Monday, March 23, 2009

New policy on continuous monitoring

We have been informed that the Mercy Hospital for Women (MHW) has introduced a new policy requiring continuous electronic fetal monitoring (EFM) in labour, once their pregnancies have gone past 41 weeks gestation.

A midwife phoned the birth centre to find out the how birth centre women would be affected. She was told that they hadn't yet decided whether all women who went past 41 weeks would be transferred to the labour ward or not. A decision is to be made in two weeks.

Women who are booked at MHW, either through the birth centre or a standard booking, are advised to consider how this new policy may impact on their birthing experience. Note that any hospital policy, including this one can not be enforced if a woman declines the intervention. The staff member - midwife or doctor - may attempt to demand compliance, and may use words such as "We can't be sure that your baby is OK (or safe, or alive) without continuous monitoring."

There is no reliable evidence supporting a policy requiring continuous EFM for healthy women who are in normal labour, which has spontaneous onset at Term (37-42 weeks). Policies such as this one are risk management strategies that are based on fear, not on evidence. The hospital has no commitment to promoting normal birth.

Midwives who take their definition seriously, with a duty of care to promote normal birth, are placed in a compromised position by such policies.

Women who have a trusted midwife working with them privately are advised to work with their midwife to develop their personal decision making plan for this and other chalenges that may arise in their maternity care.

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