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TEALE FENNING
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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 Posted: Sat Oct 20, 2007 6:06 pm Post subject: |
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The RCOG make an important statement regarding these documents which stresses the limitations of categorising women into risk groups ....
| RCOG wrote: | Whilst respecting choice and the need to offer diverse services, the RCOG continues to stress that safety remains paramount.
Complications during childbirth are unpredictable and can occur even in selected low-risk births.
The RCOG supports normal birth and the autonomy of the midwives, but favours co-located midwifery units which guarantee immediate access to a multidisciplinary team of specialists, should the need arise.
These reports stress the importance for maternity units to be well staffed by consultants and midwives so that appropriate, safe and satisfying care can be provided for women and their babies.
Improved recruitment into the specialty and the expansion of the consultant grade are pre-requisites for the quality services now recommended. |
Very sensible advice I am sure you would agree. |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Tue Apr 29, 2008 9:47 am Post subject: |
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Having discussed this at the EMQ Course and again this weekend at the OSCE Secrets Course I felt obliged to bring you all up to date on how the guideline has modified the second stage.
The Guideline is very clear and says:
| NICE wrote: | Recommendations on duration and definition of delay in the second stage of labour
Nulliparous women:
Birth would be expected to take place within 3 hours of the start of the active second stage in most women.
A diagnosis of delay in the active second stage should be made when it has lasted 2 hours and women should be referred to a healthcare professional trained to undertake an operative vaginal birth if birth is not imminent.
Parous women:
Birth would be expected to take place within 2 hours of the start of the active second stage in most women.
A diagnosis of delay in the active second stage should be made when it has lasted 1 hour and women should be referred to a healthcare professional trained to undertake an operative vaginal birth if birth is not imminent. |
When we consider this we need to remember a few key points:
1. The definition of the onset of the active second stage of labour:
the baby is visible
expulsive contractions with a finding of full dilatation of the cervix, or other signs of full dilatation of the cervix
there is active maternal effort, following confirmation of full dilatation of the cervix, in the absence of expulsive contractions.
2. The effect of an epidural / passive stage
An epidural does not really change things! It is all about the 'urge to push'. If a woman is fully dilatated but has no urge to push she should be assessed after 1 hour. Of course this is more likely in a woman with an epidural but the presence of an epidural per se does not affect the decision making process. However, the guideline does recommend that all women with epidurals are encouraged not to push for at least one hour and maybe more but that the whole 2nd stage be completed in 4 hours. Clear! 
3. What to do at 1 hour in parous women and 2 hours in nullips
For this we suggest you look at the flow chart on page 13 of the Quick reference guide
This clearly shows the action at these time points is to:
1. diagnose a delay in the second stage
2. assessment and ongoing review every 1530 min by an obstetrician
3. that oxytocin is not started
4. then consider instrumental birth if concern about fetal wellbeing or for prolonged second stage or advise CS if vaginal birth not possible BUT whatever you chose birth is expected to take place within 3 hours of start of active second stage for nulliparous women and within 2 hours for parous women |
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