) so having the monitoring visible to the midwife flying the front desk would be of benefit if it is particularly busy. Having these monitors certainly shouldn't have any impact on the midwifery care as interpreting a CTG is such a small part of the job IMO. We're there for the women to assist with pain relief, to support and encourage, to assess the labour an interpret behaviour. None of this can be done from the desk. Having this monitoring system also shouldn't change the fact that not all women need CTG monitoring during labour, it is only necessary when there are risk factors present and given this, the amount of times i have left a woman an entered the room 10 mins later to find that the CTG has lost contact for that entire 10 mins is mind boggling an may also cause the woman to be strapped to the damn thing for even longer!!! So there are benefits. But i guess the stanard of care, like always, depends on the actual midwife

[BellyBelly]

There are many women out there having monitoring though. If you have medication of any form you will be told you need it for your and baby's safety. If you have an induction you will be told to have it, if you have an epidural you will be told to have it, if you want a VBAC you will be told to have it - there are stacks of women having epidurals and slow labours and things happening to result in monitoring, of course in most establishments they like to monitor you when you get in and intermittently as standard practice unless you explicitly refuse. And who is going to say no when they have no information, no access to study and research showing how innaccurate they can be (one very popular private midwife told me around 50% and often give false readings) and you are told your baby or you could be in danger? Of course they are going to freak out and agree.

Sadly, I think that making monitoring any more easier is not a good thing and I know many midwives agree. There is a Cochrane Review on it - they compared intermittent vs continuous monitoring for high AND low risk women and found increased caesareans and instrumental deliveries as a result, with no improvement in neo-natal morbidity or mortality to show for it.

[Alan]

I want to comment on this but I first need to give you a little info about me.

I have spent the past 14 years travelling around Australia. I have worked in many hospitals; most of them have outdated policies and practices. Some of which are:-
An internal every 4 hours.
CTG on admission
Constant CTG when being induced.

I usually upset these hospitals by refusing to do the above. When I am told that I must do this I ask them why. Usually I am told that it is for the safety of the mother and baby.
When I show them the research that says that a CTG is of little use in predicting the outcome of a birth, and that internal examinations are an invasive procedure and thus require the informed consent of the mother. Also an internal examination only tells you what your uterus is doing at the time of the exam. I am then usually considered as a bit of a fruit loop. I believe that if I spend time with a woman in labour I soon learn what is happening. I don’t need a machine to tell me when she is having a contraction. When they invent a machine that can hold a woman’s hand, give her a reassuring hug, tell her in plain English what is happening, put a cool washer on her forehead, then I would consider, and only consider letting a machine do part of my job for me.

[Rouge]

I don’t need a machine to tell me when she is having a contraction. When they invent a machine that can hold a woman’s hand, give her a reassuring hug, tell her in plain English what is happening, put a cool washer on her forehead, then I would consider, and only consider letting a machine do part of my job for me.

Well said Alan, thats just beautiful!

And I think it is very care. Yes it might make the level of "care" easier for the midwives but what about the patients...

*sigh*

Very sad indeed!

*hugs*
Cailin

[christy]

Hey Alan can you email me where you are working & your shifts in late October

[BellyBelly]

OooOOh Christy I am very jealous!!! I think Alan would be wonderful

[wardygirl]

I'm moving to Qld to have my next baby with Alan.

Well, not have it with Alan, but have it with Alan IYKWIM!

[Alan]

Thank you ladies. That is so sweet.

[BellyBelly]

ROFL Rach - you and Alan go back a long way I know

[christy]

& I'm sooo serious Alan!!! I have just been told that the hospital supports VBAC's & have a high rate for VBAC but they want constant monitoring :-k I don't think I can stick on a bed & give birth, thats where all my issues came from last time....

[BellyBelly]

Negotiate Christy! Tell them as a woman giving birth in their hospital, the very most you will accept is intermittent monitoring, with a doppler. What are they going to do, throw you out?! I know VBAC women who have had healthy births without continuous monitoring - assuming they are worried about uterine rupture, perhaps you can print some doco off and give it to them, which shows that rupture is just as common in caesars (was it a little more?) and I also think it's more common in first births than subsequent? Must check that. Some will also say it's up to your Ob to make the decision. At the end of the day you can say no to anything, internals included. Henci Goer has a great section on VBAC which I am sure you have read

Wouldn't that be cool to have Alan at your birth?! You'll be famous Alan hehehehe!!! And I am sure Christy is deadly serious so you better send her that email!!!

[Trillian]

I have though about this a bit before replying and truthfully, I'm not sure if it is a good or a bad thing as a whole, but I personally prefer one on one midwife care, where she uses her skills and instincts to determine progress of labour.

Advances in technology are made to make our lives easier, but in regards to these new machines, exactly whose life is being made easier? The labouring mother or the overworked maternity staff? (this is mainly in relation to large public hospitals with many women birthing at once).

Yes, I did have CTG monitoring with all three of my births on first arrival at hospital, and even more so with Paige (scalp monitor), but once labour was established, I wasn't monitored at all by CTG. I think there would be some mothers who would welcome this, because they get to be monitored without having a midwife invading personal space by being in the room, and there are others who would hate it because they lose that one on one care. I can't answer from the point of view of the midwives, but I really don't know if it would make their jobs easier or not. They still have to make physical assessments of the mother (not VE's, but as Chelleg said by interpreting behaviour etc which can't be done from a nurses station).

I would also like to know if this monitoring from a distance is failsafe? what if a midwife or other staff member gets mixed up and reports to woman A her baby is in distress when it is really woman B's baby? can this happen? or is it impossible? In busy large public hospital's mixups have been known to happen.

Another thing, if a hospital has this technology, are the midwives required to use it, or can the individual midwife use their judgement and not use it at all?

[Alan]

Hi Christy

I sent you that email

[sonsangel]

I am actually saddened by the thought of not having a midwife by your side. I went public last time and had two wonderful midwives. Due to shift changes - long labour. They would sit next to me constantly feeling my tummy for contractions, making sure i wasn't too dehydrated. Just having the constant positive reassurance there as it was my first labour. I was induced and had to have the constant monitoring. Ended up with the scalp mointor also until i chucked up then it fell off, lol. I really hated having the constant monitoring and am willing ot refuse it this time round even though I am trying for VBAC. I guess what I am saying is I would love to have an active birth in the positions I feel comfortable. Not what their policy says for me to be stuck on the bed unable to move because of monitoring.

I am pretty much in the same situation as Christy, we are at the same stage too, so it's great to have a V/Ebac buddy.

[BellyBelly]

Sonia, what books have you read to help prepare yourself? HypnoBirthing is great too and I can even recommend some brilliant workshops for you. Cailin as you know had her natural VBAC and I am sure would be happy answer any questions you might have.

Just read this from a midwife:

Hi,

I was a student at a large Adelaide hospital and last year I witnessed
most of the midwives staying at the front desk for most of the time watching 'their' women's CTGs.

I found it appalling - that we as students were observing this as modern midwifery management; that the women were treated with such lack of compassion and skill; that this was a large teaching hospital - no wonder most of the young doctors have no idea about normal birth. Needless to say I complained to appropriate sources and have refused to revisit that hospital for a clinical placement.

Let me get a sore back and dirty knees any day and maybe I'd also have some idea of the woman I was assisting through birth and some idea of how I could help her achieve what she wanted.

Sue