Friday, February 29, 2008

Remembering your midwife

The semester has began again for 2008, new faces, new units, some repeating units, the corridors are buzzing with excitement, university staff are ensuring all is going well. But alas you know the old saying "the best laid plans of mice and men" yes something always goes astray. My week has gone smoothly and I am excited about the new semester. My energy levels are high and I am revving to go. I was given a boost the other day, that I thought I would like to share, because it is good to share the feel good stories, it makes the world go round more smoothly.
I had come out of facilitating my tutorial, happy that the session went well, when someone stopped me and asked if I was "Pauline" and did I work at a particular hospital, do you remember me?' I don't know about you, but this makes my heart stop, you rack your brain for some sort of recognition, a bell to ring, something, but all you do is draw a blank! you finally respond, smiling, and saying 'can you give me some more clues' then she said, 'yes you were the one who helped me birth my twins',your heart sinks, you still draw a blank and apologise, smiling and hoping that your memory will trigger this wonderful event. then when all else fails, you bite the bullet and say, 'I'm sorry, it is a vague memory'.
In this instance the woman relayed the story of how I assisted her not only with the birth of her twins, but in our time together I was able to empower her to believe that she could reach for the sky and attain her goal. Her goal was to do her nursing and midwifery even though she had given birth to her beautiful twins. She said "thanks to you, I am now half way through my nursing course, you inspired me, I am on track. My twins are 4 1/2, I am happy and I am glad I have had the chance to meet with you again and say thank you for encouraging me to go for what I want". I responded by saying "congratulations, she had done all the work and that she must be very proud"
I was floored, and I did remember her and our conversation, she was upset that by having twins it would put her dream on hold for many years, even though she was happy about the twins.
I guess the moral of this story is, that women remember their midwives, both positive and negative experiences. The midwife - woman relationship is the basis of a good shared decision-making process. It is always very important to find out what is significant to the woman and her family, by talking things through. The focus being on 'woman centered' care, being in a partnership with the woman. Our role as a midwife is to respect, promote and facilitate the woman's choice, the choice of individualised, personalised care. We have such an important role, we must never lose sight of that, we can and do influence outcomes for women. I feel that I am privileged to be able to work with women and their families, to attain the best outcomes. Our relationships are based on trust,respect, and commitment, that facilitates communication and enhances care. It is all about listening to women, valuing their opinions and supporting their choices in a safe environment.
"caring is a fundamental necessity rather than being a soft option and is as important as technical knowledge or science" Ann Oakley

Monday, February 11, 2008

The Pinard - The midwives companion

Are we seeing the end of an era? - the death of the Pinard. Why do I say this? in the latest clinical guidelines for Intrapartum Fetal surveillance (2006) The Royal Australian and New Zealand College of Obstetricians an Gynaecologists (RANZCOG)have sounded the death knock for the pinard. Guideline 7 "intermittent auscultation should be performed using Doppler ultrasound rather than a Pinard stethocope" Guideline 8 "auscultation should occur with Doppler signal on speaker mode". Since the publication of these guidelines, I have seen the disapearance of all the pinard on our labour and birth suite, which has promted me to ask the question? are we loosing the art and skill of using the pinard?
It is interesting to note that in the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI)2005, this report recommended training for midwives and junior doctors in CTG interpretation, because errors were being made which had a detrimental effects for both woman and baby. The question is asked what about senior doctors? who monitors them? CTG monitoring is technology spreading without justifed research.
It is a well know fact that CTG monitoring is not an exact science, however in the current litigatous climate it is the best we have and clinicans are inclined to feel protected by using this technology, even though you can have several clinicans disagreeing on the interpretation of the CTG.
Mahomed et al. (1994, pp 497-500) conducted a randomised controlled trial on the effectiveness of differnet methods of intrapartum monitoring. They found that the doppler sonicad compared with the pinard stethoscope was better at detecting abnormalities in the fetal heart rate. They also found that the pinard was more uncomfortable for the woman.
The doppler sonicad is the electronic equivalent of the pinard and has the advantage of the woman being able to hear the babys heart rate, and further protecting the midwife against litgation (Seymoour, 1995, p 47).

So is there still a place for the pinard stethoscope?
I would like to see midwives teaching students how to use the pinard again in conjuction with the doppler, so that we maintain the midwifery skill, you never know if technology fails we are still able to monitor the fetal heart.

Ayres-de-Campos D, et al. Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision, Br J Obs Gyn, 1999: 106; 1307-1310.
RANZCOG Intrapartum Fetal Survellance Clincial Guidelins. 2nd edition. 2006
Seymour, J. (1995). Fetal monitoring.

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