Birth Small Talk

Fetal monitoring information you can trust

Tag Archive for ‘decision making’

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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?

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Fetal monitoring and choice

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.

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Are “medical indications” a form of manipulation?

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 […]

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When is CTG use in labour a good idea?

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 […]

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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 […]

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Would you trust a computer to decide when to do a caesarean section?

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 […]

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Reviewing the evidence for Intermittent Auscultation

I was excited to see a new paper, setting out the evidence for intermittent auscultation in labour (Anderson, et al., 2023). It was published in a journal for US based nurse-midwives, so it relates to the context of care in that country. Let’s see how they did in terms of getting the facts right. Is their evidence accurate? They wrote that: All this is correct, except that one of the […]

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