Electronic fetal monitoring
The Dublin randomized controlled trial published in July 1985 aimed to determine the effectiveness of continuous fetal monitoring (CTG) over intermittent auscultation during labor. The trial found no significant differences in outcomes for babies. Despite its findings, CTGs remained widely used. It’s time to do something about that.
It’s a valid question. With at least 40 years of evidence showing that CTG monitoring doesn’t improve outcomes, wondering why we are still doing CTGs is a fair question. New research highlights why changing practice is so hard. And I share what I’m going to be doing to make it happen…
The article reviews a recent paper on fetal monitoring during labor by Richmond et al. which lacks a reference list, undermining its educational value. While it identifies some correct points about fetal heart rate interpretations, it perpetuates outdated practices and fails to acknowledge the need for consent in monitoring, thus serving more as promotional content than genuine education.
A recent Finnish study explored HIE and its preventability with CTG use. Findings suggest that timely interventions may have avoided HIE for one in five women with an affected. However, this study does not establish CTG superiority over intermittent auscultation for monitoring fetal health.
When is fetal monitoring not fetal monitoring? #EFM #CTG #LanguageMatters
In 2023, the MBRRACE-UK report showed an 18.3% decline in birth rates since 2013 with minimal improvements in mortality rates. Despite investment in maternal care, the rate of change in perinatal mortality rates is very slow and subject to outside influences. There is a strong need for effective intervention strategies.
A recent study examined intermittent auscultation during labor in various UK birth settings. It found that local policies exist in most units, but training and competency assessments were inconsistently implemented. The reliance on certain fetal monitoring devices and practices raises concerns, as does the use of outdated training programs and practices.
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.
Birth Small Talk 