CTG monitoring during pregnancy is called non-stress testing in some parts of the world. This is to distinguish it from stress testing, where low doses of oxytocin or nipple stimulation are used to provoke contractions so the way the fetal heart rate responds to contractions can be observed. The term non-stress testing is rather ironic however, as there is a body of evidence showing higher levels of anxiety in women […]
A tall tale about Chris and his attempts to make his daily commute safer. (But it’s actually about CTG monitoring….)
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” 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?
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 […]
What happens when you introduce a central fetal monitoring system into a maternity service who are struggling to provide adequate staffing to maintain safety?
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.
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 […]
Birth Small Talk 