“I was told it was required.”
“They said it was harmless.”
“Someone ran into the room and cut an episiotomy because they said my baby was distressed.”
“I had to have the scalp electrode because they said it was the only option.”
“I wasn’t told that people outside my room could see my CTG.”
I regularly see and hear women talking about their births. Some of their stories about what they were told about fetal monitoring, and the way it was used, make me see red. The use of fetal monitoring without consent is practically routine.
And I’m not just talking about CTG monitoring. “You are low-risk, so I’m just going to use the Doppler to listen in from time to time” is also inadequate consent for intermittent auscultation.
I have written multiple times about research showing just how much of a problem the unconsented use of fetal monitoring is (here, here, here, and here – and there’s more but that’s enough to make the point). There’s solid evidence that there is a problem.
Misinformation is widespread. Professional organisations and individual professionals who should know better regularly share incorrect information about fetal monitoring options. The most common of these is the myth that CTG use in women considered to be at high risk means better outcomes for babies. (It’s simply not true.)
The potential harms from CTG use are under-investigated. Back in 1990, researchers wrote of a 254% increase in cerebral palsy when CTGs and not intermittent auscultation were used for women in preterm labour (Shy et al.). No one has bothered to repeat the study to find out if this is a consistent finding or not, and CTG monitoring continues to be recommended for preterm labour.
We don’t know whether CTG use is associated with more severe perineal trauma and postpartum haemorrhage or not. I suspect so. There remains a persistent myth that cutting an episiotomy will somehow improve outcomes when an abnormal heart rate pattern is noted as the head is crowning. The Cochrane review (Alfirevic et al., 2017) showed higher rates of instrumental birth with CTG use. Both episiotomy and instrumental birth are associated with severe perineal trauma and heavier bleeding so it is a logical question to raise. But in the almost 70 year history of CTG use – no one seems to have cared enough to ask it in research.
Back in July 2025, the Lancet published an editorial titled Empowering women during childbirth. I’m going to leave the last words to them:
But the simple things can be the most important; not least, the value of listening to women—as so many inquiries into care have shown. Birth is an inherently radical, messy, and primal experience, but information is power, and if women can have at least some degree of control among the chaos, it can make all the difference to their experience and their transition into motherhood.
Our professional guidelines play a major role in perpetuating these abuses. I can see a glimmer of opportunity beginning with the most recent update in the RANZCOG Intrapartum Fetal Surveillance guideline. If you are an Australian or New Zealand maternity professional and you want to know what that glimmer is, and learn to use it to put an end to this abuse of rights – I can help.
I’m currently hosting an online workshop, addressing how to get the best from the RANZCOG Intrapartum Fetal Surveillance guideline. Be a part of the turning tide of people who no longer accept the unconsented use of fetal monitoring as “good practice”. The special introductory price for the workshop ends midnight tomorrow January 29, 2026.
Access the workshop today
References
Alfirevic, Z., Devane, D., Gyte, G. M. L., & Cuthbert, A. (2017, Feb 03). Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews, 2(CD006066), 1-137. https://doi.org/10.1002/14651858.CD006066.pub3
Shy, K. K., Luthy, D. A., Bennett, F. C., Whitfield, M., Larson, E. B., van Belle, G., Hughes, J. P., Wilson, J. A., & Stenchever, M. A. (1990, Mar 01). Effects of electronic fetal-heart-rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants. New England Journal of Medicine, 322(9), 588-593. https://doi.org/10.1056/NEJM199003013220904
Categories: CTG, EFM, Feminism, Reflections
Tags: Consent, decision making, guidelines, Perineal trauma, postpartum haemorrhage
Birth Small Talk 
Hi
Thanks so much for all the work you do and share.
Because I’m not in the area and I’m not a clinician, I don’t feel the workshop’s quite for me… Do you ever do more general ones for antenatal teachers / doulas? I would love to join one if you ever do.
Warmly,
Emilie
Emilie Joy Rowell emilie@thebodydoula.com
http://www.thebodydoula.com
>
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Thanks Emilie, yes I do. The Fetal Monitoring Academy is for anyone who fancies it. You might also look at Fetal Monitoring: Informed decisions for your care or my VBAC course. While both are written for pregnant women, lots of midwives and doulas have taken them. Stay tuned as I have a new course coming up in April (fingers crossed) that focusses on how to have evidence-based conversations with women about fetal monitoring to support their decision making.
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