Birth Small Talk

Fetal monitoring information you can trust

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Would you trust a computer to decide when to do a caesarean section?

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 […]

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Loud CTGs – turn it off!

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 […]

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What stops professionals from using intermittent auscultation?

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. […]

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More on epidurals, fetal heart rate patterns, and caesarean section

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). […]

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What happens to women after they leave the birth room?

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 […]

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Epidurals and fetal compromise

The journal Ultrasound in Obstetrics and Gynecology published two papers back to back recently. Both are from the same research team based in the Netherlands, and both examined the relationship between use of epidural pain relief during labour and the use of unplanned, in labour, caesarean section or instrumental birth for “presumed fetal compromise”. The research differed in the approach used. Together, the papers raise concern that epidural use might […]

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It’s complicated…

One of the problems I see over and over again is the over simplification of complexities in relation to fetal heart rate monitoring in labour. Education and clinical guidelines tend to produce what appear to be logical and straightforward explanations and advice when there is a lot of mud in the pond. Here are two examples: In both of these cases the situations are much more complicated (like this and […]

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How do we know what is normal?

When you have been using a test for years and years, you assume someone way back at the beginning did some pretty decent research to determine what numbers are “normal” and a sign of good health, and what numbers are “abnormal” and a sign of poor health. But is that always the case? Why do we test cord blood acid levels? The testing of fetal and neonatal blood acid levels […]

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Oxygen levels and lying on your back when pregnant

Going to sleep lying flat on the back (supine position) has been linked to a higher rate of stillbirth between 28 weeks of pregnancy and the start of labour, with the chance rising closer to the end of pregnancy (McCowan, et al., 2017). Because of this, many countries now issue public recommendations about going to sleep in a side lying position in late pregnancy. The McCowan study also showed a […]

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Gestational diabetes and the best time to give birth

There’s a fair bit of controversy about whether, how, and when to test for diabetes in pregnancy. This post focusses on one decision women with a diagnosis of diabetes are often asked to make – when to give birth. (If you are after information about other aspects of diabetes in pregnancy, Rachel Reed and Sara Wickham both have great blogs about this, and both have books on induction of labour.) […]

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