Tracy: Ginger what do you think about their ranges like putting every 15 to 30 or do you feel like it should be every 15 or every 30.
Ginger: I think you need to pick an organization's protocol and that would be the best answer to the policy. So you're not finding the middle of the road but you're finding what the recommendation is. Others? Leslie you have thoughts about that?
Leslie: I agree with what you said. Picking a protocol and sticking with it. I would say here in the U.S. from medical legal standpoint, A-one is always the one that's referenced on the monitoring guidelines. So that's the reason we use that one. But I don't think you'd be wrong using any of them.
Ginger: Tracy I would refer you to Eliza's PowerPoint. She goes into that pretty much in detail and talks about the differences and how they made the decision at the University Hospital of what they were going to do. That's a great question. Others? Any experiences that you've had that you want to share?
Tracy: I notice like in the latent phase, only one one place has a recommendation. So with that is that I mean mostly in birth centers people don't show up until active labor so it's a given. But does anyone have a protocol for latent labor or know of one?
Leslie: We use A1 guidelines which say in latent labor. The only time we would have somebody admitted to the person or in latent Labor is maybe she's ruptured she needs antibiotics for GBM and she lives an hour away and we're actively trying to encourage labor.
Ginger: Ok so I have a question for you guys. This was actually a scenario that happened when Judy and I ran a practice at St. Luke's here in Kansas City on the plaza of a Bradley patient who wanted no Doppler used at any point in time in her pregnancy and only wanted a fetus scope used. How would you handle that patient?
Leslie: At our birth center, our policy is no Doppler no waterbirth. But other than that we don't we don't have a preference.
Tracy: I've always been fetascope the whole way, whatever you want, whenever you want the whole pregnancy, but in labor, I think the thing to get a good assessment I think it just depends. When you have a fetus scope usually they have to be pretty still, especially for an inexperienced fetus scope user like myself. It depends on the experience.
Ginger: Others on the call? I could tell you what we did at Luke's. Judy are you still on the call? You there? We were working with maternal fetal medicine physicians as our consultants and we used the fetus scope in pregnancy but we use the Doppler in labor. And so I get it. I'm not I'm not trying to proselytize one way or the other but I think it's pretty fascinating to look back at Cochrane who actually compared the Pinard or a fetus scope to electronic devices and actually found significant differences in outcomes. It's pretty interesting. Why we have lost the faith in a tool that has stood the test of time, I mean it's liability, it's anxiety, it's our fears. But I think you heard the UK midwife talk about the exposure of sound waves for the fetus in some moms right? Did you guys catch that?
Leslie: Yes and moms come in concerned about that.
Ginger: Right, so what do you say?
Lesley: We will use the fetus scope and the prenatal for their pregnancy. And if they want the fetus scope for labor then we just, they can labor in the tub but they have to get out. When we listen to the heartbeat and we don't do it waterbirth.
Ginger: Anybody else on the call has some thoughts or questions about that?
Sherilyn: My thoughts are that, at least in my experiences when I was actively practicing if, if you could meet a patient who is really happy if they have some say and if you can really meet her halfway and maybe promise her just you know use the fetus scope until a point where maybe you hear. If you can do that all the way through and say in labor we may have to use that or we probably will, most times people will buy that at least in a hospital setting.
Ginger: Yeah I finally opened up the chat box and Portia typed something to us. I don't know if your you're audio's not working Porsche or not but we'd love to hear more from you because I do think that intermittent fetal heart monitoring is the key to sort of decreasing the technological advances we have come to rely on and literally push on patients in ways that if they don't come educated like Tracy said, it almost becomes our personal professional bias as to how we approach it. So with that what I would love to do is to get anybody who wants to sign up for the chance to win this pinard that we will mail to you to go into the chat box and just type in a number between 0 and 100. And please if you see a number typed in pick a different number you can't pick the same number. And in just a minute we're going to ask Siri to pick a number. So those of you who want to sign up for this, and Leslie you want to sign up for it and give it to one of your midwives is fine with me.
Leslie: I had to switch from computer to phone because my internet went out.
Ginger: So we have on here five people. Portia can you hear us? I'm guessing you can. Judy are you going to type anything?
Judy: Now I'm going to but somebody else went. I'll just look at the others.
Ginger: I know Porsche's still with us but I am not sure why we're not connecting. Leslie are you going to type anything?
Leslie: I can I'm just on the audio.
Ginger: Oh you can't type I see. Do you want to or do you want to pass?
Lesley: Put in 57. Our new hire just passed your board today. Maybe she'll win.
Judy: All right I'll do it too. This is Judy. I can't type either. Put in 70 seven zero. And that's Judy. I'll give it to you for your new hire.
Ginger: Yeah we're stacking that against Tracy we can't do that.
Judy: Or maybe I'll give it to Tracy.
Ginger: Portia are you with us? If not I'm going to ask Siri to pick a number and let's see what happens. I don't know if this will work through the ear buds but we're going to try it. I haven't tested this. Hey Siri pick a random number between 0 and 100.
Siri: 58 random number between 0 and 163.
Ginger: Did you guys hear it?
Lesley: I don't know what Tracy's guess was.
Ginger: Tracy Was 3.
Tracy: Yeah mine was three.
Ginger: So I think it's so that isn't it you Lesley?
Lesley: I think so. Yeah okay. Well that is all I have. Unless you guys have some questions or comments. Love for you to spread the word about the talk tonight feel free to download it and share it. We'd love to hear any topics that you'd be interested in hearing about and I really value you all being on the call.