Cardiotocography

There is no doubt about the research in the case of fetal monitors. They have no place in a normal labour. It is much better for woman and baby to have the midwife listen to the heartbeat with either a listening device called a pinnards stethoscope or with a hand held sonic aid. On a recent television programme an interviewer said to a midwife “technology and these fetal monitors have improved things dramatically haven’t they”? The poor midwife did not know what to say because the truth is that fetal heart monitors have not improved anything.

However, women and society believe they will keep their baby safe during labour. These machines were introduced into women’s labours without undergoing any research trials nearly 30 years ago. It was thought that they would indicate which babies were in danger during labour and save the lives of those babies. In nearly 30 years no babies have been saved. The stillbirth rate has not changed. What has changed however is the Caesarean section rate, which has risen to an unacceptably high level. One of the main reasons for the increase has been attributed to fetal heart monitors being used inappropriately during labour.

Trials that have been done since the introduction of these monitors have not found any benefits over other methods of listening to the babys' heart during labour.

Recently a multinational multiprofessional task force, that included the Royal College of Obstetricians, agreed that babies do not suffer as a consequence of reduced oxygen in labour in the absence of other risk factors. Healthy babies have special mechanisms to help them to adapt to mild hypoxic (reduced oxygen) episodes during labour and birth.

Very often babies that have been perceived to be “in distress” have been born pink and screaming and full of health and so too babies that have been thought healthy have not been.

No two fetal heart patterns are the same in labour and in almost all cases the monitors are showing us variations of normal. Due to so many variations professionals cannot agree in their interpretations of the heart traces. It has been known for an obstetrician to be shown the same trace twice and give different interpretations on each occasion.

Further more when women are strapped to monitors their movements are restricted preventing them taking up the natural position of their choice. Restricted movement and lack of upright position can inhibit labour which potentially can lead to further intervention causing a snowball effect which at the end of the line is caesarean section.

The evidence suggests that fetal heart monitors should be reserved for high risk labours.

Do not let a machine take the place of someone who can keep you and your baby safe during labour, a caring sensitive midwife.

© 2000-2003 V Howes
Kent Midwifery Practice