I am so mad at some of the things I see and hear on One Born Every Minute I have set up a facebook page to talk about it...so pleased that in just a couple of days it has over 800 likes!! so here it is and also here is my first bit of ranting on the subject One Born Every Minute..The Truth
Factual or fiction?
The
Channel 4 television show One Born Every Minute won a BAFTA in 2010 under the
category of Best Factual Series. A
definition of the word factual is:
"The
available body of facts or information indicating whether a belief or proposition
is true or valid".
Whilst
it may be assumed that the audience
knows that editing has taken place, especially those who are aware of the time
involved in the labour/birth of a baby, there is no doubt that what is being
seen, said, and done is fact for it is happening as we are witnessing it. What
is questionable is whether or not these “facts” or the actions and words of the
professionals involved are true or valid? Turn that into professional speak and
it could be asked if the words and actions are evidence based. Are
they in line with the rules and codes of the governing bodies of the
professionals involved? If the answer is no then surely there are further
issues to be considered and questions to be asked.
During
the Wednesday 29th March episode, Midwife Zoe Leonard was encouraging long
sustained breath-holding whilst caring for Vicki who was pushing in the second
stage of labour. This practice is known
as the Valsalva Manoeuvre which involves prolonged breath-holding.
With
prolonged breath-holding there is an increase of the maternal intrathoracic
pressure by forcible exhalation against the closed glottis, which causes a
trapping of blood in veins preventing it from entering the heart. When the
breath is released, the intrathoracic pressure drops, the trapped blood is
quickly propelled through the heart producing an increase in the heart rate and
blood pressure and followed by a slowing of the heart rate. All of this
disrupts the blood flow to the uterus and ultimately to the baby which then
shows up or is interpreted on the fetal heart monitor as fetal distress.
There
is no evidence that the Valsalva Manoeuvre shortens the second stage, decreases
fatigue or minimizes pain. The evidence suggests that it alters the contractile
pattern of uterine smooth muscle, leading to inefficient contractions and
failure to progress. Studies suggest that encouraging women to believe in their
ability to push the baby out may be as important as the type of breathing.
Studies
published between 1992 and 2009 show that the physiological effects of Valsalva
Manoeuvre can include: impeded venous return; decreased cardiac filling and
output; increased intrathoracic pressure; affected flow velocity in middle
cerebral artery; raised intraocular pressure; changed heart action
potential/repolarization; increased arterial pressure; increased peripheral
venous pressure; altered body fluid pH, which contributes to inefficient
uterine contractions; decreased fetal cerebral oxygenation. The World Health Organisation, (WHO) concluded
that it is a dangerous practice and should cease.
Later
in the same programme when interviewed, Midwife Zoe said that babies can, if
left too long in labour, "get tired" (labour ward talk for become
hypoxic) if the 2nd stage goes on too long.
There is no evidence to support better outcomes when time limits are
imposed on any stage of labour. More importantly, Zoe is obviously not aware of
the evidence around her practice with efforts to encourage Vicky to birth her
baby quickly. Is Zoe disregarding them
the evidence in favour of dangerous practice? Either way she is in breach of
her Nursing and Midwifery Council Code, (NMC) as according
to Rule 6- Responsibility and sphere of practice, the guidance indicates that
practice should be based on the best available evidence and that a midwife must
make sure that the needs of the woman and baby are her primary focus. The NMC code of professional conduct:
Standards for conduct, performance and ethics (2010) states that a midwife must
keep her knowledge and skills up to date.
This
programme needs more editing in order to stop showing bad or dangerous
practice. Whilst the programme makers must be delighted in their ability to
pull in large audiences, the success of other birth programmes has demonstrated
it does not always need sensationalism and car crash births in order to do
so. It must not be forgotten that the
viewers may include new and impressionable midwives who may get the message
that it is fine to copy what they see and for women to accept as normal what
they too may be exposed to or ask to do when they face childbirth. Questions needs to be asked and they include;
why are awards being given for dangerous practice and are the NMC watching?
REFERENCEs
Martin C 2009, Effects of Valsalva manoeuvre
on maternal and fetal wellbeing, British Journal of Midwifery, vol. 17, no. 5,
pp. 279-85
Nursing
Times 95:15, April 15, 1999.
WHO
(1996) Care in Normal Birth: a Practice Guide.
No comments:
Post a Comment
Note: only a member of this blog may post a comment.