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.

"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."

Hmm, not sure that an article from there really diminishes the results of many studies and 2 subsequent systematic reviews suggesting that post-dates induction reduces c-section. I'd suggest reading the Cochrane review for a far more balanced opinion!

The article linked to doesn't actually say anything of any note and, as a clinical scientist reading papers all the time, I don't think it added anything other that, "Hmm, this isn't what we expected. Doctors are bad, that'll be what it is."

"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"

The recommendation for intermittent monitoring is that the midwife should listen in every 15 minutes in the first stage, and after each contraction in the second. If things went so wrong so quickly I wonder if continuous monitoring would have made a difference? In the US pretty much everyone has CEFM, and babies sometimes still die in labour, even the babies of low risk women, despite all the monitoring :-(

"Hmm, not sure that an article from there really diminishes the results of many studies and 2 subsequent systematic reviews suggesting that post-dates induction reduces c-section. I'd suggest reading the Cochrane review for a far more balanced opinion!"

Did you read the article?

There is a fundamental problem with RCT's when it comes to research into childbirth - that's the problem the article flags up. She flags up the same concerns about the Cochrane review of induction.

I know it's not clear cut. But so much can happen to a baby in 15 minutes. My son crashed before I was fully dilated, and with my contractions the way they were, he would have endured trauma around ten times in those 15 minutes. Which would have either killed him, or left him brain damaged.

I think I'm too personally invested in this topic tbh so need to step away from the thread. It's amazing how much a traumatic experience can affect you nearly 8 years on.

I am so sorry for what happened to you and your friend Blue.

Didn't you say you were a VBAC, so generally considered important to monitor.

The thing with low risk women being monitored is, if at a population level it doesn't improve outcomes, the situation is either incredibly rare or there are other downsides balancing outcomes for babies.

When I was being monitored in my first birth, no one looked at the trace more than once an hour. Short of a flat line I don't suppose any one would have picked up a problem in time.

I have had 2 babies here in the US. With the first delivery I was induced and they monitored the baby. I was able to move around as not hooked up to a machine. They also had a command station with one nurse monitoring all machines. Friends in the UK who had monitoring had a midwife come into the room to read the machine.

Another big difference is that forecepts are no longer used at most hospitals because of the risk of damage to the pelvic floor of the mother plus risk of head trauma to the child. The closest thing you get is the vacuum. I think this is a huge factor in the difference in rates.

WRT having babies 10 days past due, my 2nd has a development delay and I was told by the developmental paediatrician that the incidence of a development delay is increased if the child is born 10+ days early or late. He was saying that I should not go too far past 40wks with this pregnancy given my babies are big.

I had continuous monitoring in my first labour with my Dd. I had pre-eclampsia, and realised quite quickly that my birth plan was out the window. I was on the cusp of 37 weeks and it was to monitor her and me to check that nothing more severe was happening. It was a 4 hour labour.

My ds was a spontaneous labour where it took longer and when I got quite tired there was concern over his heart rate. But a consultant gave me an hour before they would intervene and he was born 20 minutes later. She was delighted to find him there when she returned.

I never felt pressured into anything but realised that sometimes things are taken out of your hands and they were only making sure myself and my baby were safe both times.

I had continuous monitoring in my first labour with my Dd. I had pre-eclampsia, and realised quite quickly that my birth plan was out the window. I was on the cusp of 37 weeks and it was to monitor her and me to check that nothing more severe was happening. It was a 4 hour labour.

My ds was a spontaneous labour where it took longer and when I got quite tired there was concern over his heart rate. But a consultant gave me an hour before they would intervene and he was born 20 minutes later. She was delighted to find him there when she returned.

I never felt pressured into anything but realised that sometimes things are taken out of your hands and they were only making sure myself and my baby were safe both times.

There are risks and benefits of continuous monitoring as has been mentioned previously. It definitely increases the risk of intervention and currently the research coming out of a big London centre is that a normal CTG is a very good indicator of fetal wellbeing but an abnormal CTG is only correct 50% of the time. The problem is that there is no more accurate way of fatal monitoring currently available. As someone mentioned previously, unless there is a fatal bradycardia the CTG should not be used alone to diagnose fetal distress. The mother's observations at the time (pulse/BP/temp), hydration status, progress in labour all need to be taken into account and if the CTG is abnormal then fetal blood sampling should be undertaken to give an accurate assessment of wellbeing or hypoxia. The reason that CTGs are undertaken in high risk women is that a normal CTG is very reassuring but they shouldn't be used lightly as they definitely increase the risk of intervention and as mentioned previously this is well documented.

