October 18, 2003

How often should midwives listen to the fetal heart?

Birthing women are losing out all around the western world. Amongst the group of midwives on the workshop I have just completed in Burton on Trent (UK) were a number from the large Queens Medical Centre.

This unit, which is due to be redeveloped at some time in the future, has a few regular bathtubs in the labour area. Women sometimes use them for easing labour pain but the staff are under strict instructions that under no circumstances are women to be allowed to give birth in the bath. It seems that few of the staff have the necessary “training” and that without policies for staff safety, cleaning etc etc women just have to forgo this useful pain management strategy. Epidurals, pethidine and Entonox are freely available (and used) as alternatives. Never mind that some staff already know how easy it is to facilitate a water birth or that there are other maternity units nearby where the training could be obtained.Itis crazy - midwifery managers are losing the plot.

We also heard from members of the group who work in a Birth Centre nearby, that they are being forced to follow the National Institute of Clinical Excellence (NICE) guidelines that state fetal heart rates must be recorded every 15 minutes. They have been told that if they don’t follow this policy then they will be forced to close the unit down.

This is a clear case of bullying. These midwives, all experienced in normal birth and working with healthy, low risk women, are being told how to conduct their practice by people (doctors) who have no concept of natural labour the way constant disturbance can effect normal hormonal flows. The NICE guidelines are not based on any scientific evidence at all - there are no studies that state that listening every 15 minutes will given better outcomes than listening every 30 minutes, or any other time frame. They have been arrived at in an arbitrary manner by a group of obstetricians who are just plain scared of being sued if they don’t have a continuous reading of the fetal heart, The evidence against continuous electronic monitoring for low risk women is now so strong they have had to accept that it cannot be justified and so they have tried to establish frequent auscultation with a sonicaid or Pinard as an alternative. It is nonsense for well women, and midwives know it.

I am afraid that the midwives in Burton have been brainwashed into accepting these dictates and are anxious as a result. I suggested that they contact the other birth centres around the country and find out how they are coping with these inappropriate guidelines. I just hope they don’t find all the others have buckled under as well!

Posted by andrea at October 18, 2003 02:31 AM

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Dear Andrea,

I am writing in response to your comments about bullying.I currently work as a Midwife in a Birth Centre that is under investigation. The brainwashing that you speak of is happening and 'buckling under' does appear to be the only way to keep the birth centre open for the benefit of local women.
There is no room to practise as individuals, there are strict rules that have to be adhered to. Support for and from my immediate colleagues is infinite and much needed as the management persistently needle away at our very souls. Leaving us feeling vulnerable and inept, perpetuating a feeling of sadness and humiliation. However, we are Midwives and advocates for the women in our community and in our care and those women repeatedly tell us that they want us here. Therefore, we will continue to fight for what we believe in. There are midwives here who have invaluable experience of all that is good in midwifery whose talents are not only being wasted but are being placed in jeopardy as they consider a future away from a trust that treats their employees in such an appalling manner.

Posted by: Joanne Prescott on November 10, 2003 02:23 AM

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