There has been a lot of research about whether health professionals agree on what to call the pattern on a CTG during labour. And the experts all agree, that the experts don’t agree. That is to say, there is a troubling degree of variability in how maternity professionals interpret the same CTG pattern. This is something I have written about before (here, here, and here). Until recently, I had never […]
What happens when you introduce a central fetal monitoring system into a maternity service who are struggling to provide adequate staffing to maintain safety?
Many things related to fetal monitoring in labour have been introduced because they seemed like a good idea, but never properly evaluated to determine whether they work (like “Fresh Eyes” checks, and central fetal monitoring). There is increasing recognition that one of the reasons for poor outcomes when CTG monitoring is used is not realising the heart rate being recorded is that of the woman and not her fetus. Many […]
Short term thinking is a problem in maternity care. It seems to me as though a good five minute Apgar score, or normal cord blood gases, is the primary end point in far too many studies. These things are not inappropriate outcomes to aim for, but they aren’t enough and can end up meaning professionals in clinical practice lose sight of the big picture. As a parent and birthing woman, […]
The thinking that went into the creation of CTG monitoring was itself fundamentally flawed.
Last week I published a post about why I’m not on a guideline writing group. I mentioned that I sometimes provide anonymous gentle suggestions for people who are working on fetal monitoring guidelines about how to make theirs better. You might like to get a copy of the fetal monitoring guideline where you work / where you support women to birth / where you plan to birth and read the […]
From time to time, I get feedback from people who are surprised / disappointed / angry / annoyed that I’m not a member of a guideline writing group taking on fetal monitoring guidelines. It is true – I’m not. It seems like a reasonable thing to expect me to do, right? I’m across the evidence and I often write about what is wrong with existing guidelines. Why would I not […]
What is epistemic trust? Imagine for a moment that computer interpretation of the CTG has become so good that it now significantly outperforms skilled maternity professionals ability to detect impending fetal hypoxia. As a maternity professional, you can’t see what the computer is seeing, because your brain simply lacks the capacity to interpret the trace the same way the computer does. What criteria would need to be met for you […]
The type of fetal monitoring you decide to use can potentially have a big impact on your experience of giving birth, how you give birth, and the health of your baby.
Central fetal monitoring systems are becoming more and more common in maternity services in high-income countries. Once-upon-a-time heart rate and contraction data were printed directly to paper. Increasingly, these data are turned into a digital signal and shown on a computer screen. Digital data are easy to move to a place outside the birth room. With central fetal monitoring, data are moved to a central location in the maternity service, […]
Birth Small Talk 