In Labor and Birth Care

A review due out at the end of the month reinforces that continuous fetal monitoring could have little effect on reducing incidence of cerebral palsy because the causes are almost always related to antenatal events, not inadequate oxygen in labor. The review’s authors point out that despite the dramatic increase in cesarean delivery rates since 1980, the cerebral palsy rate has remained the same and that fetal monitoring has not been shown to have any long-term benefits.

The last, best hope for continuous fetal monitoring has been adding analysis of a fetal electrocardiogram (ST-segment analysis) to standard internal fetal heart rate (FHR) monitoring. That hope has been dashed by a large (11,100 women) multicenter randomized controlled trial adding fetal ECG analysis to FHR monitoring vs. standard FHR monitoring. Investigators failed to find any improvements in perinatal outcomes or any reduction in cesarean or instrumental vaginal delivery rates. 

Meanwhile, an article in the New Republic: “Most Common Childbirth Practice in America is Unnecessary & Dangerous,” neatly sums up the evidence against standard FHR monitoring. 

Not that anyone seems to be paying attention. Exhibit A on that point is a hospital raising $225,000 to finance installation of a central monitoring system because, according to an OB nurse interviewed for the piece: “It’s definitely going to advance the care of my patients which is something very near and dear to my heart.” When you think of the ways that money could be better spent, it makes you want to cry.

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