I think the most important thing is that care is individualised and I spend a lot of time talking to people about this. If something is recommended to you in your care, ask why and what the risks and benefits are. You shouldn't be being cared for by someone that can't have a reasoned discussion with you about why they are recommending what they are and then you can make informed decisions about your care.

*FETAL bradycardia...not fatal. Sorry.

Labour causes stress to a baby. That's just the nature of it. It is quite likely that in a lot of cases where mothers are not on ctg machines their babies are having decelerations during contractions due to compression and stress but obviously it's not monitored. Therefore no intervention occurs

Labour causes stress to a baby. That's just the nature of it. It is quite likely that in a lot of cases where mothers are not on ctg machines their babies are having decelerations during contractions due to compression and stress but obviously it's not monitored. Therefore no intervention occurs

I'm reading this thread with interest. I'm currently 16 was pregnant with dc2. I had a emcs with ds1, at 40+12 after getting to 6cm dilated naturally. As soon as we arrived I was automatically put on Ctg monitoring which was showing decelerations his heart rate. They attempted foetal blood samples and couldn't obtain them, so proceeded to emcs. I was reassured after his birth that his blood samples after birth were fine. I was concerned at the time that I'd spent approximately 3 hours effectively strapped on my back with a ctg monitor on, and that may have been impacting on his distress. I had an appointment last week at the consultants clinic to discuss vbac, where when discussing the monitoring equipment the hospital had I was told that I had required monitoring continually as my ds was distressed and his borderline blood results showed this also. Naturally after being told all was fine and then 14 months later being told it maybe wasn't quite so fine wasn't reassuring.
I have concerns regarding cfm during vbac, I have been told no water birth, no pacing the room etc. After the birth of my ds1 I'm a little concerned that the poor position I was kept him contributed to his borderline results, and I'm also wondering if there has been any research to show whether cfm increases the rate of uterine rupture due to poor position in labour thus prolonging labour.

Sweet I'll have to have a look for the references but I'm fairly sure there's evidence to the contrary in VBACs, that continuous monitoring decreases the risk of neonatal morbidity. It wasn't UK research, maybe Scandinavian, I'll have a look. Have you checked with your unit that they don't have wireless monitoring, it's made a huge difference in our unit to VBACs. It's definitely something quite a few people decide against as the risks of rupture are still very small and the chances of successful VBAC likely increased without continuous monitoring. In your case it sounds like you can't be sure exactly what happened last time. Have you thought about making an appointment with a Supervisor of Midwives to go through the notes properly with her and discuss what happened and a plan for this time?

sweet Def ask about the wireless monitoring and when I was induced with DD they had me on my side not my back when I was in agony and they didn't want me on my back. They also have an alternative medicine group attached to L&D so I had acupuncture and massage to help move things along/ reduce any of my stress. While I still ended up with a CS it was all very relaxed. I get the NHS don't pay for alternative medicine for delivery but if you have the funds I would def look into it.

Sweet, I am going to try for a vba2c and will be having wireless monitoring (telemetry) and so will be using the birth pool, albeit on a consultant led unit rather than a midwife led unit. I did have to have specific conversations with my consultant and then (with her support) had everything signed off by the supervisor of midwives, as my birth plan is not the usual VBAC plan.

I had a mobile monitor, they're quite common. I took it into the pool with me.

Still ended up with an emergency c section as it was giving "false" readings and you can't always get enough blood for a fetal blood sample- my second came back I sufficent and off we went.

Insufficient not I sufficent!

Betty isn't fetal bradycardia just decelerations? That's what we had but I understood it to be decelerations. It was used on its own (albeit after sometime) to justify my c section under GA

No 90s. Decelarations are temporary dips in the fetal heart, that recover back to the baseline. A bradycardia is a prolonged reduction of the fetal heart.

Ah I see thank you. So we obviously had both

It's not a bradycardia until the fh has been down for 3 mins.

Want2besupermum I wish they wouldn't use forceps here tbh.. Or at least give women a choice of a section. I would be more inclined to risk another vbac if they got rid of those horrid things.

The vast majority of forceps births result in a well mother and a well baby, and doing a c-section in the second stage of labour can be more risky than doing one in the first stage of labour. I'm very, very glad that forceps are still in use, as are many people I know, as it meant I could have a vaginal birth with my first. For me that was really important for my pregnancies and births which followed.