First day!
Independent midwifery means truly with woman and family centred care, and apparently this Monday everyone is busy so a day of self directed study is in order!
As suggested from the midwives, i've reacquainted myself with the blogs of Sara Wickham and Midwife Thinking and particularly on the posts around 'post dates' induction, as well as ordering myself a copy of Bump by Kate Evans which is a must read they say.
Local policy that i'm familiar with is to offer induction at 41+5, rationalised to me by the midwives as the placenta doesn't function as well after 42 weeks and the baby/ies will have grown more, as well as the risk of stillbirth this brings. The reason its at 41+5 is because of the time it will take for the induction process to happen.
I'm ashamed to say the care i've participated in hasn't really reflected informed choice around post dates, mostly all I've observed is "So we'll book you in for induction on x date in case you don't go in to labour yourself and i'll see you when you've had the baby". Some ask questions, such as is it more painful etc but the way its often phrased is that there is no choice...
Looking at the evidence, the risk of unexplained stillbirth decreased from 35 to 40 weeks where it increases on a gradient again, making the risk at 43 weeks similar to that at 37 weeks Cotzias et al (1999).
I won't repeat ALL the research which you can find online, but the Sara Wickham and Midwife Thinking summaries are rather fantastic.
As suggested from the midwives, i've reacquainted myself with the blogs of Sara Wickham and Midwife Thinking and particularly on the posts around 'post dates' induction, as well as ordering myself a copy of Bump by Kate Evans which is a must read they say.
Local policy that i'm familiar with is to offer induction at 41+5, rationalised to me by the midwives as the placenta doesn't function as well after 42 weeks and the baby/ies will have grown more, as well as the risk of stillbirth this brings. The reason its at 41+5 is because of the time it will take for the induction process to happen.
I'm ashamed to say the care i've participated in hasn't really reflected informed choice around post dates, mostly all I've observed is "So we'll book you in for induction on x date in case you don't go in to labour yourself and i'll see you when you've had the baby". Some ask questions, such as is it more painful etc but the way its often phrased is that there is no choice...
Looking at the evidence, the risk of unexplained stillbirth decreased from 35 to 40 weeks where it increases on a gradient again, making the risk at 43 weeks similar to that at 37 weeks Cotzias et al (1999).
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| Taken from Sara Wickhams article for AIMS |
It's definitely reiterated for me, that just because something is logical or is 'whats always been done' does not mean its evidence based we, as students, should be researching all the rationale we are told about, not just taking it at face value. I'll definitely be stepping up in 3rd year when I'll be more independent and be able to provide the care that I want to!
Tomorrow is set to be busy, with a team meeting to start the day.
Bye for now x
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