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

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...

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.

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.

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 :lol:

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.

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.

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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.

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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

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

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

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

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

Thank you ladies. That is so sweet.

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

& 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....

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!!! :)

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?

Hi Christy

I sent you that email

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.

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:

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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

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Just read this from a midwife:

:

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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

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Wow, that's fantastic. All of the midwifes I had were fantastic as I said but from reading some of the stories on here I think there need to be a lot more like Sue and the ones that I had.

Yeah I had fantastic ones too. In fact one told DH off for trying to adjust the strap saying his job was to look after me.

aaaggh yuck!!! I hate monitering - it makes me feel so trapped. I swear that every time I have had one of those things strapped to me my labours have slowed - and now they've invented a machine that will no doubt make monitering easier and hence increase its use.
Then again there was another woman in hospital who had a an emergency c-section at the same time as me. The moniter picked up that her babies' heartbeat was dropping and she was rushed to surgery. It turned out that he son's cord was wrapped around his neck and each contraction was squeezing the cord tighter so there was less blood/oxygen getting through to her baby. Without monitering it could have died so she probably loves the horrible machine.
I geuss they have thier place but why don't they work on one that can be incorperated into active birth (waterproof & mobile).

Well I dont see that it will make that much of a difference....

I had weekly monitoring for the last 2 months of my pregnancy and the midwives never stayed in the room with me, and yeah we keept an eye on the thing and if bubs moved we had to move the thing about to try to find her or else we knew we would be in there for longer if we just waited for the midwives to come back....

This is not pre-labour monitoring we're talking about but monitoring in labour emz.

I was on the monitor a lot coz of having the drip to augment my labour. It was a pretty old clunky one, and I had to stay by the bed. I was still able to stand up and move around the bed etc, but it had to come off for me to go into the bathroom. I didn't mind having the monitor on, I liked the sound of the heartbeat, and I like being able to see the contraction "ending". The midwives only popped in every so often to check on me during my labour (which I didn't mind, we were having a problem free labour, and it was nice just being me and DH). But it would be sad to have them not pop in at all if they could see the monitor from their desk. However I'm one to welcome new technology wherever possible :) so I guess it comes down to the midwives themselves and the care they want to provide. Surely midwifery isn't something you'd do unless you loved it, so there must be an element of caring that wouldn't be lost due to a new machine? Am I just naive to the midwifery profession? 8-[

I just found out that to set up three machines and for one midwife/desk unit, it will cost $500,000. Hmmm I wonder how far that would go in keeping a birth centre open, or midwife salaries to have one on one care? :-k

Good point Kelly. It is hard to justify the Government spending that much money, when they are closing birthing centres left right and centre and neglecting country hospitals who have to fundraise for every piece of equipment they get.

i don't know how much midwives get paid, but if they got paid $50,000 a year, they could pay for 10 midwives with what that machine costs.

In all likelihood, it will only be 'rich' hospitals getting them anyway.

I think the Northern here in Melbourne already has them, and the RWH is getting them. I think places like the RWH would get more than 3 units though - can you imagine the cost!!!

I might see if I can find out if the Mercy (Heidelberg) has/will be getting them. I agree that it's a very sad development. However if women can be vocal about their disapproval then it might eventually have some impact.... especially on the private hospitals. I see a bit of an analogy with these monitors and autotellers... sure people thought they were great but when it involved the total withdrawal of human presence especially regarding country banking branches, then there will be outcry. The bank my DH works for is now acknowledging the backlash and starting to reinstate human presence. I know this analogy is offensive to the importance compared to labouring women and newborn babies... but I use it because midwifery and access to our money are both essential services that shouldn't be changed in such a radical way without public consultation. The more I think about these remote monitors the more upset i'm feeling :fuming: why hasn't it been in the media? As one labouring mum who knows the feeling of "abadonment" during labour I'm starting to feel really angry on behalf of every first-timer out there who's chances of being likewise "abandonded" because of these machines are surely going to increase. Thanks Kelly for bringing this to our attention.

From someone that has recently been in the situation of being constantly monitored by CTG. I hate the stupid things! During my labour with Bella I was hooked up to it for the whole time and recently when I was in the hospital I was hooked up to it for 18 hours straight, no time off to go to the toilet, or even allowed to sit up. I was allowed to use a portable once but even that was uncomfortable and they took it off as soon as I was back in bed.
I do agree though that they are useful, but hospitals have to learn that just by making them easier to use doesn't mean that they are more comfortable for the mother.

I did some study on CTG's a few years ago. Here is a few quotes with references. They are a little old but I don't think much has changed.


The CTG monitor can be over used and findings often insignificant. Although the CTG monitor has high sensitivity in predicting the normal foetus, the foetal monitor is not able to accurately and consistently predict a sick newborn (Cabaniss, 1993 p. 19).


The benefits of foetal monitoring are modest and resulted in prolonged labours and gains are achieved at the cost of a higher rate of caesarean section and operative vaginal delivery. Stroup and Peterson (1996 p.317)


The only significant effect of continuous electronic foetal monitoring was an increase in the caesarean rate. Odent (1996)







Cabaniss, M.L. 1992. Fetal Monitoring Interpretation. J.13 Lippincott, Philadelphia.

Odent, M. 1996. Kitting needles, cameras and electronic fetal monitor. MIDIRS Midwifery Digest. 6(3).


Stroup, T.S. and Peterson, H.B. 1996. Routine intraparturn electronic fetal monitoring decreases neonatal seizures but increases operative deliveries. MIDIRS Midwifery Digest. 6(3).