I heard this week that my thesis has been accepted as meeting the standard required for the Doctor of Philosophy degree. I’ve just uploaded the final version of it to the university’s online system. In a year it will be freely available for anyone who wishes to read it. My next task is to publish academic papers from it. I thought I would share the opening of the thesis with you.

Perhaps worst of all, electronic [fetal heart rate] monitoring has dehumanized obstetrics. We cannot divert our eyes or ears from electronic monitoring’s alluring light emitting diodes, beeps, and stylus-chattering graphs. We no longer listen to, talk with, gaze upon, or touch our patient. … She dare not interrupt our silent vigil. 

(Munsick, as cited in Haverkamp et al., 1979, p. 410).

If my life had a sound track it would sound something like this: tickticktickticktick. It is the sound that represents the fetal heart rate, electronically extracted, manipulated, then amplified and projected into the birth room, ticking along at about 2 beats per second. The lead in an orchestra of sound. Accompanying the fetus are the sharp intake of breath as the birthing woman gathers her strength to push again and a hiss as she releases it, the scratching of pen on paper as the midwife makes notes, the running of water, rustling of paper towel, and the snap of the gloves that I put on. 

Sometimes the tempo slows: tick – – – tick – – – tick – – – tick, and all eyes turn to the monitor the sound is emerging from. I can sometimes hear my own heart thump inside my head when the fetal heart rate slows. My eyes wordlessly meet those of the midwife. We have both done this so many times that we know what the other is thinking. I open the cupboard and find the equipment I might need to help the baby out, just in case. The midwife checks the oxygen and suction on the neonatal resuscitation trolley. The woman’s contraction passes, and we all breathe more freely as the fetal heart rate climbs back up again. This musical composition cycles through four more stanzas as the woman pushes, the baby descends, the heart rate slows, she breathes, the heart rate recovers. The finale for this particular opus consists of the sound of the first gasp, then the yell of the newborn infant who has arrived in fine form. 

The electronically generated sound of the fetal heart has accompanied me throughout my career. It is so commonplace that it often recedes from my immediate awareness, yet it impacts significantly on how I do and how I experience my work. Much of what we maternity clinicians do in relation to fetal heart rate monitoring operates as part of the background of our lives, unchallenged and unexamined. The time has come for me to pay attention to the musical score and ask questions. Who is benefitting and who is paying the price in this performance? 

Haverkamp, A. D., Orleans, M., Langendoerfer, S., McFee, J., Murphy, J., & Thompson, H. (1979). A controlled trial of the differential effects of intrapartum fetal monitoring. American Journal of Obstetrics and Gynecology, 134(4), 399–412. https://doi.org/10.1016/s0002-9378(16)33082-4

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Categories: CTG, EFM, Reflections