Why does fetal monitoring cause unnecessary intervention?

[BamBamMania]

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.

Distress obviously needs to be dealt with and I am glad your DD was delivered safely.

But just to reassure people who may be panicking , a cord round the neck is not inherently dangerous. It's the fact it was causing distress. Something line 1/3 babies has a cord round their neck to some extent.

Really interesting question OP.

Haven't read the research articles attached but thought might throw something in...

I had an epidural (which increases the risk of instruments which in turn increases the risk of severe tears which in turn increases the risk of serious urinary and/or faecal incontinence) and was continuously monitored.
An epidural means you are lying down in bed or sitting in bed. This is not a good position for labour as it closes the pelvis outlet (less space for baby basically) and therefore increases risk of needing instruments.
Being monitored continuously also seems to mean having to lie down. I was wearing a belt around my tummy. I had had that at the end of pregnancy to check heartbeat (can't remember why) but clearly remember lying down with belt on.

Could it be that because some monitoring devices require you to sit or lie down, it increases the risk of interventions because your pelvis is "closed"? Just a thought.

Otherwise I wholeheartedly agree with other posters about
1-not trusting all NCT says
(they have a strong bias for so-called natural birth without explaining all risks of "unnatural births" such as instrumental deliveries or scare you that pethidine will disrupt breastfeeding when if comparing with a no pethidine birth which ends up with forceps or c-section women might have so many issues to deal with as a result that breastfeeding can become highly compromised - I was naive and trusted them too much)
2-and that correlation is not causation

LumpySpaceCow
Could you tell us more about wireless telemetry? Sounds like ideal device to monitor baby.

If some posters have had "walking epidurals", how does that work?
Heard about it before birth (NCT and pregnancy books) but hospital never mentioned it and didn't understand opening/closing pelvis issues nor risks of instruments (pretty dumb pre-birth).

How does one get one of them? Do you need to request it before birth (to midwife or in birth plan) or can you just go in hospital in labour and scream "I want an epidural, a WALKING epidural!!!#@?

It depends what facilities your hospital has basically Ping. Six years ago, mine didn't offer mobile epidural. But a friend in another city had one no problem.

pinguina
I've not seen it yet but from what the midwives / doctors say, it basically continuously monitors your baby and contractions, but as it is waterproof and not connected to any mains wires, you have full mobility and can go in pool. I assume it transmits the information via Bluetooth or something similar.

What really isn't clear is whether an epidural causes more intervention or whether women with more complicated labours/a less ideal presentation etc are in more pain, therefore have an epidural, with the reasons for the epidural being the reasons for the intervention, not the epidural itself.

The other bit of research that I quote here quite a bit is that induction for post-dates (after 41 weeks) is associated with a lower risk of C section, which given the increased monitoring etc suggests that increased monitoring isn't itself to blame.

www.ncbi.nlm.nih.gov/pubmed/22696345

Induction on its own does not mean continuous monitoring.

I have been induced five times, it depends on the method of induction and how it is going as to if you need continuous monitoring.

If you end up needing the syntocinon drip they like to use continuous monitoring as the contractions can be stronger and baby may become distressed. If you just have the pessary or your waters broken and thst gets labour goung then you don't need continuous monitoring. I have had pool birth even with being induced and in the labour where I did have the drip and hence continuous monitoring I still stayed mobile, active using birth ball, walking about etc. It was more awkward due to wires but the midwife helped with this. And as others have said some hospitals have the wireless monitors now.

There is evidence that continuous monitoring can lead to more intervention but doesn't improve outcomes.

So it's down to choice, I have always opted for intermittent monitoring and taken advice of midwife. It's a case of weighing up risks, V benefits as with everything in pregnancy and childbirth there is no zero risk option so you have to do what you are comfortable with.

