Heart Of Labour Research Articles

How does Labour intend to achieve Economic Growth? A Response to Rachel Reeves's Mais Lecture

AbstractThe new Labour government's overriding priority is economic growth—and chancellor Rachel Reeves's March 2024 Mais lecture is the clearest statement of how they intend to achieve it. The anticipated ‘dullness dividend’ from being more stable than recent Conservative governments is likely to be small, while the incoming government will have to confront trade‐offs—for example, accepting lower consumption—to increase investment. Planning reform is at the heart of Labour's proposed supply side reforms, but it remains unclear whether the party will be bold enough to follow through on its rhetoric. Labour also believes that stronger worker protections will increase productivity. By contrast, education, migration and trade are more marginal in Labour's growth narrative. It is to be seen how far Labour has made a virtue of necessity by prioritising cheaper and apparently less politically contentious growth measures.

A post-structuralist feminist analysis of electronic fetal monitoring in labour

Constant electronic fetal monitoring has become a ubiquitous part of birth management in most high-income countries, both reflecting and creating the social context. This article uses a post-structuralist feminist critique to show that the use of the cardiotocograph in birth reinforces and reflects the logic of the separate sovereign self. This creates a rupture in the intrinsic relationality of the mother–fetus and the mother–midwife on a philosophical and physiological level. The cardiotocograph in labour privileges the medical model, constrains women through wires and the imperative to ‘keep the trace’, takes everyone’s attention and gives midwives tasks other than caring for the woman. It externalises the fetus and gives it selfhood separate from the mother, to the extent that it can seem like the machine is keeping the baby alive. This undermines women’s and midwives’ subjective knowledge, relegating women to organic containers. A reimagining of birth that centres relationality would start by acknowledging the nature of the self as semi-permeable and the being/doing, both/and nature of the mother–placenta–fetus in pregnancy and birth. Intermittent auscultation of the fetal heart in labour is better able to centre the mother–placenta–fetus relation and the midwife–mother relation.

A Social Guarantee to Meet Everyone's Needs within Environmental Limits

AbstractThe Social Guarantee is part of the everyday economy and contributes a distinctive, normative approach. It maintains that the primary purpose of the economy is to meet everyone's needs within the limits of the natural environment. It offers a principled framework for policy and practice to address three interlinked crises that are all rooted in a failed economic system: soaring living costs, widening inequalities and the climate emergency. The starting point is that everyone should have a sufficient income. Crucially, this is derived not only from wages and cash transfers, but also from publicly funded services, infrastructure and other collective measures that constitute in‐kind benefits. These make a substantial contribution to living standards, they are highly redistributive and they are far more ecologically sustainable than aggregated market transactions. It is time to reassert the collective ideal and put in‐kind benefits at the heart of Labour's programme.

An Exploration of the Views and Experiences of Midwives Using Intermittent Auscultation of the Fetal Heart in Labor

OBJECTIVES: To identify the experiences of midwives using intermittent auscultation of the fetal heart rate in labor.DESIGN: A qualitative descriptive study with a sample of 8 midwives, 3 from a DOMINO scheme and 5 from the labor ward at an Irish urban maternity unit. Data collection was through tape-recorded semistructured interviews. Data analysis involved transcription of the interviews verbatim and thematic analysis.FINDINGS: Three core themes were identified: vulnerability, the culture of the organization, and walking the tightrope. The findings suggest that the main challenges which inhibit midwives using intermittent auscultation is the lack of professional guidelines, inconsistency in documentation, and working in a biomedical model of care. The participants also identified that midwives practicing in a midwifery social model of care have more confidence and use midwifery skills to support the use of intermittent auscultation.CONCLUSIONS: The findings suggest working within a midwifery social model of care facilitates the use of intermittent auscultation. Guidelines and education on the explicit use of intermittent auscultation need to be made accessible to midwives. Midwives believed that women could promote the use of intermittent auscultation through their own education on monitoring fetal heart rate options in labor.

PLD.45 The use of telemetry for continuous fetal heart rate monitoring in labour: results of a survey of UK maternity units

BackgroundThere is very little recent evidence regarding the use of telemetry to continuously monitor the fetal heart in labour, and no information about its current use within UK maternity units....

The Modernising Antecedents and Historical Origins of One Nation Labour

Launched at the 2012 conference, Ed Miliband's One Nation Labour initiative draws heavily on the party's experience under Neil Kinnock during the late 1980s as well as from Tony Blair's tenure as leader of the opposition between 1994 and 1997. In policy terms, Miliband promised a Labour government would prevent firms from ‘poaching’ trained workers from other businesses and would stop short term predatory behaviour in the economy by offering companies greater protection from takeovers. Both proposals echo those at the heart of Labour's 1989 policy review document, Meet the Challenge, Make the Change. The link between One Nation and Tony Blair's New Labour concerns the discourse with which the party's outlook is articulated. As such, One Nation Labour has not been shaped by current political debates. Rather it reflects the party's ability to learn from previous initiatives, building on their strengths in a reflective fashion.

