Cardiotocograph monitoring
The post examines the misconception that early decelerations in fetal heart rate indicate head compression and normal oxygen levels, tracing this belief to Edward Hon’s research in the 1950s, and unconsented experimentation on women. Newer studies suggest these decelerations may signal hypoxia, revealing flaws in current fetal monitoring guidelines.
Maternity professionals face pressure to continuously record fetal heartbeats, leading to interventions that prioritise monitoring over women’s birth priorities. Evidence suggests that uninterrupted heart rate tracing does not improve neonatal outcomes and can increase complications. The focus should be on overall fetal wellbeing rather than solely on heart rate data accuracy.
The paper by Westergren et al. (2025) examined how gender norms played out in birth, emphasising the negative impact of “well behaved” women and midwives on birthing experiences.
The paper investigates the relationship between umbilical cord size and fetal heart rate patterns during labor. Findings suggest that less Wharton’s jelly correlates with repetitive heart rate decelerations. However, misconceptions about fetal decelerations and their impact on fetal health were noted, along with a lack of evidence for suggested monitoring interventions.
CTG monitoring during vaginal birth after caesarean section (VBAC) is often deemed essential, but evidence suggests it does not prevent uterine rupture. Abnormal fetal heart rate patterns indicating rupture can also occur for other reasons. Therefore, CTG is not mandatory; women should choose their monitoring method based on individual circumstances.
The design of the very first RCT about CTG monitoring is interesting, and it raised a question which we really haven’t ever answered fully. Does the use of CTGs create the very problem they are meant to prevent?
The Dawes Redman system, used for CTG monitoring in pregnancy, aims to predict adverse outcomes. Recent research indicated a low overall accuracy of 54.4%, with high negative predictive values but low positive predictive values, especially in high-risk scenarios, questioning its effectiveness and endorsement in clinical guidelines.
There is a lack discussion surrounding the unconsented use of women’s clinical data for CTG analysis training in AI. Women should know when and how their data is being used, and benefit from their data use when corporations profit from it.
Fetal heart rate monitoring often shows abnormal patterns that don’t reflect an underlying problem for the fetus. Research on fetal blood sampling has been limited. A recent study found weak correlations between fetal blood pH levels, umbilical cord pH levels and Apgar scores. It is vital that further research takes into account how fetal physiology actually works, rather than repeating inaccurate assumptions.
Central fetal monitoring systems gather data from CTG machines and show it in a central place. While aimed at improving outcomes this has not been proven in research. Midwives reported disruptions in response to what was seen at the central monitor, leading to altered care practices focused on documentation over support for birthing women. It is time to pause and think, rather than continue to accept the introduction of these systems.
Birth Small Talk 