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The ‘Worst Test in Medicine’ is Driving America’s High C-Section Rate

Nearly every woman who gives birth in an American hospital is strapped with a belt of sensors to track the baby’s heartbeat. If the pattern is deemed abnormal — too slow, for example — doctors often call for an emergency C-section. But this round-the-clock monitoring, the most common obstetric procedure in the country, rarely helps baby or mother. Decades of research have shown that the tool does not reliably predict fetal distress. In fact, experts say, it leads to many unnecessary surgeries as doctors overreact to its ever-changing readouts. The obstetrics field has long ignored these problems. Now, it’s putting more trust than ever on the flawed technology, often prioritizing business and…

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  Fetal monitoring research resources

Fetal monitoring is a controversial area. The word ‘monitoring’ can mean many different things, but on this page I am discussing the use of electronic fetal monitoring (EFM) in labour, which is also known as CTG (cardiotocograph) monitoring. Many women are told that their baby needs to be electronically monitored, and yet the research shows that this doesn’t confer the benefits that people think it will. Monitoring, like other screening/diagnostic tests, also has downsides.

 A half century of electronic fetal monitoring and bioethics: silence speaks louder than words

The appearance of bioethics in 1970 coincided with the introduction of electronic fetal monitoring (EFM), which evolved to become the fetal surveillance modality of choice for virtually all women in labor. Autonomy rapidly pervaded all medical procedures, but there was a clear exemption for EFM. Even today, EFM remains immune to the doctrine of informed consent despite continually mounting evidence which proves the procedure is nothing more than myth, illusion and junk science that subjects mothers and babies alike to increased risks of morbidity and mortality. And ethicists have remained utterly silent through a half century of EFM misuse.

 Is fetal monitoring to blame for too many C-sections?

A recent New York Times investigation confirmed what many of us in obstetrics have known for decades: though many of us were trained to use it and have put a LOT of stock in continuous electronic fetal monitoring (EFM), the use of it during labor is driving up cesarean birth rates…without improving outcomes for healthy pregnancies. And honestly? I agree with almost everything in this article—especially the part about how we got here.

Articles of Interest

When Evidence Fails to Change Practice: Examining the Persistence of Continuous Fetal Monitoring

Using scientific evidence to guide medical practice seems self-evident but, in certain specialties, it has proven difficult to realize. Use of continuous electronic fetal monitoring (cEFM) during labor is a case in point: research has shown that when compared to intermittent auscultation (IA), use of cEFM in uncomplicated labors of healthy women offers no clinical benefit and may result in unneeded interventions, and yet it remains common practice in obstetric care.

Despite Criticism, Fetal Monitors Are Likely to Remain in Wide Use

Electronic fetal monitors have been under attack for more than a decade by some women's groups and parts of the medical community. But despite research showing that using monitors does not produce healthier babies, most obstetricians say that a complicated interplay of legal and economic pressures makes it almost impossible to stop using them.

Doctor Roils Colleagues In Debate on Fetal Monitors

As a young doctor 40 years ago, Barry Schifrin worked with the Yale medical team that pioneered the electronic fetal monitor. The machine, which tracks a fetus's heart rate during labor, was developed to help reduce fetal death and brain damage. But in an early experience, Dr. Schifrin says he saw trouble ahead: He was a bystander as an obstetrics team interpreted a fetal monitor's reading to be an impending crisis and rushed to deliver the baby by Cesarean section. Dr. Schifrin took a look at the reading and thought the baby was fine, but kept his opinion to himself. The baby emerged healthy, he recalls, and the surgery had been unnecessary. The incident, he says, showed him doctors could misinterpret data from this technology to the potential detriment of patients.

Fetal monitoring can be essential during labour – but many women don’t realise they have choices

You’re feeling ready for birth – but then things start to get real. The hospital is discussing induction of labour, or maybe you went into spontaneous labour – but they tell you they need to monitor the baby. Health workers attach electrodes, straps and wires. “It’s for the wellbeing of the baby” they say – but nobody has talked about monitoring in any of the classes or visits. Does everybody have monitoring, you wonder? Are there different ways to check the baby’s heart rate? And do you have a choice? The answer is yes. Women do have choices about fetal monitoring during childbirth, but few realise it.

No Benefit Found for Fetal Monitors

The goal of monitoring is to avoid premature delivery, a leading cause of disability and death in newborns. Studies of home monitoring have been conflicting, with some showing that it lowers the rate of preterm births and others finding that it is no more effective than daily telephone conversations with a nurse to discuss labor symptoms.

Poor foetal monitoring a leading cause of death in babies in England, review finds

The CQC found inadequate foetal monitoring occurred in 45 of 92 cases in which a baby died or suffered serious brain damage while being born in a midwife-led unit in England.

The Fetal Monitoring Polemic

Advocates consider electronic fetal monitoring to be a routine technique, potentially beneficial to all pregnancies. Critics believe it is a meddlesome, cumbersome technique that offers no advantage over auscultation for low-risk, or even high-risk, patients. The author attempts to reconcile these disparate views and discusses the correlation between fetal heart rate patterns and outcome results that have prompted these views.