Is Fetal Monitoring Necessary?
What's the Point?
Intrapartum fetal monitoring techniques used in hospitals immediately preceding or during childbirth are designed to allow medical personnel to detect and analyze the fetal heart rate (FHR). The information and interpretation of the data is dependent upon the reading of the two lines that appear on the readout. It all sounds purely medically scientific - and it is - except that the reading of the data is seldom consistent and often leads to interventions that may not be necessary.
Originally introduced in the late 1960s, fetal monitoring technology was embraced by the medical profession as a good thing because now doctors could monitor the state of the fetus during labor and prior to delivery. It was thought that monitoring would lead to better outcomes and reduce the incidence of conditions like cerebral palsy, which were thought to be the result of labor stress. Fifty years later, evidence indicates otherwise. What did increase was the number of cesarean deliveries and interventions employed as a result of fetal monitoring.
The Good, The Bad and the Courtroom
Continuous fetal monitoring became a standard practice in most hospitals in Western countries before any studies to determine whether the values outweighed the risks were done. Therefore, the use of fetal monitoring has produced both positive and negative results.
· Electronic monitoring has lead to a significant increase in delivery interventions in the forms of cesarean deliveries and forceps deliveries.
· It has not reduced the risk of fetal deaths nor has it reduced incidents of cerebral palsy.
· It has been used to back malpractice cases against doctors which have lead to increased insurance costs for doctors causing many obstetricians to stop delivering babies.
What When Wrong in the Labor Room?
In the labor room, the results have also been negative and the criticisms of continuous fetal monitoring are myriad.
· There is poor understanding of the data and measurements gathered from the readouts
· Fetal monitoring is indirect but is treated as direct monitoring of the fetal condition
· Usefulness affected by technical problems
· Measurements and recording techniques vary too much
· No agreed systems of classification
· Confusion about fetal heart rate interpretations
· High false-positive finding rate
· Screening tool to detect fetal distress being used as a diagnostic tool leading to instrumental or surgical deliveries due to high false-positive rate
· No criteria on how, when, and whom to monitor
· Contributes to lawsuits
Can Anything Good Come From This?
With all of the things going against it, one would wonder what the point of fetal monitoring is at all. What it is good for is as a relatively reliable screening test to indicate the normal condition of a fetus. It can tell if the fetal heart rate and pattern are normal, and can positively identify that the baby is not suffering from distress. It is this point that has made it so commonly used in labor rooms. Unfortunately, its very presence has resulted in overcomplicated interpretations of readings without solid evidence of a problem.
There are situations when fetal monitoring really is a good thing. Certain risk factors make it appropriate to monitor the baby during pregnancy and labor. These risk factors include:
· A previous cesarean delivery
· Fetal growth restriction
· Use of oxytocin during delivery
· Preeclampsia in the mother
· Post-term pregnancy (more than 42 weeks gestation)
· Oligohydramnios (too little amniotic fluid)
· Vaginal bleeding during labor
· Induced labor
· Multiple pregnancies
· Antepartum hemorrhage
· Fresh meconium in the amniotic fluid
Any of these situations can put the baby at risk and cause distress. The fetal monitor can pick up how the baby is doing in these situations, and that's important.
The bottom line is that electronic fetal monitoring is a useful tool in the right hands and if used selectively and appropriately. Used as a routine practice, it has obviously increased the numbers of unnecessary cesarean and forceps deliveries and interventions.