Notes from textbook: “Fetal Monitoring in Practice” by two obstetricians from hospital w/ annual birth of 25,000+

by faithgibson on September 11, 2019

Notes from the textbook: “Fetal Monitoring in Practice” by two obstetricians from hospital w/ annual birth of 25,000+

Background on the authors 

At the time these two authors Dr. Donal Gibb and Dr. S. Arulkumaran published this 2nd edition of “Fetal Monitoring In Practice”, they were employed by the Singapore public healthcare system and working as obstetrical supervisors in the city’s largest public hospital. Its staff attended over 25,000 birth a year, and yet the obstetrical unit has only 2 electronic fetal monitors.

Obviously, the American model of routinely using EFM for every laboring woman was out of the questions, so Drs G & A had to figure out how to make the very best use of this important resource.

For the multitudes of healthy women delivered every year by the hospital’s midwifery staff, the standard of care was auscultation. Their auscultation protocol identified specific intrapartum risks or symptoms of possible complications that warranted evaluation by the on-call obstetrical consultant. Often, but not always, EFM was used to access the fetus of these women, but with only 2 monitors available, the obstetrical staff had to figure out who and what situations were most likely to need or benefit from this medical technology.

Over their many years of experience, these obstetricians became very astute about the use of EFM, having developed a well-informed and evidence-based understanding of the kinds of labor-related situations that benefited from EFM, and which patients would or would not benefit from continuous EFM during the balance of their labors.

Equally important, is the understanding of these two obstetrical authors for the social importance to the family of childbirth as “one of the most important events in their lives with enormous emotional impact”, therefore how important communication with the parents and not interfering unless there was a life-threatening problem.  

“Good communications with the mother and her partner is vital. Obstetric cases are unique, in that they are not sick, as are patients in other departments of the hospital. On the contrary, they are experiencing one of the most important events in their lives with enormous emotional impact.

The intimacy of this should not be compromised except in the ‘genuine interest’ of safety for mother and child. This book should help us recognize this ‘genuine interest’. Without this {i.e. qualities of knowledge and clinical experience} we will not earn the approbation of those who have entrusted their care to us.” p. 19

Info the book

Most important for our purposes, Fetal Monitoring in Practice provides the reader with a thorough understanding the physiology of normal fetal heart and how to recognize stressful situations and/or early and subtle signs that a previously healthy fetus is becoming stressed. This is particularly relevant for community midwives, as we only plan to attend OOH labor in women who are healthy and have normal term pregnancies.   healthy well-grown fetuses do not suddenly become clinically-distressed babies. Typically this is a slowly devolving process that takes more than 100 minutes except for the rare obstetrical emergencies of cord prolapse and placental abruption. That means that astute auscultation by community midwives give us a reasonable warning of this serious complication by displaying one of more indicators of stress well before the baby becomes distressed. This allow us as care providers to offer appropriate interventions  before the baby’s condition deteriorates and emergency delivery becomes necessary.

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