I need to move in labour and use water for pain relief if I can so intermittent monitoring with hand held doppler was best for me. The newer wireless monitors sound great, I think my hospital has these now so if I end up induced for no 6 due April and for any reason continuous monitoring is necessary I will be asking for the wireless monitoring but I would rather just intermittent monitoring.

It really is something that depends on individual circumstances and your preferences.

The other bit of research that I quote here quite a bit is that induction for post-dates (after 41 weeks) is associated with a lower risk of C section, which given the increased monitoring etc suggests that increased monitoring isn't itself to blame.

That's a very specific sub set though.

As far as I can see from the research I've read in the past (a couple of years ago)

• Routine CFM (e.g. as done in the US) increases intervention rates;
• CFM done for a clinical reason (e.g. induction, VBAC) is far less clear, because there is a lot of muddling together or correlation with potential causation and it's very difficult to separate them.

Luckily in the UK we'd generally be the latter group, so if my HCP was telling me I needed monitoring I'd want to hear why and, assuming I agreed (in my first labour I was bullied into CFM basically because of understaffing), I'd agree.

I had constant monitoring with DS2 nearly 8 years ago.

He was a vbac baby. I had a mobile epidural- I could stand, walk to the toilet, walk around the room. My wires for monitoring weren't short, I could be on a birthing ball or standing at the edge of the bed.

The constant monitoring saved my child's life though. Without it, he would be dead or brain damaged.

If you can have things like epidural and monitoring whilst remaining fairly mobile it's not a bad thing.

Thank you info on wireless monitoring and mobile epidurals.

Link to why epidurals may not lead to more interventions (correlation not causation)
<a class="break-all" href="https://www.google.co.uk/url?sa=t&source=web&rct=j&url=www.birthtraumaassociation.org.uk/publications/epidurals.pdf&ved=0ahUKEwjY78uZ8urJAhUJpnIKHbhWCEYQFggiMAA&usg=AFQjCNFYIo6yvIsfglaD7jXTDw96najLCg&sig2=fsLwseJf4UU8Xye_Ab32kQ" rel="nofollow" target="_blank">www.google.co.uk/url?sa=t&source=web&rct=j&url=www.birthtraumaassociation.org.uk/publications/epidurals.pdf&ved=0ahUKEwjY78uZ8urJAhUJpnIKHbhWCEYQFggiMAA&usg=AFQjCNFYIo6yvIsfglaD7jXTDw96najLCg&sig2=fsLwseJf4UU8Xye_Ab32kQ

I had continuous monitoring in my second labour due to meconium in waters. I think a lot of the time continuous monitoring means being stuck on the bed UNLESS you specifically ask your midwife to help set you up somewhere more comfy. Being stuck on a bed with a tight band around your abdomen is probably the most uncomfortable position possible to labour in and I'm sure almost always leads to the mother feeling distressed and in pain, maybe it has a knock-on effect on the baby? (disclaimer I have no evidence to support this)

My DH was great and urged the midwife to set me up on a birthing ball beside the bed, and then later the midwife got hold of a mobile monitor which meant I could stand up and walk around the room. But if you don't know those are options they may not be floated at all so stuck on the bed it is.

There is definetly valid research showing that being continuosly monitored increases unnecessary intervention.

One of the main thoughts is that we don't really know what's normal for a fetal heart. A good ctg is a good indicator that baby is alright but a poor ctg is a poor indicator that baby is in trouble. The majority of babies where the ctg shows that the baby is in distress will actually be ok. Which is why nice guidelines say that decisions on labour shouldn't be taken using ctg interpretation alone......should be backed up by fetal blood samples which is a more measureable/accurate method of ascertaining fetal wellbeing.

Half star it's definitely down to mother led - I asked for an epidural which would mean I could stand and walk. I asked for meptid instead of pethadene as it lasted a shorter time.

Constant monitoring usually happens in higher risk situations, where there will be a higher chance of emergency situations surely? It's very hard to tell whether they cause interventions.

