Twenty fetal monitoring myths that won’t go away

The level of misinformation about fetal heart rate monitoring that circulates in maternity care is vast. One of the triggers for my journey into the evidence was discovering that no research has ever sought to address the question of whether CTG monitoring produces better outcomes for babies born to women with a multiple pregnancy. I had been taught that the evidence was settled on that question. That experience opened my eyes to my own lack of knowledge – and a desire to fix that for myself and for others.

As the blog enters its 7th year, I thought it was time to pull together a list of twenty myths that won’t go away. If you keep encountering a myth, and it isn’t on this list, comment and let me know! I’ll add it to my to do list…

1. CTG monitoring saves babies lives. There’s no good evidence for this one. Here’s the blog post where I cover the evidence.

2. CTG monitoring prevents brain injury. This one is also unlikely to be true. Here’s that blog post.

3. Fetal monitoring is essential to ensure the wellbeing of both mother and fetus. That’s a direct quote from a paper. Here’s what I had to say about it.

4. This one particularly gets under my skin – there’s no alternative to the CTG (so we have to keep using them).Myth busted here.

5. This one seems logical. Until you apply some critical thinking. Misinterpretation of the CTG leads babies to suffer from adverse outcomes and unnecessarily expedited births. I set this one right here.

6. CTG monitoring is vital for women considered to be high risk. This is quite possibly the most commonly occurring myth out there. Here’s the evidence.

7. CTG monitoring is essential for women having a VBAC in case they experience uterine rupture. I put that particular myth to rest in this blog post.

8. Computer interpretation of the CTG during labour prevents poor outcomes for babies when compared to clinician interpretation. Not according to the current state of the evidence base.

9. Computer interpretation of the CTG during pregnancy (Dawes-Redman criteria) improves outcomes when compared with clinician interpretation. This one is mostly an issue in the UK where the Dawes-Redman system was created and continues to be used and recommended widely. But the evidence doesn’t stack up.

10. Women have longer labours when they use CTG monitoring. I used to say this. Until I challenged myself to find proof that this is true. Turns out there’s no good evidence to back this up.

11. Fetal monitoring education has been proven to improve outcomes. A huge amount of time and money is poured into education (and usually the focus is on CTG interpretation). Often education is considered mandatory. But there’s no good evidence to show that it actually works.

12. Each time fetal monitoring guidelines are updated, they get better at preventing poor outcomes. It isn’t often that research is done to see whether a guideline change makes things better or not. In Sweden, things took a turn in the wrong direction.

13. CTGs are harmless. I have three blog posts that set out the potential harms of CTG use. Here, here, and here.

14. CTG monitoring is an effective way to prevent stillbirth during pregnancy for women with risk factors. Here’s what the tiny amount of evidence that has been done really shows.

15. Admission CTGs are useful. In fact the theoretical basis for them is deeply flawed. Read about that here.

16. Early decelerations are caused by head compression and they are harmless. Nope. Not true.

17. Fetal blood sampling for pH reliably predicts which babies will have a low pH at birth. Almost 60% of babies with a low pH at birth had a normal scalp pH during labour . More about that here.

18. You can’t assess heart rate variability with intermittent auscultation. You can and here’s how.

19. Wireless CTG monitoring is associated with less need for pain relief, reduced occurrence of “fetal distress”, fewer emergency caesarean sections, flexible birthing options, higher satisfaction in labour, and reduced length of labour. These were the claims made by the Western Health Foundation back in 2023. Here’s what the evidence about wireless CTG monitoring actually looks like…

It’s no wonder I feel confident shouting CTGs ARE NONSENSE from the roof tops…

One I haven’t written about, but that has popped up recently again, is number 2o on the list – the myth of the second stage trace (the idea that heart rate patterns mean something different in the second stage to what they mean earlier in labour). I have added that to the list of things to write about.

Is there a myth you would like me to cover that isn’t already listed here? Let me know in the comments…

Wish you could find detailed summaries of all the evidence in the one place? And be able to come back to it over and over again whenever you need to check something? Want to connect with a growing tribe of people working to solve the fetal monitoring problem?

The Fetal Monitoring Academy is a HUGE resource library covering just about every aspect of fetal monitoring research, with expert analysis and critique, set out so it is easy to understand. New content is added regularly in response to requests from Academy members – so you will find exactly what you are looking for. You also get:

Ready access to leading expert Dr Kirsten Small to have your questions answered
A secure online community space where like-minded people hang out. It’s place to be supported and to support others as we work together to stop the nonsense
Downloadable resources
Certificates you can use to claim professional development hours

If you are a maternity professional, student, doula, educator, researcher, or simply a birth nerd who wants to know more – the Fetal Monitoring Academy is perfect for you.

Enrolments will be opening again very soon. Pop your name on the waitlist to be sure you hear about it when the doors are open! You’ll hear about the half-price early bird offer and my student scholarship program before everyone else does.