Reducing anxiety during antenatal CTG monitoring

CTG monitoring during pregnancy is called non-stress testing in some parts of the world. This is to distinguish it from stress testing, where low doses of oxytocin or nipple stimulation are used to provoke contractions so the way the fetal heart rate responds to contractions can be observed. The term non-stress testing is rather ironic however, as there is a body of evidence showing higher levels of anxiety in women during and after a period of antenatal CTG monitoring!

This anxiety is associated with higher levels of stress hormones, like adrenaline/ epinephrine. These hormones can reduce placental blood flow and therefore can (at least in theory) act as a stressor for the fetus. Researchers have been looking at ways to reduce women’s stress levels during antenatal CTG monitoring. This is motivated in part by a desire to improve women’s experiences with their care, and also in order to minimise the impact of maternal stress on the fetus. That’s where this new piece of research fits in (Yilmaz Sezer et al., 2024).

What did they do?

The research was undertaken in a high-risk obstetric clinic in Turkey. Women who were 32 weeks pregnant or more, with a single baby who was not known to have a congenital anomaly, and who had been referred for CTG monitoring were recruited. In total, 102 women consented to be randomised. They were equally divided between a group who used a virtual reality headset (watching relaxing nature scenes), a group who listened to relaxing music, or a control group who used neither.

Women completed the State Anxiety Inventory-S (STAI-S) before and after the monitoring, and a survey where they ranked their experience during the monitoring. The authors also provided findings about the interpretation of the CTG.

What did they find?

Women who used the virtual reality headset, and those who listened to music had a similar reduction in their anxiety score after the monitoring was complete, while women in the control group had no change in anxiety. There were no differences in the proportion of women with a reactive CTG between the three groups, though there were more accelerations noted in the traces of women in the music and virtual reality groups than in the control group.

Women were satisfied with the virtual reality and music, indicated they would like to use it again, and recommended it be available to other women during CTG monitoring.

So here’s the thing…

One way to make use of this research would be to offer the option of listening to music or using virtual reality to all women during a period of antenatal CTG monitoring. But can you see how this results in the use of technology (like virtual reality) to solve a problem created by technology (CTG monitoring) in the first place? I can see this leading to the development of high tech monitoring rooms with massage chairs, aromatherapy, fancy sound systems, and relaxing nature scenes projected onto all four walls – with a patented design sold at great expense to maternity services…

There is a 100% guaranteed and highly effective and safe way to entirely eliminate anxiety related to antenatal CTG monitoring.

Stop doing it.

There is no research showing antenatal CTG monitoring leads to better outcomes. (You can read the evidence here.) As lovely as it is to make CTG technology more acceptable to women, if it doesn’t make outcomes for the baby better, it makes no logical sense to keep using it!

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References

Yilmaz Sezer, N., Aker, M. N., Yucel, A., & Calisici, D. (2024, May). The effect of virtual reality and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests: Randomized controlled trial. European Journal of Obstetrics, Gynecology & Reproductive Biology, 296, 52-58. https://doi.org/10.1016/j.ejogrb.2024.02.038