What’s wrong with central fetal monitoring?
Central fetal monitoring is sneaking its way in pretty much everywhere. Lots of people love it. Here are some of the reasons I have serious concerns about it…
EFM
Electronic fetal monitoring
When “experts” get it wrong: CTG research and “high-risk” women
Accurate information is essential for informed decision-making in fetal monitoring conversations. The myth that there is no, or very little, research about CTGs in population of women at higher risk has popped up again. Here’s the real story…
Exploring the link between fetal heart rate patterns and brain injury
There are some major limitations of continuous CTG monitoring during labour. Recent studies exploring fetal heart rate and contraction patterns fail to identify patterns that reliably predict problems. Maybe we need to stop and head in a different direction altogether…
Central Fetal Monitoring: More evidence
Central fetal monitoring systems, adopted globally, consolidate data on fetal heart rates and uterine contractions for real-time display. A Swedish study compared outcomes during traditional and central monitoring. No significant differences in metabolic acidosis or neonatal outcomes were found. Instrumental birth rates fell, likely due to revised guidelines, questioning the investment in central monitoring without definitive improvements.
The stress of non-stress tests – more evidence about CTG use without informed consent
This study explored women’s experiences with antenatal CTG monitoring and their understanding of its purpose. It revealed limited information was shared by healthcare professionals, leading to inadequate informed consent. It’s a great reminder of how important it is to have access to accurate information that supports decision-making regarding fetal monitoring.
Stepping back in time to understand the present
Let’s talk about the history of how CTG use rose to prominence in maternity care. It has something to do with ultrasounds, moon exploration, washing machines, President Kennedy’s son, and husbands in birth rooms…
CTGs and autonomy
Fetal monitoring affects women’s autonomy in childbirth by influencing their freedom of movement. A survey of Australian midwives revealed that continuous CTG monitoring restricts mobility, while intermittent auscultation is underused due to barriers. Solutions are right in front of us, easy to achieve, and not expensive.
When policy makes safety worse
Three strikes and you are out! How a guideline meant to make maternity care safer undermined good communication.
The emotional costs of moving away from CTG use
Maternity professionals often find comfort, competence, and control in CTG monitoring. Transitioning to intermittent auscultation requires that we address these emotional attachments. My suggestions on how to achieve this are in this week’s blog.
Cerebral palsy after caesarean section
A new study examined neurological outcomes in children born via caesarean section due to non-reassuring fetal monitoring. They found no differences in the rates of neurological problems when compared with caesarean done for non-progressive labour. The authors conclusions implied one possible reason for this – but there are other ways to interpret these results.
Birth Small Talk 