Fetal Heart Monitoring During Labor Revisited

Fetal Heart Monitoring During Labor Revisited

One of the most common obstetrical procedures that occur is Fetal Heart Rate Monitoring using the electronic fetal monitoring (EFM) techniques during labor – these are the straps with a probe wrapped around the mother to monitor fetal heart rate and contractions of the uterus. It was introduced in hopes that it would reduce the incidence of ischemic (lack of oxygen) injury to children during labor. It was introduced in 1980 and it was quickly implemented as policy by the American college of Obstetricians and Gynecologists (ACOG).

But as with many procedure in the medical field, I believe it was implemented more to avoid lawsuits than due to medical necessity.

Since its implementation numerous research articles have tried to argue its need – again and again the research has not shown that it provides a positive benefit over less “invasive” or “restrictive” methods of monitoring the child’s heart rate. In fact many articles – and even this article reiterated them – have shown it leads to a more complicated and riskier unnecessary procedures that may have not been warranted; C-Sections, forcep and vacuum deliveries.

The American College of Obstetricians and Gynecologists revisited this procedure again this year to “redefine” its definitions and procedures concerning EFM. Dr George Macones, MD who was the lead author in the new ACOG guidelines states that “although EFM is the most common obstetric procedure today, unfortunately it hasn’t reduced perinatal mortality or the risk of cerebral palsy.”

Seems like those are the most severe complications in any delivery on can experience – death of the mother and a severe ischemic event in the child.

They identified in this paper the lack of efficacy of EFM due to the following; interobserver and intraobserver variability (meaning how it is interpreted by doctors and nurses) and medications given during labor that can severely impact the measurements.

Am I saying you should have your child’s heart rate monitored during deliver – no – what I want you to realize is that our medical system – despite claiming it is solely founded on evidence based medicine – at times works more from a legal standpoint than from a patient standpoint. That should you choose to move or walk or shift around during labor – YOU CAN – and when the hospital tells you that it is medically necessary to have these monitors on, know it is rarely due to your health and the health of your child, but to the health of the hospital. In my opinion, the least intervention usually provides a better outcome for our children.

References:

Obstet Gynecol.2009;114:192-202