Does CTG monitoring make it harder to have a great birth?

There’s not been a lot of research about women’s experiences with different types of fetal monitoring during labour. What we do have is old, and probably no longer relevant as different approaches to CTG monitoring (like wireless telemetry monitoring) have been introduced. So I was excited to see new Australian research that aimed to examine women’s experiences of fetal monitoring in labour (Levett et al., 2025).

What did they do?

This study is part of a larger project called the WOMB study, and I have already shared some of this team’s previous papers on the blog. They ran an online survey, asking Australian women who had given birth in the previous five years to answer questions about their labour experiences. In total 861 women took the survey, with 798 providing information about what type of fetal monitoring was used for their birth. Most women were born in Australia, having their first birth, had tertiary education, and had a partner. Most gave birth in a hospital, with 54 women using a birth centre. The findings from this paper therefore might not be the same for women from other backgrounds.

What did they find?

CTG monitoring of some sort was the most common monitoring approach used – with 84% using it, and the remainder having had intermittent auscultation with a handheld Doppler. A quarter of women reported having had an admission CTG. For women who used CTG monitoring, standard “wired” CTG monitoring was the most commonly used approach (42%), with telemetry (24%), fetal spiral electrodes (6%), and noninvasive (“beltless”) CTG monitoring (>1%) less common, and just over a quarter having more than one approach to CTG monitoring used in their labour.

Women having their first births were more likely to report CTG use than women who had given birth before. Not surprisingly, women who gave birth in out-of-hospital settings were more likely to have had intermittent auscultation than those who gave birth in hospital. Women who gave birth in a private hospital were more likely to have had CTG monitoring than those who gave birth in a public hospital, particularly if this was the woman’s first birth.

As you would expect, given the evidence, women who had wired CTG monitoring were more likely to give birth by emergency caesarean section. They were three and a half times more likely to do so – with the caesarean section rate being 10% for women who used intermittent auscultation, and 34% when wired CTG monitoring was used. What is unusual here was the size of the increase. In the Cochrane review (based on older research) the increase in caesarean section rates was much smaller than this. Once the researchers took into consideration whether the woman was having her first baby or not, the differences in types of births were no longer statistically significant.

Women who used intermittent auscultation rather than wired monitoring were more likely to use non-pharmacological approaches to pain management and less likely to use an epidural or nitrous oxide. This is at odds with the Cochrane review, where no difference was found. However, given that epidural use is now considered an indication for CTG use, this is not unexpected.

Next, women were asked whether they felt that fetal monitoring was beneficial or negative, for themselves or for their baby. Women who used wired CTG monitoring were more likely to agree or strongly agree that fetal monitoring had a negative impact on them during their labour than women how used intermittent auscultation. Only a small proportion of women felt that fetal monitoring had a negative impact on their baby, and there was no significant difference across each of the different types of fetal monitoring.

The take home message

When considering their findings along with those from their previous study (confirming widespread lack of consent for fetal monitoring) the authors made the important point that:

Collectively, these findings suggest that the burden remains on women to understand the impact of monitoring and to have planned for, and articulated their wishes prior to birth. This suggests that routine care is often not woman-centred or embedded in a culture of encouragement and support for handheld, or wireless monitoring, especially for primiparous women [first-time mothers]. (p. 12)

There is a well recognised misalignment between professional standards relating to consent and woman-centredness and what actually happens with fetal monitoring approaches in practice. This misalignment doesn’t happen to quite the same degree as other aspects of pregnancy, birth, and postpartum care (though I acknowledge there are problems with some of these as well). While the solution is ultimately and rightly to achieve reform of maternity care systems so birthing women don’t have to do the heavy lifting, that isn’t going to happen anytime soon. The work I do here at Birth Small Talk is designed to equip birthing women to make decisions that support them to have a great birth, and to support woman-centred maternity professionals and birth workers to provide care that is values aligned in a system that doesn’t make that easy for them. Let me take some of the heavy lifting off your to do list. Check out my courses and see what fits your situation best.

Want nonsense free information about fetal monitoring to support YOUR birth decisions?

I can help you with that. I’m a leading expert on fetal monitoring and an experienced educator – and I have personally designed a course with up-to-date information you can rely on. Knowing what the options are, how they work (or don’t work), and what the latest research says on the benefits and risks of each gets you off to a great start when making a decision. Fetal monitoring: Informed decisions for your birth covers all this and more! You’ll also find practical and effective communication strategies that help make sure you get the type of fetal monitoring you want for your birth.

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References

Levett, K. M., Fox, D., Bamhare, P., Coddington, R., Sutcliffe, K. L., Newnham, E., & Scarf, V. (2025, May 13). Differences in women’s experiences of labour according to type of fetal monitoring: a quantitative analysis of an Australian national survey. BMC Pregnancy Childbirth, 25(1), 565. https://doi.org/10.1186/s12884-025-07509-z