Tuesday, 6 March 2012

I am so mad at some of the things I see and hear on One Born Every Minute I have set up a facebook page to talk about it...so pleased that in just a couple of days it has over 800 likes!! so here it is and also here is my first bit of ranting on the subject One Born Every Minute..The Truth

Factual or fiction?

The Channel 4 television show One Born Every Minute won a BAFTA in 2010 under the category of Best Factual Series.  A definition of the word factual is:

"The available body of facts or information indicating whether a belief or proposition is true or valid".

Whilst it may be assumed that  the audience knows that editing has taken place, especially those who are aware of the time involved in the labour/birth of a baby, there is no doubt that what is being seen, said, and done is fact for it is happening as we are witnessing it. What is questionable is whether or not these “facts” or the actions and words of the professionals involved are true or valid? Turn that into professional speak and it could be asked if the words and actions are evidence based.   Are they in line with the rules and codes of the governing bodies of the professionals involved? If the answer is no then surely there are further issues to be considered and questions to be asked.

During the Wednesday 29th March episode, Midwife Zoe Leonard was encouraging long sustained breath-holding whilst caring for Vicki who was pushing in the second stage of labour.   This practice is known as the Valsalva Manoeuvre which involves prolonged breath-holding.

With prolonged breath-holding there is an increase of the maternal intrathoracic pressure by forcible exhalation against the closed glottis, which causes a trapping of blood in veins preventing it from entering the heart. When the breath is released, the intrathoracic pressure drops, the trapped blood is quickly propelled through the heart producing an increase in the heart rate and blood pressure and followed by a slowing of the heart rate. All of this disrupts the blood flow to the uterus and ultimately to the baby which then shows up or is interpreted on the fetal heart monitor as fetal distress.

There is no evidence that the Valsalva Manoeuvre shortens the second stage, decreases fatigue or minimizes pain. The evidence suggests that it alters the contractile pattern of uterine smooth muscle, leading to inefficient contractions and failure to progress. Studies suggest that encouraging women to believe in their ability to push the baby out may be as important as the type of breathing. 

Studies published between 1992 and 2009 show that the physiological effects of Valsalva Manoeuvre can include: impeded venous return; decreased cardiac filling and output; increased intrathoracic pressure; affected flow velocity in middle cerebral artery; raised intraocular pressure; changed heart action potential/repolarization; increased arterial pressure; increased peripheral venous pressure; altered body fluid pH, which contributes to inefficient uterine contractions; decreased fetal cerebral oxygenation.  The World Health Organisation, (WHO) concluded that it is a dangerous practice and should cease.

Later in the same programme when interviewed, Midwife Zoe said that babies can, if left too long in labour, "get tired" (labour ward talk for become hypoxic) if the 2nd stage goes on too long.  There is no evidence to support better outcomes when time limits are imposed on any stage of labour. More importantly, Zoe is obviously not aware of the evidence around her practice with efforts to encourage Vicky to birth her baby quickly.  Is Zoe disregarding them the evidence in favour of dangerous practice? Either way she is in breach of her Nursing and Midwifery Council Code, (NMC) as according to Rule 6- Responsibility and sphere of practice, the guidance indicates that practice should be based on the best available evidence and that a midwife must make sure that the needs of the woman and baby are her primary focus.  The NMC code of professional conduct: Standards for conduct, performance and ethics (2010) states that a midwife must keep her knowledge and skills up to date.

This programme needs more editing in order to stop showing bad or dangerous practice. Whilst the programme makers must be delighted in their ability to pull in large audiences, the success of other birth programmes has demonstrated it does not always need sensationalism and car crash births in order to do so.  It must not be forgotten that the viewers may include new and impressionable midwives who may get the message that it is fine to copy what they see and for women to accept as normal what they too may be exposed to or ask to do when they face childbirth.  Questions needs to be asked and they include; why are awards being given for dangerous practice and are the NMC watching?


 Martin C 2009, Effects of Valsalva manoeuvre on maternal and fetal wellbeing, British Journal of Midwifery, vol. 17, no. 5, pp. 279-85

Nursing Times  95:15, April 15, 1999.

WHO (1996) Care in Normal Birth: a Practice Guide.

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