Friday, January 28, 2011
The question is do you use a partograph or not?
The partograph or partogram graphically represents key events in labor and provides an early warning system for the health professional caring for the woman. Until recently I had not given this much thought, I just accepted as part of my practice. I would use a partograph as part of my normal care in labour. I do notice when I go to different hospitals how they all vary slightly. Some are just cumbersome, some not practical and some just down right difficult to use......... and as for that action line....that is a different question all together... I would happily use a partograph without the action line...because part of my normal practice is to know that if the woman is at 4cm and contracting well (3-4:10) then her cervix is dilating and I would make a mental note that in 6 hours I would expect to being seeing signs of being fully dilated.
I understand possibly the need for a partogram in the hospital setting when you have several people looking at the notes; therefore there needs to be a quick review process. However in a home setting you are the only person as well as your partner midwife looking at the notes...so I question the value of using a partogram:
As I was doing a search on the web looking for a partograph template, I found lots of literature supporting the use of the partograph and the action line in preventing or recognising obstructed labour. In fact The World Health Organization partographs are the best known partographs in low resource settings. Some people argue the partograph is essential for good decision making.....and therefore is considered best practice...
A midwife is legally bound to document to clearly / comprehensively all our care, recognise / interpret /act / inform on abnormalities found in a timely fashion however does this mean she/he has to use a partogram to do this?
I am thinking that it is not necessary to use a partogram in the home setting if your documentation clearly tells the story.
What do you think?
can you write your notes in a fashion that does not need a visual expression of what is occurring? and does it make a difference using a partogram?
please leave me a comment on what you think?