"BUT, I second the comment about monitoring being used for concerns skewing the stats. DC1"

No - NICE recommends that continuous monitoring not be used for low risk mothers, where the labour is progressing normally, as it doesn't improve outcomes for the baby and results in higher rates of emergency surgery.

Once a labour appears to deviate from the norm then continuous monitoring may improve outcomes for some women and babies.

I've had two births with cfm. Both ended with emergency intervention due to feral heart rate. Not ideal for anyone really and both times baby born with apgar score of 9. I'm grateful to have healthy babies but I don't think either were at risk. Any more babies I want elcs to avoid cfm again and a falsely perceived emergency situation arising again.

Re: epidurals and birth complications - it's impossible to separation correlation from causation.

• all trials looking at the impact of epidurals on labour have very high rates of cross over from the non epidural to the epidural arm of the trial.
• most trials compare epidurals with pethidine, not with women having unmediated births.

However - the Birth Place study which is referenced constantly in NHS patient information on place of birth, shows that low risk women who choose birth settings where epidurals are available without transfer have double the rate of emergency c-section compared to similar low risk mothers who choose birth settings where accessing epidurals requires transfer.

The figure for low risk women having a second baby is higher than that (5X the risk). No improvement in fetal outcomes.

Can you think of anything other than epidural use which could cause this huge difference? Especially given the fact that epidurals sometimes cause fetal distress?

My hospital also have the wireless monitoring thingy, I didn't realise it meant I could use the pool though!
I was monitored for my first because if an induction then epidural. I then ended up being internally monitored with the clips being on my son's head!

This time I'm hoping to be monitored all the way through just for the reassurance but all the professionals I've talked to about it (and there have been a LOT) haven't said anything about increased interventions.

Good luck, kx

"or scare you that pethidine will disrupt breastfeeding when if comparing with a no pethidine birth which ends up with forceps or c-section women might have so many issues to deal"

I don't understand the logic of your statement. Pethidine doesn't make it less likely that you will have a forceps delivery or a c-section. Nothing I've seen has suggested that NCT are saying this is the only thing which can disrupt breastfeeding.

Pethidine can and often does disrupt breastfeeding. Regardless of the NCT - this information is available everywhere including the obstetric anaesthetists association - hardly big advocates for natural birth!

"One of the main thoughts is that we don't really know what's normal for a fetal heart. "

Some hospitals are having great success (ie practically halving their unplanned c/s rates while improving fetal outcomes) by using baseline information to develop an individualised method of interpreting fetal traces.

here

A discussion of the validity of the research claiming to show that induction reduces likelihood of c-section.

From Practicing Midwife and worth a read.

Constant fatal monitoring has not been shown to lower rates of morbidity or mortality overall.

"You won't be continually monitored unless there's a medical reason for it"

In fact you will never have any suboptimal or non-evidence based care in an NHS hospital because the NHS is completely without fault and all health professionals are careful to always engage in NICE mandated practices all the time, regardless of external pressures.

NOT.

Much as I love the NHS and admire midwives, they aren't perfect. My local hospital is notorious for doing entrance traces on low risk mums (not advised by NICE) and then leaving them attached to the monitor for hours while the midwife busies herself with other things and 'forgets' to take it off.

Mini fingers, I guess with my pct and nhs local we are lucky - lots of midwife led care, monitoring only with higher risk if possible (I knew a few midwives)

In fact I had 1 on 1 care in 2008. Felt extremely lucky hearing stories here!

Whothefuck sadly I know a case where constant monitoring would have saved a life. Sadly, the mother wasn't deemed "at risk" as she had a natural birth previously. We had almost identical labours. Only difference was my son was seen to be in huge amounts of trouble and rushed for an emergency section. Hers wasn't seen. He died.

I'm not against mothers not wanting monitoring, but I have seen so many internet posts on various discussions boards advising mothers against it. And I would in lots of cases argue for it.

It's got to be an individual thing though, discussed between the mother and consultant. Who have more fetal health training than me after all.