Should cord pH be performed routinely after normal birth?
Care of women in labour and how we monitor the wellbeing of baby remains a contentious issue. The National Institute for Clinical Excellence (NICE) guidance informs us that for low risk women intermittent auscultation is the method of choice. It also informs us that cord pH sampling should be performed in those cases where there has been fetal blood sampling in labour, caesarean section, or instrumental delivery. It does not say that all babies should have their acid base or pH determined after birth (NICE, 2001: 29). Nevertheless, in the hospital where the author practiced until July 2002 it remains hospital 'policy' to perform cord sampling on all babies. The net result influenced how midwives practiced, in that many midwives felt unable in the main to go against Trust policy. It became even more difficult to encourage midwives to practise intermittent auscultation as they felt the new policy made them more fearful of not using the cardiotocograph. Even when midwives protested and put forward their case, they were forced by fear of blame and litigation to practise defensively and not in the best interests of women. Midwives made their concerns known, but the practice continues and the issues remain largely unresolved. This paper is an account not only of the impact of cord pH sampling on well babies, but also of the unequal status of midwifery in relation to medical dominance that still persists in the NHS today.
Shallow
Helen
H
Derby City Hospital.
D000136:Acid-Base Equilibrium; D001291:Attitude of Health Personnel; D004993:Ethics, Nursing; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D009321:Natural Childbirth; D016134:Organizational Policy; D011247:Pregnancy