When policy makes safety worse
Three strikes and you are out! How a guideline meant to make maternity care safer undermined good communication.
Obstetrics
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.
How the RANZCOG policy changed
Analysis of the RANZCOG Intrapartum Fetal Surveillance guideline reveals significant changes between the 3rd and 5th editions. Key improvements include clear responsibility shifts to clinicians, realistic evidence levels for CTG use, and better evidence organization regarding risk factors.
I’m 41 weeks pregnant. What’s the deal with CTG monitoring?
RANZCOG’s fifth edition guideline highlights prolonged pregnancy (over 41 weeks) as a risk factor for intrapartum fetal compromise. Low-grade evidence suggests a slight increase in the risk of brain injury for babies born after 41 weeks. The guideline sets out professional’s responsibilities to support women to make their own decisions about fetal monitoring methods.
There’s a new RANZCOG fetal monitoring policy: What do they get right and what do they get wrong?
The recent fifth edition of RANZCOG’s fetal monitoring guideline adopts a new approach, providing more accurate summaries of the quality of their evidence. Although it emphasises women’s autonomy, they have not quite completed the task of shifting decision-making from obstetricians.
Australian folks – are you interested in joining me in a workshop in the new year for a detailed look at how to apply the guideline to your practice?
Routine umbilical cord gas analysis – is it worth it?
Routine cord blood gas analysis – harmful or helpful?
Why bother?
If you have been hanging around Birth Small Talk for more than a moment, you’ll know I’m very focussed on putting the evidence about fetal heart rate monitoring in front of as many people as possible. And you’ll know that this position puts me at odds with a lot of what most people will hear in mainstream maternity services. So I get some pushback from time to time. And even […]
Is teaching keeping up with evidence?
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.
The CTG as a self-fulfilling prophecy
This week I explore flawed beliefs in the effectiveness of fetal monitoring technology through a circular argument. It highlights three steps: assuming success when bad outcomes don’t occur, blaming individuals when they do, and declaring some cases unavoidable. It’s time the research to settle this was done.
Inventing the CTG
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.
Birth Small Talk 