Just try harder, then it will work! An allegorical tale.
A tall tale about Chris and his attempts to make his daily commute safer. (But it’s actually about CTG monitoring….)
Education isn’t the solution
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 […]
High risk obstetrics and high risk women: a wee rant about language
“High risk” is a term that gets tossed around a lot in maternity services. Have you ever stopped to think about what is being hidden under the surface when it is used?
Do people agree on antenatal CTGs?
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 […]
Add central fetal monitoring and stir: Is this the solution to understaffing?
What happens when you introduce a central fetal monitoring system into a maternity service who are struggling to provide adequate staffing to maintain safety?
Maternal heart rate recording to improve outcomes
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 […]
Caesarean section and stillbirth risk
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, […]
Is more technology the solution to fetal monitoring?
The thinking that went into the creation of CTG monitoring was itself fundamentally flawed.
What would a good fetal monitoring policy look like?
Last week I published a post about why I’m not on a guideline writing group. I mentioned that I sometimes provide anonymous gentle suggestions for people who are working on fetal monitoring guidelines about how to make theirs better. You might like to get a copy of the fetal monitoring guideline where you work / where you support women to birth / where you plan to birth and read the […]
Why I’m not on a guideline writing group
From time to time, I get feedback from people who are surprised / disappointed / angry / annoyed that I’m not a member of a guideline writing group taking on fetal monitoring guidelines. It is true – I’m not. It seems like a reasonable thing to expect me to do, right? I’m across the evidence and I often write about what is wrong with existing guidelines. Why would I not […]
