A Midwife’s Perspective: Mobility during Birth
Dianne Garland has been a midwife since 1983 and has seen many changes in maternity care. “This is true especially with regard to fetal well-being,” says Dianne, “and in particular with the introduction of fetal surveillance. The evolution of this care has seen fetal assessment units, continuous monitoring in labour, (including the use of telemetry equipment) fetal scalp blood sampling and post-natal examination and screening tests”.
For Dianne, one of the biggest impacts was the introduction of continuous fetal heart rate monitoring during labour in the 1980s: “During that decade, studies implied that the reduction in intrapartum stillbirths was due to the increase in the use of fetal monitoring during labour. However, it was identified that continuous cardiotocography (CTG) monitoring may have contributed to the increase in lower (uterine) segment Caesarean section(LSCS)”.
Methods of assessing the fetal heart had previously remained unchanged for approximately a century and a half before the first commercial monitors for clinical practice were made available in the late 1960s. Since then, assessment practices have mirrored the development of biotechnology but have also been shaped by unrealistic expectations, disagreements about interpretations, women’s choice and own responses to the new techniques and technology.
For Dianne, the complexity of pregnant women today is one of the main determining factors in ongoing concerns about fetal heart rate monitoring: “Mothers are often now more mature and have higher BMI (body mass index), medical conditions such as gestational diabetes and communication issues.”
According to National Institute for Health and Care Excellence NICE:
“Women presenting with gestational diabetes may require more frequent monitoring for growth and fluid volume as they often present with concerns about fetal growth restriction where fetal heart rate monitoring is advisable in many cases.”
On a positive note, Dianne welcomes the re discovery that labour is enhanced by mobility and upright positions: “As carers we need to support alternatives in continuous monitoring. Women with complex needs may now have the opportunity to use water pools, low-dose (mobile) epidurals and telemetry monitoring.”
Dianne believes that there is always a time and place for continuous fetal heart rate monitoring in labour: “One element which is often forgotten is the woman’s choice in how her baby and body (as monitors record the fetal heart rate and uterine contractions) are recorded. Women require unbiased evidence-based information to ensure they have the knowledge to make an informed choice.”
“Within today’s diverse economic, social and cultural healthcare challenges, as practitioners we need to ensure that we provide evidence-based practice, working with robust observation including technology. If any new equipment is introduced, we should be able to balance benefits to mother and baby against cost-effectiveness.”
About Dianne Garland SRN RM ADM PGCEA MSc
Dianne has been a midwife since 1983, having qualified at Queen Charlotte’s Hospital, London.
Since 1989 Dianne has been teaching about waterbirth and gentle birth choices. She has travelled worldwide to Europe, Australia, China, the United States and India. She has written numerous articles, and a revised version of her book Revisiting Waterbirth: an attitude to care was published by Palgrave in December 2011.
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