Why does fetal monitoring cause unnecessary intervention?(90 Posts)
I keep hearing that fetal monitoring causes unnecessary interventions. This is the heartbeat monitor isn't it? Does anyone know why it's meant to cause unnecessary interventions? I understand that u are meant to move around in labour so that's obviously one concern but i keep seeing suggestions that fetal monitoring makes it look like the baby is in distress when it's not? I can't understand this? They have a monitor that can be put on the baby's head to confirm if they suspect an issue. How can this one be wrong? Is it case of when fetal monitoring is used incorrectly or misread it causes unnecessary interventions? Or are they saying it causes unnecessary interventions even when used correctly? In that case are they saying that if doctors tell me the monitor says the baby is not okay should I ignore them and tell them fetal monitoring is often incorrect and continue with a natural birth? Because that's what it sounds like to me . I find this whole idea that the doctors don't really know if the baby is okay and are using equipment that doesn't work very worrying. hopefully someone on here will be able to explain it to me a bit better.
Is it not induction rather than monitoring ?
"You keep hearing" from whom? Where?
Surely monitoring only happens if there is something to worry about in the first place? Therefore stats skewed by high risk cases inevitably ending in intervention?
It's not common to have continously monitoring unless you are being induced (in the uk)
Who are 'they'? What is it that you're concerned about? Have you read a particular article that's worried you?
Are you referring to foetal monitoring for delivery post CS?
There is a train of thought that says hospital births are more likely to results in an intervention by nature of the fact you are in a hospital and therefore less likely to be moving around.
Certainly with a monitor for deliveries after DC1 I was considerably less mobile than without.
BUT, I second the comment about monitoring being used for concerns skewing the stats. DC1 resulted in a section, but the monitor and two capillary blood gases were done because of concerns in labour, and the section occurred when they detected problems.....
Sorry I think i should have said continuous monitoring. It's not the Doppler used on and off that I've heard this about. I heard it in our nct class and here it says it www.nct.org.uk/birth/encouraging-straightforward-birth-what-do-labour. There were a couple of other places too. Let me see if I can find the links it was a while ago tho....
Continuous monitoring happens only if the midwives/doctors have cause for concern. With high risk cases, ie already those which are likely to end in intervention. I was not continuously monitored, I had a natural water birth but correlation is not causation.
Be wary about NCT publications. My NCT teacher told me a breech vaginal delivery was safer than a planned cesarean and that epidurals stop a baby wanting to breastfeed
Continual monitoring is important imo. A midwife doesn't have X-ray eyes and can see how the baby is. What if you refused cont monitoring and inbetween checks the baby became on reid my distressed and the heart beat slowed right down. You'd never know. Hideous.
If you go to the 'Campaign for Safer Births' Facebook page there is a request for parents to get involved in some research by Oxford Centre for Fetal Monitoring Technologies in there is says that current monitoring causes many unnecessary emergency operative deliveries.... this is where I've seen it mentioned most recently.
Are you in the UK OP? I'd avoid reading articles about birth in the USA if I were you as it is so different there and many articles are advocating for what is already standard practice on the NHS. (Thankfully for us Brits)
I had the continuous monitoring as I had an induction with my second. I was just as active, just couldn't get in the bath like I could with my first. I still laboured standing up and it was great.
When I give birth last month i just had a remote Doppler check on DS every hour. Other than that I was free to do what I liked I wasn't hooked up to anything.
I didn't have an epidural so I might be wrong but I think maybe you need continual monitoring for those?
You can't have such a mobile, active birth if you are being continuously monitored, which is why some women dont want it, as they believe it can be the start of a cascade of intervention. . For example, if you're having a VBAC, the doctors will often want to continuously monitor, but the chances of having a successful VBAC can be lower if you're not mobile during labour, iyswim.
I'm not against continuous monitoring, by the way. I had c-sections, so didn't even have a proper labour. Just trying to explain why some people seem 'against' continuous monitoring.
I think that is what the NCT webpage the OP linked to is getting at, angelontop - continuous monitoring leads to intervention (because you're in a situation that needs monitoring!)
well I'm relieved that people are questioning the articles and not wholly in agreement with them. wish i'd posted this earlier as I was really scared by this. I understand that continuous monitoring isn't the norm but I would like to be sure it works if its needed!
I don't think the right expertise has yet turned up on this thread . There are definitely reputable studies showing exactly what you suggest. I don't understand either and hope somebody with specialist knowledge will be along to explain.. I'm guessing that it happens because babies heartbeat slowing isn't always a sign of distress, but obviously as an obstetrician (or a mother!) you can't really know when it is, so you have to act in all cases as if the baby is in distress. The consequences of inaction in a given case are much more serious than the likely consequences of intervention. But at a population level you obviously want to minimise unnecessary interventions, hence the need for more research. But I'm neither a doctor nor a scientist, so that is just my best guess!
The above links to the cochrane review comparing continuous monitoring with intermittent. The author sums it up:
Continuous cardiotocography during labour is associated with a reduction in neonatal seizures, but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography was associated with an increase in caesarean sections and instrumental vaginal births. The challenge is how best to convey these results to women to enable them to make an informed choice without compromising the normality of labour.
So basically, continuous monitoring increases the chance of intervention without a decrease in neonatal mortality / morbidity.
Discuss with your midwife if you have concerns/ for more information.
Cochrane looks at all available evidence/research and critically appraises them so is extremely reliable. NICE guidelines reference them.
Continuous monitoring is a problem when it is used as a substitute for proper midwifery care. When I had my first baby the midwife was looking after 4 mothers and would zip from room to room to look at the trace rather than the mother. (Almost 14 years ago)
I feel there is a place for continuous monitoring and monitoring needs to be made smarter so the mother can be mobile.
I had continuous monitoring had no fetal movement on a Thursday so was induced on a Tuesday it caused me no harm obviously this is classed as medical intervention though.
If you're induced you're continuously monitored. If your baby is breech you're continually monitored this often leads to medical intervention.
It's no so much the monitoring that causes the intervention it's the reason why you're being monitored that causes it.
Basically, the argument is that continuous monitoring makes doctors treat every episode of possibly foetal distress as distress. And that taking that one indicator isn't massively reliable - as the lack of difference in outcomes at a statistical level shows.
It is for that reason we limit continous monitoring in the uk to situations where there is a clinical indication monitoring may be helpful.
In the uk, the issue is more that the monitors can stop you moving about.
Yes, Lumpy and Libraries are correct.
However we're talking about meta analysis here, the kind of research that influences NHS policy on who should have CEFM - that's not the same as saying that there is no benefit in CEFM - in high risk labours or in normal labours where intermittent monitoring suggests that the foetus is not coping well CEFM can and does save babies' lives. I certainly don't think anyone sane would recommend ignoring medical advice on an instrumental or surgical delivery - the risks to your baby of doing so would be huge.
Please take everything you learn at your NCT classes with a pinch of salt and keep an open mind when it comes to child birth. You won't be continually monitored unless there's a medical reason for it I.e. if you have a water birth in a birth centre you won't be monitored. My baby was in distress and was born with the cord wrapped around her neck; she was delivered by forceps after a 21 hour labour and without monitoring this wouldn't have been spotted- I don't like to think what the outcome might have been. Please don't go in with the mindset that all medical intervention is a bad thing - hypnobirthing and NCT classes made me think this way which didn't help me inthe event. Good luck
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