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?
No I don't use a partogram. I have a 'grid' for recording obs (happy email you or anyone a copy if you are interested). I also have a VE form which I rarely use. The rest of my labour notes are in narrative form. I have just written an article for AIMs on the assessment of labour progress. Partograms were developed for use in remote areas to ensure that transfer took place in good time. The WHO still recommends them as a method of diagnosing obstructed labours but their focus is global ie. societies with limited access to medical help.
ReplyDeleteRecent research disputes the notion that 'normal progress' fits the confines of a partogram. A recent Cochrane review into the effect of partogram use in labour concluded that: ‘On the basis of the findings of this review, we cannot recommend routine use of the partogram as part of standard labour management and care’.
Also a partogram assumes you are doing routine VEs which again is not evidence based and not part of routine practice at homebirth.
When you are 'with woman' you don't need graphs to know when something isn't right for that particular woman/situation. Midwives need to stop embracing the non-evidence based medicalisation of birth in an attempt to be considered 'good midwives' by the system. We have our own knowledge base and skills based on knowing the birth journey on a much deeper level. I'll happily stand up in court and explain why I don't use a partogram. There is no legal requirement to use a partogram and it does not fit with midwifery practice.
thanks midwifethinking...really value your thoughts... and would love to see your grid... infomidwife@gmail.com
ReplyDeleteI agree with everything you have said...its time we set our own documentation for homebirth....the evidence is scant on the value of partogram in the homesetting...and as usual it is the system of medicalisation that we are up against.....our only legal requirement is to have Contemporaneous records....
All Midwives should learn how to use a Partogram.Wether your are a homebirth attendant or not.
ReplyDeleteLts try it all
Edwidge
midwiferytoday.edwidge@gmail.com