Fetal movements: What are we telling women?

PROBLEM: Information that women receive about the importance of monitoring fetal movements and what to do if there are changes is inconsistent and may not be evidence based. BACKGROUND: This paper reports a summary of the kind of messages a group of South Australian midwives (n=72) currently give pregnant women. METHODS: Comment data from two questions in a larger survey asking (1) what information midwives routinely provide to women about fetal movements and (2) their practice regarding advice they give to women reporting reduced fetal movements. Data were analysed using summative content analysis. FINDINGS: Four main recurring words and phrases were identified. With respect to information midwives give all women about monitoring fetal movements, recurring words were "10", "normal", "kick charts" and "when to contact" their care-provider. Recurrent words and phrases arising from answers to the second question about advice midwives give to women reporting reduced fetal movement were "ask questions," "suggest fluids," "monitor at home and call back" or "come in for assessment". DISCUSSION: These findings suggest that a group of South Australian midwives are providing pregnant women with inconsistent information, often in conflict with best practice evidence. CONCLUSION: As giving correct, evidence based information about what to do in the event of an episode of reduced fetal movement may be a matter of life or death for the unborn baby it is important that midwives use existing guidelines in order to deliver consistent information which is based on current evidence to women in their care.

Detecting fetal compromise during active labour and managing neonatal after-effects.

Evaluating fetal wellbeing during the intrapartum period to detect fetal compromise and hypoxia is a topic of considerable importance to midwives. In part this is because the events during this time can have profound significance for the physical and emotional wellbeing of all those involved, including the infant, mother and midwife. This article explores the ways midwives can detect fetal compromise, what they can do to limit the effects of cerebral hypoxic-ischaemia, and reviews neonatal treatments that,can optimise infant neurological outcome.

Atuação no intra operatório da correção cirúrgica de mielomeningocele a "céu aberto" intraútero / Practice in the intraoperative period of surgical correction of a “sky open” myelomeningocele in utero

Relatar a experiência da atuação da enfermeira no intraoperatório de correção de mielomeningoceles a céu aberto intraútero. Método: Relato de experiência da prática em um hospital privado de São Paulo. Resultados: A enfermeira possui papel fundamental na previsão e na provisão de materiais e equipamentos para a cirurgia, no acompanhamento da paciente na admissão no Centro Cirúrgico e no auxílio durante o ato anestésico-cirúrgico. Conclusão: Fatores primordiais para o sucesso da cirurgia são o conhecimento e o domínio da equipe sobre as fases da cirurgia e o atendimento a pacientes gestantes, considerando as possíveis complicações que podem envolver a mãe ou o feto...

Consumer information on fetal heart rate monitoring during labor: a content analysis: a content analysis.

Electronic fetal monitoring (EFM) is used for the majority of births that occur in the United States. While there are indications for use of EFM for women with high-risk pregnancies, its use in low-risk pregnancies is less evidence-based. In low-risk women, the use of EFM is associated with an increased risk for cesarean birth compared with the use of intermittent auscultation of the fetal heart rate. The purpose of this investigation was to evaluate the existence of evidence-based information on fetal heart rate monitoring in popular consumer-focused maternity books and Web sites. Content analysis of information in consumer-oriented Web sites and books was completed using the NVivo software (QRSinternational, Melbourne, Australia). Themes identified included lack of clear terminology when discussing fetal monitoring, use of broad categories such as low risk and high risk, limited presentation of information about intermittent auscultation, and presentation of EFM as the standard of care, particularly upon admission into the labor unit. More than one-third of the sources did not mention auscultation, and conflicting information about monitoring methods was presented. The availability of accurate, publically accessible information offers consumers the opportunity to translate knowledge into the power to seek evidence-based care practices during their maternity care experience.

Detection and management of decreased fetal movements in Ireland: a national survey of midwives' and obstetricians' practices.

