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Friday, 31 January 2014 10:06

Fetal Monitoring - Is it Really Safer?

Beep. Beep. Beep. You are in labor, lying in bed attached to an electronic fetal heart monitor (EFM).  A medical professional enters the room and immediately walks over to this machine, and with no eye contact he or she unfolds the long strands of paper to read a foreign language that no one explained to you.  Nervously you peer down at your fingers as if you are getting graded. Beep. Beep. With that he or she responds,  “Okay, looking good. I will be back to check on you in a couple hours.”  Beep. Wait a minute. Did the professional check on you or the machine? That is where lines blur. Babies all over the world are being continuously monitored without clear evidence of the benefit.

EFM was enthusiastically introduced into the medical system during the 1960s and took off in the 1980s with hopes that continuously detecting a baby’s heart rate would ensure safety and lower the risk of perinatal death.  Ina May Gaskin explains that this, in turn, increased the rate of cesarean section because doctors had not expected that “the lowered fetal heart rates during uterine contractions that could be picked up for the first time with the continuous monitor...were absolutely normal” (116).  Many heart rate tracings are identified as abnormal when the baby is in no distress. Continuous EFM is highly sensitive and has the ability to identify fetuses that are distressed, but also has low specificity, or the ability to identify those that are not in distress. The EFM “therefore has a high false positive rate” (Walsh 60). 

Walsh conducted a systematic review involving 12 studies and 37,000 women comparing continuous EFM to intermittent auscultation (listening by hand with a fetoscope periodically after a contraction). This review found (58):

  • No differences between the two in perinatal death, Apgar scores, NICU admissions, or cerebral hypoxia (or lack of oxygen to the brain).
  • EFM halved neonatal seizures, but also resulted in a significant increase in cesarean sections and assisted vaginal births.

Evidence shows that intermittent listening with a fetoscope is just as reliable as EFM, and in most cases takes away much of the fear involved in birth resulting in fewer cesareans.  So why is this method still in practice? Continuously monitoring a woman in labor requires less human contact. One nurse is able to “monitor” several patients at a time from a local station. Doctors are able to monitor an entire unit. This in turn lowers costs and shows evidence, via the long strands of paper, that the baby was watched throughout labor if a courtroom was ever involved.

Beep. Beep. Beep. Imagine that you are back in that hospital room. Let’s say that your female nurse walks in and begins to document your baby’s heart rate. This time instead of looking down, look into her eyes and ask her to turn down that noise. Maybe even ask if she will turn the machine away from your line of vision so that it is no longer your concern, just hers.  Then ask her the best ways to move around. Most likely she will respond with compassion and understanding.

As a labor and delivery nurse I do this for all of my patients. I always offer to educate them regarding what we are monitoring, why we are monitoring and the policies that go along with that. Then I ask permission to tilt the machine away so that it is no longer a concern. Sometimes the mother and I even cover the machine with a blanket! I then show her how to move around the room while still being monitored, and encourage her to get out of bed if she does not have an epidural. 

Technology has a way of creating the illusion that we are progressing. This is not always true and there are data to prove it.  Hospital staff and even parents tend to depend on these machines, creating a mind-body split. Sometimes the monitor becomes more important than the internal experience. Don’t let that happen to you – keep yourself empowered and ask questions. The ancient ways of birthing through continuous human contact are still relevant and vital to health and safety for mothers and newborns.

For more information on this topic, pregnancy, or to read birth stories visit: http://birthwithbalance.com

Gaskin, Ina May. Birth Matters a Midwife’s Manifesta. New York City. Seven Stories Press. 2011. Print. 

Walsh, Denis. Evidence and Skills for Normal Labour and Birth a Guide for Midwives. New York City. Routledge. 2012. Print

 

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