When there’s a string of poor outcomes in a maternity service, and issues around fetal heart rate monitoring in labour are found to part of the problem, what invariably happens next is a recommendation for more and better education. It seems logical to believe that people who know more about the indications for CTG monitoring, how to interpret fetal heart rate patterns, and how and when to intervene in labour […]
There has been a lot of research about whether health professionals agree on what to call the pattern on a CTG during labour. And the experts all agree, that the experts don’t agree. That is to say, there is a troubling degree of variability in how maternity professionals interpret the same CTG pattern. This is something I have written about before (here, here, and here). Until recently, I had never […]
Many things related to fetal monitoring in labour have been introduced because they seemed like a good idea, but never properly evaluated to determine whether they work (like “Fresh Eyes” checks, and central fetal monitoring). There is increasing recognition that one of the reasons for poor outcomes when CTG monitoring is used is not realising the heart rate being recorded is that of the woman and not her fetus. Many […]
Short term thinking is a problem in maternity care. It seems to me as though a good five minute Apgar score, or normal cord blood gases, is the primary end point in far too many studies. These things are not inappropriate outcomes to aim for, but they aren’t enough and can end up meaning professionals in clinical practice lose sight of the big picture. As a parent and birthing woman, […]
The thinking that went into the creation of CTG monitoring was itself fundamentally flawed.
What is epistemic trust? Imagine for a moment that computer interpretation of the CTG has become so good that it now significantly outperforms skilled maternity professionals ability to detect impending fetal hypoxia. As a maternity professional, you can’t see what the computer is seeing, because your brain simply lacks the capacity to interpret the trace the same way the computer does. What criteria would need to be met for you […]
Sometimes I spot a new research paper and I ended up thinking – well that was something I never really thought about before! That was what happened when this one came my way. I’m pleased someone thought to do this research and I hope maternity professionals can adopt their practice with these findings in mind. How was it done? The paper has the slightly confusing title of “The effect of […]
I wrote this post back in February 2020 when this research was new. It’s a paper I often reference and use in my presentations. I’ve refreshed the post and am sharing it again because I think it contains valuable information. Research published this week by Chuey, De Vries, Dal Cin, and Low (2020) explored facilitators and barriers to the use of intermittent auscultation (IA) rather than CTG monitoring during labour. […]
Last week I shared two different research papers highlighting a link between epidural use and caesarean section for abnormal fetal heart rate patterns, pointing out that how these things were connected was not explained by this research. An independent group of researchers, based in Italy, have also recently published research in this area, and their findings provide some additional clues about what might be going on (Ghidini et al., 2023). […]
One of the problems I see with the evidence base relating to fetal heart rate monitoring during labour, is the focus predominantly on the immediate outcomes of birth. This is really obvious when you look at outcomes for the woman. The studies included in the Alfirevic et al., 2017 Cochrane review report on how women gave birth (caesarean section, instrumental birth, or spontaneous vaginal birth), whether they made use of […]
Birth Small Talk 