Central Fetal Monitoring: More evidence

Central fetal monitoring systems take digital data about the fetal heart rate and a woman’s uterine contractions (and often other data elements too) and shift it to a central location in a maternity service where it is displayed. The CTG trace then appears in real-time, along with the CTG traces of all other women using CTG monitoring in the same location at the same time. Central fetal monitoring was introduced in the belief that having more sets of eyes on the CTG would improve outcomes. It has been widely adopted in high income countries.

However – no randomised controlled trial to examine whether it helps, harms, or is neutral in the impact central fetal monitoring has on outcomes for babies or women has ever been conducted. Some retrospective before-and-after style studies have been published – and I have written about these previously on the blog. A new piece of research has been added since I last wrote about central fetal monitoring (Sorod & Gyllencreutz, 2026). Today I’ll explore what they found and how it ties to what is already known.

What did they do?

The research was done at a single hospital in Sweden. Only women who were 18 years or older, giving birth to one head first baby or at least 34 weeks gestation contributed data. A time period (2012 – 2015) when CTGs were printed to paper was compared to a period when central monitoring was in use (2016 – 2019). There was a six month gap between the two periods to allow for people to adjust to central fetal monitoring. The main outcome of interest was metabolic acidosis (arterial cord blood pH <7.05 and base deficit of > 12 mmol/L). The researchers did a power calculation so they could choose a sample size that gave them a decent chance of finding a difference in metabolic acidosis if one really did happen. They also looked at Apgar scores, neonatal resuscitation, and how babies were born.

What did they find?

The comparisons were between 4,520 births in the paper CTG group and 4,057 births in the central monitoring group, all of whom had paired cord blood gases collected at the birth. Let’s start with metabolic acidosis. The rate was 0.5% in the paper CTG group and 0.6% in the central monitoring group. This was not significantly different – even once other factors that might have impacted on the outcome were mathematically adjusted for.

There were also no differences in low pH on its own, Apgar scores, neonatal resuscitation, or the use of caesarean section, either overall or only for suspected fetal hypoxia. On the other hand the instrumental birth rate fell when central fetal monitoring was introduced. The overall rate dropped from 6.7% to 4.7% (OR 0.69, 95% CI 0.57 – 0.83), and for suspected fetal hypoxia the rate fell from 3.6% to 2.6% (OR 0.72, 95% CI 0.56 – 0.93). The authors noted that in 2017 a new fetal monitoring guideline was introduced in Sweden. Other researchers (Jonsson et al., 2022) have documented that the guideline introduction led to a fall in the use of instrumental birth. It seems likely that this, and not the central monitoring was responsible for the difference.

What does this mean?

Central fetal monitoring systems are an expensive investment. This study now brings us to four non-experimental studies finding no improvement in perinatal outcomes from central fetal monitoring (the others are Brown et al., 2016; Weiss et al, 1997; Withiam-Leitch et al., 2006). My own research has raised several concerns about the impact they are potentially having on women’s births and on what it means to be a midwife (Gottfreethsdottir et al., 2025; Small et al., 2021; 2022). No one else has to date picked up on these concerns and designed any research to explore this possibility further.

It’s time to put a stop to the introduction of central fetal monitoring systems, unless the introduction is part of a well designed body of research that aims to deepen our knowledge of the usefulness or otherwise of these systems. Without this evidence, public monies are better spent elsewhere on things that actually do move the needle on improving maternity care outcomes.

Decisions about fetal monitoring are for YOU to make. This is true whether you are considered “high risk” or not. It remains true even when someone tells you that you don’t have a choice and that CTG monitoring is mandatory. My recently published book Monitoring your baby in labour: An evidence-based guide to help you plan your birth supports you to make these decisions.

Buy your copy today

Details about where to buy it are here!

References

Brown, J., McIntyre, A., Gasparotto, R., & McGee, T. M. (2016). Birth outcomes, intervention frequency, and the disappearing midwife – potential hazards of central fetal monitoring: A single centre review. . Birth, 43(2), 100-107. https://doi.org/10.1111/birt.12222

Gottfreethsdottir, H., Small, K., Helgadottir, B. P., & Gamble, J. (2025). Who is in the centre? A qualitative study on midwives’ experience of working with central fetal monitoring system. Women Birth, 38(2), 101891. https://doi.org/10.1016/j.wombi.2025.101891

Jonsson, M., Soderling, J., Ladfors, L., Nordstrom, L., Nilsson, M., Algovik, M., Norman, M., & Holzmann, M. (2022). Implementation of a revised classification for intrapartum fetal heart rate monitoring and association to birth outcome: A national cohort study. Acta Obstetricia et Gynecologica Scandinavica, 101(2), 183-192. https://doi.org/10.1111/aogs.14296

Small, K., Sidebotham, M., Gamble, J., & Fenwick, J. (2021). “My whole room went into chaos because of that thing in the corner”: Unintended consequences of a central fetal monitoring system. Midwifery, 102, 103074. https://doi.org/10.1016/j.midw.2021.103074

Small, K. A., Sidebotham, M., Fenwick, J., & Gamble, J. (2022). “I’m not doing what I should be doing as a midwife”: An ethnographic exploration of central fetal monitoring and perceptions of clinical safety. Women Birth, 35(2), 193-200. https://doi.org/10.1016/j.wombi.2021.05.006

Sorod, M., & Gyllencreutz, E. (2026). Introduction of central fetal monitoring and impact on neonatal outcome – a retrospective observational cohort study. Journal of Maternal, Fetal & Neonatal Medicine, 39(1), 2629687. https://doi.org/10.1080/14767058.2026.2629687

Weiss, P. M., Balducci, J., Reed, J., Klasko, S. K., & Rust, O. A. (1997). Does centralized monitoring affect perinatal outcome? Journal of Maternal-Fetal and Neonatal Medicine, 6(6), 317-319. https://doi.org/10.3109/14767059709162013

Withiam-Leitch, M., Shelton, J., & Fleming, E. (2006). Central fetal monitoring: Effect on perinatal outcomes and cesarean section rate. Birth, 33(4), 284-288. https://doi.org/10.1111/j.1523-536X.2006.00120.x