Cordless and waterproof cardiotocography

S38 Background: Epidural analgesia has become the gold standard for control of pain in labour. However, it requires specialised resources, is not always effective, significantly increases assisted and operated deliveries, and is contraindicated for a number of medical conditions. In addition, there is a population of women who do not wish to be given an epidural. Under these circumstances, IM pethidine remains the most widely used narcotic administered for labour pain. To date, many women are unaware of alternative options should they choose to use pharmacological pain relief. Several South Australian country hospitals have been undertaking an innovative practice of administering fentanyl via the subcutaneous route. The efficacy of this method, however, had not been examined. Aim: This study examined the safety and efficacy of fentanyl administered subcutaneously for pain relief during childbirth for both mother and neonate. Research methods: An observational study was undertaken using two approaches: (1) Medical records of 418 labouring women birthing within one rural hospital during January 2000—December 2007, were examined to explore the clinical effectiveness of subcutaneously administered fentanyl. These results were compared with an equal number of women who used no pharmacological pain relief. (2) A pilot study (n = 10) was conducted between July 2008 and October 2008 to assess the efficacy of subcutaneously administered fentanyl for pain relief during childbirth. Findings: Fentanyl was found to be a clinically effective narcotic when administered for pain relief in childbirth. In the neonate Apgar scores at five minutes, and time to establish breathing and breastfeeding outcomes did not differ significantly between women who had received fentanyl in labour and those in the control group. Implications: Should a woman request pharmacological pain relief, subcutaneously administered fentanyl provides an alternative choice without causing sedation or restricting the women’s mobility. In addition, this option is less invasive than current forms of systemic analgesia. However, more research, with a larger sample size is required. doi:10.1016/j.wombi.2011.07.122 Tales of an Australian midwife: water birth in Singapore Deborah Fox National University Hospital, Singapore When Melbourne midwife Deborah Fox followed her husband overseas to a teaching appointment, she was ready for an adventure but had little idea what an exciting midwifery journey was to follow. Collaboration with Singapore’s water birth pioneering obstetrician has resulted in the development of an innovative natural birth programme in the private sector of a tertiary teaching hospital. Childbearing is managed by the same caregivers and without the need for transfer, regardless of whether complications arise or pharmacological assistance is needed. This private model of care is available to women of all risk profiles and has seen a seven fold increase in demand. Clinical outcomes are excellent and maternal satisfaction is high. Caesarean rates, instrumental birth and epidural use are low and few women birth on the bed. A full range of physiological birth options

Posters have been introduced, including water immersion, water birth, continuous support, mobility and upright positioning, music, massage, aromatherapy, hypnosis, immediate skin to skin contact, physiological third stage management and protected bonding time. None of these practices are routine in maternity care in Singapore. Collaborating with an obstetrician to pave the way for greater choices for childbearing women has been an exciting experience. Mutual respect for the value both obstetrics and midwifery can offer, a woman centred philosophy and healthy doses of humour underpin the success of the programme. Collaborative care is of emerging interest internationally and can be achieved if such principles override traditional patterns of adversity between obstetricians and midwives. Childbearing women and their families as well as the professionals involved all may reap the rewards. doi:10.1016/j.wombi.2011.07.123 Cordless and waterproof cardiotocography Deborah Fox National University Hospital, Singapore Aim: How the use of cordless cardiotocograph (CTG) technology for intrapartum fetal monitoring may improve women’s birth experiences and increase normal physiological birth outcomes, when compared to conventional wired CTG. Methodology: Systematic review of the literature. Key findings: Women with a range of risk factors and complications during pregnancy and the intrapartum period are deemed to require continuous electronic fetal monitoring. These risk factors may include examples such as a previous caesarean section, intrauterine growth restriction, prostaglandin induction, the presence of meconium stained liquor, oligo/polyhydramnios, diabetes, prolonged rupture of membranes and many others. The value of maternal freedom of movement in labour in producing normal birth outcomes and improved maternal satisfaction is well known. Recent literature demonstrates the benefits and safety of water immersion for women and babies. The existing literature suggests that cordless CTG technology is as safe and reliable as conventional wired CTG, is associated with a decrease in the number of women needing pethidine and epidurals, results in slightly higher rates of unassisted vaginal births, and enables water immersion in labour and/or birth. Midwives are mandated with the responsibility to keep birth normal. Cordless CTG technology and successful collaboration with obstetricians may enable midwives to care for women with risk factors without the cascade of intervention which may occur simply due to the restriction of movement and positioning of the woman. doi:10.1016/j.wombi.2011.07.124 Back to the future: support for complementary and alternative medicine in contemporary midwifery practice Helen Hall ∗ , Lisa McKenna, Debra Griffiths Monash University, Victoria, Australia