FETAL PHYSIOLOGY AND PATHOPHYSIOLOGY

Fetal Physiology And Pathophysiology

Fetal Physiology And Pathophysiology

Introduction

Evidence Based Care is a desired goal in modern obstetrics. The fundamental consideration is the wish to base practice on clear evidence derived from large trials or systematic reviews rather than on tradition and/or personal experience. Thus inconsistencies between practitioners are reduced and caring and curing become more efficient. Although evidence is at hand, the process of implementing it into obstetrical practice seems to be a painful delivery. Strategies and program guidelines were developed and installed which aimed to achieve change in practice by using certain elements. The effect of these programs was mostly disappointing. (Haan, Martin, Evers, 1981)

Little attention has, however, been paid to factors which influence daily obstetric interventions. These factors might play a crucial role when it comes to implementing new evidence. It seems important to gain more knowledge about these factors before trying to bring about change. (Haan, Martin, Evers, 1981)

We decided to focus on a particular aspect of obstetrics, the monitoring of the fetus intrapartum — a subject on which the midwives in Switzerland are well informed.

Midwifery in Switzerland is defined as being an independent profession. Antenatal care is mostly supervised by obstetricians in a hospital setting or a private practice. Risk assessment (low risk/high risk) takes place during antenatal care and at the beginning of labour according to a risk catalogue. Most midwives work in a hospital setting where they do not entirely work on their own responsibility. Intrapartum care is lead by the midwife within the hospital guidelines. The midwife is the main caregiver during childbirth with a low obstetrical risk. When abnormalities occur, an obstetrician is consulted. An obstetrician is usually present at birth. (Haan, Martin, Evers, 1981).

The representativity of the data of our sample is debatable, though the data on the distribution of the work place shows a close resemblance. Although representativity can not definitely be established by the data we collected, our study shows a trend which confirms earlier studies. (Yagel, Gembruch , Silverman, 2008) Although the skill of FHR monitoring by intermittent auscultation is still mastered by midwives, prominent factors playing a major role in obstetrical practice for midwives in Switzerland are their own personal experience and hospital policies. Staffing levels and time factors were less important. The most intriguing finding of this study was that EBM studies were of minor importance as were litigation fears and colleagues' opinions.

The need for Evidence Based Care is a relevant issue for our professional body. Established practice depends on a complexity of very strong factors, some of which are mentioned in this study. These might be a barrier to change and impede the establishment of Evidence Based Obstetrics or they might be the key factor of a program to facilitate it. (Yagel, Gembruch , Silverman, 2008) As programs are being developed, the implementation of evidence into obstetrical practice in Switzerland could be reached by basing future hospital guidelines on evidence. This could also have consequences for professional guidelines and for possible cases of ...