Assessing the preference of women for different methods of monitoring the fetal heart in labour

Objective. To assess which of three different methods of monitoring the fetal heart in labour was preferred by labouring women. Method. Ninety-nine women in the first stage of labour were enrolled into a prospective clinical study to compare their preference for fetal monitoring with a Pinard fetal stethoscope, an innovative wind-up Doppler ultrasound fetal heart rate monitor, and cardiotocography. Result. Significantly more women preferred the fetal heart rate monitor to the other two methods (p=0.001). Conclusion. Intermittent auscultation of the fetal heart during labour with a fetal monitor is more acceptable to labouring women than monitoring with a Pinard fetal stethoscope or a cardiotocograph.

Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time

To find out the efficacy of continuous fetal heart monitoring by analyzing the cases of cesarean section for nonreassuring fetal heart in labor, detected by cardiotocography (CTG) and correlating these cases with perinatal outcome. To evaluate whether a 30 minute decision to delivery (D-D) interval for emergency cesarean section influences perinatal outcome. This was a prospective observational study of 217 patients who underwent cesarean section at > or = 36 weeks for non-reassuring fetal heart in labor detected by CTG. The maternal demographic profile, specific types of abnormal fetal heart rate tracing and the decision to delivery time interval were noted. The adverse immediate neonatal outcomes in terms of Apgar score <7 at 5 minutes, umbilical cord thornH <7.10, neonates requiring immediate ventilation and NICU admissions were recorded. The correlation between non-reassuring fetal heart, decision to delivery interval and neonatal outcome were analyzed. Out of 3148 patients delivered at > or = 36 weeks, 217 (6.8%) patients underwent cesarean section during labor primarily for non-reassuring fetal heart. The most common fetal heart abnormality was persistent bradycardia in 106 (48.8%) cases followed by late deceleration in 38 (17.5%) cases and decreased beat to beat variability in 17 (7.8%) cases. In 33 (15.2%) babies the 5 minutes Apgar score was <7 out of which 13 (5.9%) babies had cord thornH <7.10. Thirty three (15.2%) babies required NICU admission for suspected birth asphyxia. Rest 184 (84.7%) neonates were born healthy and cared for by mother. Regarding decision to delivery interval of < or =30 minutes versus >30 minutes, there was no significant difference in the incidence of Apgar score <7 at 5 minutes, cord pH <7.10 and new born babies requiring immediate ventilation. But the need for admission to NICU in the group of D-D interval < or = 30 minutes was significantly higher compared to the other group where D-D interval was >30 minutes. Non-reassuring fetal heart rate detected by CTG did not correlate well with adverse neonatal outcome. There was no significant difference in immediate adverse neonatal outcome whether the D-D time interval was < or = 30 minutes or >30 minutes; contrary to this, NICU admission for suspected birth asphyxia in </= 30 minutes group was significantly higher.

Developing a tool to appraise fetal monitoring guidelines for women at low obstetric risk

The aim of this paper is to report the development and use of a tool to appraise guidelines for fetal heart rate monitoring and discuss the findings generated in the appraisal process. Expert guidance on the appropriate method of monitoring the fetal heart in labour has been available for some time. However, practices not based on evidence were continuing routinely in the United Kingdom. We produced an 18-item tool for the appraisal of guidelines. Heads of Midwifery Services were asked to send the guideline currently in use. Twenty-four out of 28 responded, and sent 32 guidelines. Pairs of multidisciplinary reviewers appraised each guideline. A prevalidated generic appraisal instrument was not found to be appropriate for intrapartum fetal monitoring guidelines. When using our own specifically-developed appraisal tool for assessing the quality of fetal monitoring guidelines, only 11 reviewer pairs showed 'good' or 'moderate' agreement in their scores. Generically-validated guidelines may not be sufficiently discriminatory for specialized areas of practice such as intrapartum fetal monitoring.

New Labour and the Public Sector: A Tale of Two Green Papers

Public sector reform will be at the heart of Labour's third term of office. The changes under way or planned in children's services and adult social care services in England are prototypes of the pursuit of services that are person‐centred, seamless and proactive, with a focus on positive outcomes and well‐being. This article examines the similarities in approach between the two sets of changes, and warns that implementation will be a difficult task.