OBJECTIVE: to determine midwives' and obstetricians' practices for detecting and managing decreased fetal movements (DFM) during pregnancy. DESIGN AND PARTICIPANTS: a descriptive survey of all consultant obstetricians practising obstetrics in the Republic of Ireland and a representative sample of midwives practising midwifery in all 19 maternity units in the Republic of Ireland at the time of survey distribution. METHODS: following ethical approval, a questionnaire was mailed to consultant obstetricians and to Directors of Midwifery in September 2011 with a request for completion. Two postal reminders with further copies of the questionnaire were issued to non-responders. Data were analysed with SPSS Version 18. FINDINGS: midwifery and obstetric response rates to the survey were 82% (n=47) and 71% (n=89) respectively. The majority of respondents reported an absence of local guidelines for detecting and managing DFM in pregnancy. Less than 10 movements in 12 hours was the most frequently provided definition of DFM. A minority of respondents routinely recommended formal fetal movement counting for low-risk women (24% and 19% for midwives and obstetricians respectively). This increased considerably, however, for women who presented with DFM (62% and 47% in low risk women and 78% and 51% in high-risk women for midwives and obstetricians respectively). The Cardiff count-to-ten method was the chart of choice for more than 70% of all respondents. Large variations in management strategies for women presenting with DFM was identified; however, almost all respondents would perform a cardiotocograph (CTG) in women presenting with DFM. CONCLUSION: further research on DFM and, in particular, large prospective studies on optimum management strategies for women presenting with DFM during pregnancy are needed.

Maintaining the passion for pinards.

Throughout my midwifery programme I have developed a passion for the use of pinards; a skill that may be lost within midwifery. It is often acknowledged that the use of pinard stethoscopes prior to the use of electronic devices is best practice (Royal College of Midwives (RCM) 2012), yet it is a practice that seems to be losing its place. This article aims to share some of the benefits of using a pinard and encourages the reader to reflect on their own feelings towards using this tool in practice. I will analyse whether or not there is still a value for pinards following an event I experienced whilst on clinical placement. This reflection uses an adapted version of Driscoll's Model of structured reflection (Driscoll 2000).

Effect of self-instructional module on foetal well-being measures among nurses in Bengaluru.

Perinatal mortality (accounting for 90% of all foetal deaths in developed countries) and morbidity remains a challenge for health functionaries and health purveyors. The present study was therefore undertaken to assess the existing knowledge of staff nurses regarding foetal well being measures, evaluate the effectiveness of self-instructional module and find the association, if any, between post-test knowledge score and selected variables. The sample consisted of 40 staff nurses of Vanivilas Women & Children Hospital, Bangalore. Using non-probability purposive sampling, the views of staff nurses were elicited 40 knowledge items. All the respondents were female, had GNM qualification; majority of them were married and in age range 30-39 years; over half of them had not undergone in-service education in obstetrics/paediatrics. It is concluded that screening and monitoring in pregnancy are important strategies to monitor the well being of the foetus and reducing the incidence of perinatal mortality and morbidity.

The amniotomy question: examining the pros and cons of rupturing membranes.

The culture of birth establishes practices and embraces rituals. Currently there is a movement toward midwifery and away from hospital births as women and professions question the values of some practices and interventions common in hospital births. Amniotomy is a well-established practice that is accepted as an intervention to help women in their birth process, with the hope that it will shorten labor. There is little research regarding the psychological implication of amniotomy on the infant. This paper explores the pros and cons of amniotomy, its role as a ritual for birth attendants and the possible psychological effects on the infant.

ST analysis as an adjunct to electronic fetal monitoring: an overview.

Conventional electronic fetal monitoring in the United States has value as a screening tool but is extremely limited as a diagnostic tool. ST analysis was developed as an adjunctive technology, able to measure changes in the ST segment of the fetal electrocardiogram during periods of hypoxia, improving the identification of the fetus at risk for metabolic acidemia at birth. Currently used only in a handful of hospitals in the United States, studies abroad have demonstrated that an integrated approach utilizing electronic fetal monitoring, ST analysis, and standardized guidelines in a selected patient population can improve neonatal outcome, decrease acidemia at birth, and decrease obstetric operative delivery. Research is needed to determine whether similar results are possible in the US population.