Maternal factors implicated in fetal bradycardia after combined spinal epidural for labour pain

BACKGROUND AND OBJECTIVE: Combined spinal epidural analgesia is effective for fast relief of severe labour pain but has been associated with worrisome decreases in fetal heart rate. Since the reasons for this phenomenon remain elusive, some anaesthesiologists may abstain from using this technique. We postulated that factors unrelated to the neuraxial technique could play a role in the decrease in fetal heart rate. To our knowledge, no prospective study has previously looked into this possibility. METHODS: We collected prospective data on 223 consecutive patients who received combined spinal epidural analgesia (123) or epidural analgesia (100). Maternal blood pressure, analogue pain scores, exogenous infusion of oxytocin, cervical dilatation, maternal age, parity and ethnicity were collected and correlated with the occurrence of decreases in fetal heart rate post combined spinal epidural. RESULTS: Univariate analysis showed a correlation between the incidence of fetal bradycardia and higher maternal pain scores, older maternal age, and combined spinal epidural analgesia. Multivariate analysis revealed that only pain scores and maternal age were independent predictors of fetal bradycardia post neuraxial blockade. CONCLUSIONS: Maternal pain scores and older maternal age are factors unrelated to the neuraxial technique that are independent predictors of fetal bradycardia after neuraxial analgesia for labour.

The Role of Fraternal Organisation in Migration and Informal Labour Organisations in Mining Communities: Cornwall, the Keweenaw, and California Compared

During the second half of the nineteenth century fraternal and benevolent associations of numerous descriptions grew and prospered in mining communities everywhere. They played an important, but neglected role, in assisting transatlantic migration and movement between mining districts as well as building social capital within emerging mining communities. They helped to build bridges between different ethnic communities, provided conduits between labour and management, and networked miners into the non-mining community. Their influence spread beyond the adult males that made up most of their membership to their wives and families and provided levels of social and economic support otherwise unobtainable at that time. Of course, the influence of these organisations could also be divisive where certain groups or religions were excluded and they may have worked to exacerbate, as much as ameliorate, the problems of community development. This paper will examine some of these issues by looking particularly at the role of Freemasonry and Oddfellowry in Cornwall, Calumet, and Nevada City between 1860 and 1900. Work on fraternity in the Keweenaw was undertaken in Houghton some years ago with a grant from the Copper Country Archive and has since been continued by privately funded research in California and other Western mining states. Some British aspects of this research can be found in my article on mining industrial relations in Labour History Review April 2006

Policy Contexts of Social Work in Britain: the wider implications of 'New' Labour and the 'New Legal Regime'

Several commentators have expressed disappointment with New Labour's apparent adherence to the policy frameworks of the previous Conservative administrations. The employment orientation of its welfare programmes, the contradictory nature of the social exclusion initiatives, and the continuing obsession with public sector marketisation, inspections, audits, standards and so on, have all come under critical scrutiny (c.f., Blyth 2001; Jordan 2001; Orme 2001). This paper suggests that in order to understand the socio-economic and political contexts affecting social work we need to examine the relationship between New Labour's modernisation project and its insertion within an architecture of global governance. In particular, membership of the European Union (EU), International Monetary Fund (IMF) and World Trade Organisation (WTO) set the parameters for domestic policy in important ways. Whilst much has been written about the economic dimensions of 'globalisation' in relation to social work rather less has been noted about the ways in which domestic policy agenda are driven by multilateral governance objectives. This policy dimension is important in trying to respond to various changes affecting social work as a professional activity. What is possible, what is encouraged, how things might be done, is tightly bounded by the policy frameworks governing practice and affected by those governing the lives of service users. It is unhelpful to see policy formulation in purely national terms as the UK is inserted into a network governance structure, a regulatory framework where decisions are made by many countries and organisations and agencies. Together, they are producing a 'new legal regime', characterised by a marked neo-liberal policy agenda. This paper aims to demonstrate the relationship of New Labour's modernisation programme to these new forms of legality by examining two main policy areas and the welfare implications they are enmeshed in. The first is privatisation, and the second is social policy in the European Union. Examining these areas allows a demonstration of how much of the New Labour programme can be understood as a local implementation of a transnational strategy, how parts of that strategy produce much of the social exclusion it purports to address, and how social welfare, and particularly social work, are noticeable by their absence within policy discourses of the strategy. The paper details how the privatisation programme is considered to be a crucial vehicle for the further development of a transnational political-economy, where capital accumulation has been redefined as 'welfare'. In this development, frameworks, codes and standards are central, and the final section of the paper examines how the modernisation strategy of the European Union depends upon social policy marked by an employment orientation and risk rationality, aimed at reconfiguring citizen identities.The strategy is governed through an 'open mode of coordination', in which codes, standards, benchmarks and so on play an important role. The paper considers the modernisation strategy and new legality within which it is embedded as dependent upon social policy as a technology of liberal governance, one demonstrating a new rationality in comparison to that governing post-Second World War welfare, and which aims to reconfigure institutional infrastructure and citizen identity.