Editor's Choice

Editor's Choice

Including the socially excluded: League tables and Labour’s schools policy

In the autumn before he was elected prime minister, Tony Blair, in a fit of possibly misplaced hubris, announced that his party would have a thousand days to prepare for the next thousand years. In the event it was only 974 days from the election to the millennium, but who could possibly be pedantic when the stakes were that high? Of course Blair was only being rhetorical with the truth, but the message his pronouncement contained, that of hope for the future after eighteen years of Tory misrule, lay at the heart of Labour's electoral appeal. Things, we were promised on that glorious night in May, could only get better. Yet, speaking from the other side of the millennium divide, one thousand days into a Labour administration, we have to ask whether or not they have. Although it is the health service that has arguably received the most attention when considering Labour's record, education is perhaps a better place to start. For education, education, education, as Tony Blair's inelegant use of the Ciceronian triad put it, was the top priority. That and joined-up government, a theme to which we shall return. To be fair, the Labour party did inherit a parlous state of affairs. True, exam results had been steadily rising under the Tories, but everything else had fallen; in particular, teachers' salaries and the overall expenditure on schools. This left Labour with a demoralised profession teaching large classes in crumbling school buildings. Perhaps Labour's biggest challenge, however, was to tackle the legacy of the Conservatives' drive to transform education into a marketplace. The Conservatives' essential premise was that, as with business, competition between schools would drive up standards. The economic indicators of success were to be exam results. For the first time, a stock exchange of school performance, the so-called league tables, were to be published to enable parents to trade their children against a school's future success. In the event it was shrewd investors and schools already rich in cultural capital, to use the sociologist Bourdieu's term, who profited by the system. Stephen Bali's(1) work, along with that of fellow researchers Sharon Gerwirtz and Richard Bowe, did much to expose the means by which the education market privileged those parents who knew how to work the system. More particularly, however, their research demonstrates the way in which it was certain schools who benefited from the market rather than the consuming parent. As schools grew in popularity, so they became oversubscribed, and more often than not this led to selection via the back door, either because the house prices in the catchment area became so prohibitively expensive that only the well-to-do could afford them, or because the schools themselves began to introduce screening devices through entrance tests and interviews, to ensure that only the academically able or socially adjusted gained entrance. Many of these schools became what was known as `grant maintained'. This enabled them to opt out of local authority control and so to control even more tightly their own entrance procedures. Unlike local authority schools, they could, if they chose, refuse to accept pupils with special needs or to take children that had been excluded from other schools. In addition they received preferential funding from a central government quango, rather than being reliant on local authority expenditure. Both these features accelerated the divide between the educational haves and have-nots until the distance between schools looked more like a chasm. Yet the rhetoric insisted that the schools at the top were `good' schools, while those at the bottom were `bad'. No acknowledgement was made of the fact that what these figures most revealed was the level of deprivation of the communities that the schools served. This failure to admit the glaringly obvious is an issue to which we shall return, for it also lies at the heart of Labour's shortcomings. …

Monitoring the fetal heart in labour: stop and think

The midwife is the only expert in the maternity services who specializes in normal pregnancy and birth. Part of the specialist role of the midwife is to support physiological processes. Clearly, in this regard, something has gone badly wrong with British midwifery. The amount of routine interference with labour and birth, such as electronic fetal heart monitoring, does not seem to have declined in recent years, and the operative birth rate is climbing steadily, despite a mandare from Changing Childbirth initiatives for midwives to take on a stronger role. The National Report of the Audit Commission says that the use of caesarean section has increased in most developed countries to a level that concerns clinicians (1997:43). Through their national survey they found that the use of caesarean section at 11 NHS Trusts varied between 11% to 18% of deliveries. The operative delivery rate of 12 NHS Trusts varied between 13% to 5%. In some teaching hospitals, the rate of caesarean sections reaches above 25% on occasion. Our operative delivery rate may exceed that of North America in the near future.

Changing patterns of birth asphyxia and trauma over 20 years

Comparison of birth asphyxia and trauma in the same obstetric service during periods 18 years apart shows some reassuring and some disquieting findings. Liberalized cesarean sections, electronic monitoring of fetal heart in labor, and replacement of opiate sedation by epidural anesthesia have had their effect. There has been dramatic reduction in perinatal death and neonatal encephalopathy due to birth asphyxia and trauma and only rarely do affected infants now develop permanent cerebral injury. Severe birth asphyxia, defined by need for prolonged ventilation, has, however, remained unchanged in frequency. Unexpectedly, fractures and paralyses have dramatically increased. The major hazard today for the term infant is the use of midforceps, which has become much more common in parallel with the increased use of pain relief by continuous epidural anesthesia.