Why Monitoring Only Sometimes In Labor is Better Than All the Time

Most people would think that having more information on their babies wellbeing during labor would equal a better outcome.

Not so when it comes to electronic fetal monitoring.
 
Electronic Fetal Monitoring (EFM) refers to taking the baby’s heart rate through using electronic devices, known as dopplers, ultrasounds, and monitoring belts. What we will be focusing on here, is the EFM with the monitoring belts done in a hospital setting during labor and delivery.

EFMs,attached to the mother by large belts or a belly band strapped around her abdomen, print out a record of both the fetal heart rate and the strength, duration, and frequency of the uterine contractions (although
the readout may not mirror how the mother is interpreting the contractions), so that deviations from normal patterns can be identified.

“If you mess around with a process that works well 98 percent of the time, there is much potential for harm. Most women in labor may be much better off at home than in the hospital with the EFM”
Dr. Hon, EFM inventor, March 1987

Most hospitals routinely use it in this way: Upon arrival at the labor and delivery unit, they will assess your progress by strapping the EFM on for 20 minutes or more, then monitor intermittently until you are at five or six centimeters, when they will want to monitor you continuously with the EFM until delivery, unless you instruct them otherwise.

Certainly monitoring of some sort is called for in labor and delivery, it is a matter of obtaining the appropriate type.

Risk of continuous monitoring are:

Increased Cesareans
| Four studies on continuous EFM all had the same results: More cesareans were done when a woman was continuously monitored, opposed to intermittently monitored, with no improved fetal outcome. Cesarean rates ranged between 63% and 314 percent higher for continuous EFM woman intermittent EFM women(Brackbill et al. 1984:10). Even in the high risk case of prematurely, no benefits result from continuous EFM (Shy et al. 1990).

Immobilization
| When continuously or even momentarily belted to the EFM, you are, in a sense, tied to the machine by the cords, rendering you somewhat immobile and certainly not free to respond to whatever position is comfortable for the mother. Being restricted can decrease the mother’s blood supply, and hence the oxygen supply to the fetus, leading to heart rate abnormalities, and therefore, EFM tends to produce the very abnormalities it is supposed to measure. (Young and Shearer 1987:10-11).

Study

Fetal Heart Fails to Signal cerebral palsy risk
Society for Gynecologic Investigation Annual Meeting: Houston, Texas; 24-7 March, 2004
 
Fetal heart monitoring used to identify babies at risk of cerebral palsy since the 1960s may be ineffective. US researchers have found evidence to suggest that fetal heart monitoring is not useful in detecting the white matter brain injury that precedes cerebral palsy (CP). White brain matter injury can occur during labor if the fetus does not receive an adequate supply of oxygen from the mother's blood. Consequently, since the 1960s, doctors have believed that fetal heart monitoring could identify babies experiencing such hypoxia, and allow them to intervene. Noting, however, that the incidence of CP has not fallen within the last 40 years, researchers from the Johns Hopkins University in Baltimore, Maryland, compared fetal heart monitoring data for 40 babies born with white brain matter injury and 40 who were not. Data were analyzed for the final hour to delivery in cesarean sections, and in the last hour of the first stage of labor during vaginal deliveries. Finding no difference between the two groups in any of the heart parameters studied, lead author Dr. Jayne Althaus said at the annual meeting of the Society for Gynecologic Investigation in Houston, Texas, that "electronic fetal monitoring really can't tell us the status of the baby's brain. "If the fetal monitoring that we currently have doesn't help us identify those babies who are later diagnosed with these brain lesions, then we need to explore other options," she concluded.

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