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.
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?
Informed consent is a critical principle in healthcare. A recent Australian survey revealed that many women lacked sufficient information and choice about fetal monitoring methods. Only 35% reported being asked for consent. This highlights a significant issue in maternity care, and it is well past time it was addressed.
From time to time, I encounter women saying some version of “I’ll only have (insert birth intervention here) if it is medically indicated“. I completely understand the sense in which this is meant – that if something bad is highly likely to happen, and the proposed intervention is highly likely to stop that bad thing happening, then it makes sense to choose the intervention. People use this language as short […]
Fetal monitoring guidelines around the world recommend CTG use in labour when women are considered to be a higher risk for a bad outcome for the baby that is linked to low oxygen levels in labour. Regular readers of my blog will have seen me write repeatedly about the lack of great evidence to back this up. There’s no compelling research showing better outcomes with CTG use for women planning […]
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 […]
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 […]
The type of fetal monitoring you decide to use can potentially have a big impact on your experience of giving birth, how you give birth, and the health of your baby.
Birth Small Talk 