Can CTGs harm? Part 2

BirthSmallTalk is two and a half years old, with over 150 posts. The last few months have seen a bunch of new people join me. (Hello! And thank you for dropping by!) I’ve decided it is time to go back to some earlier posts to refresh and update them, and given the entire blog a fresh look. This is week five of a six week plan to revisit posts covering basic concepts and background information to help understand what is going on with fetal heart rate monitoring.

This is part two of a series of posts about the potential harms of the use of intrapartum monitoring. Last week, I examined evidence of short and long-term physical harms to birthing women relating to higher rates of caesarean section and instrumental birth when intrapartum CTG monitoring is used. This week I focus on possible psychological harms relating to CTG use.

What is having a CTG like?

There has been limited exploration of women’s experiences of intrapartum fetal heart rate monitoring through the history of the technology, with most of the research occurring prior to 1988, when the evidence up to this point was summarised in a literature review (Snydal, 1988). Thirteen studies, varying in design, quality, timing and country, were analysed. Women reported CTG monitoring limited their mobility during labour and the belts used for external monitoring were restrictive and uncomfortable. CTG monitoring was described as producing a technical atmosphere in the birth room. Women said this led to partners and health practitioners being focused on the machine, rather than on themselves.

Women often reported anxiety, and this arose for two reasons. First, women lacked understanding about how the technology worked (for example women feared that they might be electrocuted by it), and second, changes in the fetal heart rate they could see or hear led to anxiety about the wellbeing of their fetus. While many women included in the research reported positive experiences with CTG monitoring, this was not the case for all women.

One of the papers reviewed by Snydal was noteworthy. Shalev et al. (1985) compared blood levels of hormones associated with stress in a group of women exposed to CTG monitoring during the antenatal period, and a group without CTG monitoring. A significant rise in insulin, cortisol, growth hormone, and catecholamines started 10 minutes after CTG monitoring was initiated, with the rise being sustained over an hour. This mirrors the later findings of Mancuso et al. (2008), who used validated psychometric texts for anxiety and documented a significant increase in anxiety scores after antenatal CTG monitoring.

Such research has not been repeated for the use of CTG monitoring during labour. Elevated levels of stress hormones have the potential to impact labour progress and safety, for example slowing labour progress by reducing oxytocin production, a hormone also known to have neuroprotective effects on the fetal brain (Buckley, 2015).

Another piece of research into birthing women’s experiences regarding intrapartum fetal monitoring undertaken since Syndal’s review was that of Killien and Shy (1989) who surveyed women enrolled in an randomised controlled trial examining the use of either CTG or intermittent auscultation in premature labour. Women randomised to intermittent auscultation were slightly more likely to rate their experience of monitoring and the “nursing” support provided during labour more favourably.

What is missing?

What strikes me most about the research regarding women’s experiences of intrapartum fetal heart rate monitoring is the absence of it. In the past thirty years there has been very little research examining how women experience intrapartum CTG monitoring, what they prefer, and the meaning they assign to fetal monitoring. The use of CTG monitoring has become close to universal, and there have been significant changes in the technology used for CTG monitoring during this period.

I am not surprised by the paucity of research however. The drive to use continuous intrapartum CTG monitoring has always been about something other than meeting the needs of birthing women. Given how often CTGs are used, it is well past time that researchers began asking birthing women about what they want.

Sign Up for the BirthSmallTalk Newsletter and Stay Informed!

Want to stay up-to-date with the latest research and course offers? Our monthly newsletter is here to keep you in the loop.

By subscribing to the newsletter, you’ll gain exclusive access to:

Exciting Announcements: Be the first to know about upcoming courses. Stay ahead of the curve and grab your spot before anyone else!
Exclusive Offers and Discounts: As a valued subscriber, you’ll receive special discounts and offers on courses. Don’t miss the chance to save money while investing in your professional growth.

Join the growing community of birth folks by signing up for our newsletter today!

Subscribe to the newsletter

References

Buckley, S. J. (2015). Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. https://www.nationalpartnership.org/our-work/resources/health-care/maternity/hormonal-physiology-of-childbearing.pdf

Killien, M. G., & Shy, K. K. (1989). A randomized trial of electronic fetal monitoring in preterm labor: mothers’ views. Birth, 16(1), 7-12. https://doi.org/10.1111/j.1523-536x.1989.tb00847.x

Mancuso, A., De Vivo, A., Fanara, G., Denaro, A., Laganà, D., & Maria Accardo, F. (2008). Effects of antepartum electronic fetal monitoring on maternal emotional state. Acta Obstetricia et Gynecologica Scandinavica, 87(2), 184-189. https://doi.org/10.1080/00016340701823892

Shalev, E., Eran, A., Harpaz-kerpel, S., & Zuckerman, H. (1985). Psychogenic stress in women during fetal monitoring (hormonal profile). Acta Obstetricia et Gynecologica Scandinavica, 64(5), 417-420. https://doi.org/10.3109/00016348509155159

Snydal, S. H. (1988). Responses of laboring women to fetal heart rate monitoring. A critical review of the literature. Journal of nurse-midwifery, 33(5), 208-216. https://doi.org/10.1016/0091-2182(88)90213-3