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.
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.
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?
Today’s post reflects on a 1959 trial concerning “fetal distress”. It highlights findings that meconium was a critical indicator of poor outcomes, while abnormal fetal heart rates weren’t reliably predictive. Should we be reevaluating current obsessions with CTG use and focusing on alternative clinical markers?
In 1910, suffragist Helen Todd highlighted the importance of women’s voting rights for improving working conditions, coining the phrase “Bread for all, and Roses too.” While maternity services focus on physical health (Bread), there is a pressing need to enhance women’s emotional and experiential birth outcomes (Roses), fostering joy and meaning in the process.
The development of the cardiotocograph (CTG) in obstetrics evolved from earlier fetal monitoring methods over a century. While intended to enhance fetal safety, its integration shifted focus towards legal liability and technology reliance, often undermining maternal care. Concerns about research integrity and the effectiveness of CTGs suggest the need to reassess their use in maternity care.
Fetal monitoring guidelines around the world recommend CTG use in labour when women are considered to be a higher risk for a bad outcome for the baby that is linked to low oxygen levels in labour. Regular readers of my blog will have seen me write repeatedly about the lack of great evidence to back this up. There’s no compelling research showing better outcomes with CTG use for women planning […]
Professor Susan Bewley is a professor of obstetrics with an interest in a great many things. I first became aware of her work many years ago, when I saw her writing about the potential links between the timing of cord clamping, cord blood pH testing, fetal monitoring methods, and perinatal outcomes. Susan recently challenged me to summarise the issues in a blog post – so here we go! Setting the […]
In some settings, women are offered the option of having intermittent CTG use rather than continuous CTG use. This might look something like having 20 to 30 minutes of CTG use every hour or two, with intermittent auscultation used during the time off the CTG. A first look, this seems like it might be a way to reduce some of the downsides associated with CTG use (like the increased rate […]
Let me begin, like the good researcher I am, by defining some terms. Intermittent auscultation is a type of fetal heart rate monitoring. A device of some sort is used to make it easy to hear the fetal heart rate, so the person listening (auscultating) can assess certain features of the heart rate, to determine whether it is considered normal or not. Typically, a handheld Doppler device is used. This […]
Birth Small Talk 