My thoughts and ideas
Life is full in very lovely ways – but I can’t fit it all in anymore. Changes are coming, including for the Birth Small Talk Blog. Comment BLOG and I’ll send you the link so you know what is going on, what is changing and what isn’t.
While there’s some debate in the world of fetal physiology about the meaning of fetal heart rate variability – it is widely considered to be useful information. Are women who choose intermittent auscultation missing out on their care provider knowing what the variability of the heart rate is? Or is there a way to determine this…
Central fetal monitoring is sneaking its way in pretty much everywhere. Lots of people love it. Here are some of the reasons I have serious concerns about it…
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.
It’s time to highlight the serious issue of unconsented fetal monitoring during childbirth, and the widespread misinformation about its safety and efficacy. It’s time to fix the underlying causes – starting with how guidelines are applied in practice.
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.
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.
Fetal heart rate monitoring traditionally involves professionals interpreting patterns, but technology has introduced complex, expensive systems aimed at improving outcomes. Despite this, there are ethical concerns regarding women’s consent and data use. The focus appears to prioritize cost reduction for healthcare systems over meaningful enhancements in maternal and fetal care outcomes.
I have lived through the rapid evolution of digital technologies. While digital tools offer new possibilities, they also raise ethical concerns, particularly with fetal monitoring. We need to talk about the ethics of digital fetal monitoring more than we currently are.
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 […]
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