Electronic fetal monitoring

"Joseph Campbell, the comparative mythologist noted that cultures which are the most subject to the variable forces of nature, such as seafaring peoples, have the most rituals, in order to exert some sense of control over the uncontrollable. The obstetrical community must fit that model, insisting on specific rituals of care, even in the absence of absolute evidence of their efficacy, in order to gain a sense of control and mastery of the birthing process. The fetal heart rate tracing is poured over like tea leaves or cast bones, and the doctor becomes the shaman.

This belief system has been preached to future physicians and obstetricians, who passed it along to their students until the whole culture of childbirth medicine became steeped in a religious-like belief in the power of the fetal monitor, labor curves, ultrasound measurements and the like. This belief is similarly conveyed to patients who are assured that if their pregnancy was managed according to the protocols developed by trusted researchers, their babies would be delivered without fail and without harm.

Reality, however, has proven otherwise. Despite close and continuous monitoring in labor by the best trained and most capable staff and doctors, babies still die suddenly, or are born with unexpected asphyxia, or unanticipated illness. Families feel bewildered and betrayed and seek explanation and often recourse. If the latest technology was employed, then certainly human error must have been the cause."

This quote comes from the science and sensibility blog. And it was oh so timely. I just taught in a college class about the birth process. During this presentation, I spoke about electronic fetal monitoring(efm) and how that is not necessarily the best option during birth. My opinions on this has come from research and also my own experiences.

First off, the efm was implemented without any prove that it was effective in preventing fetal death or complications. Since that time, it has actually been shown to have no benefits of intermittent monitoring(where the heart rate is listened to every 15-30 min). The only thing that I can think of that is beneficial is that it allows the nurse to be out of the room more often, and that is more beneficial to the nurse and hospital, not the patient.

Second, it is much easier for a woman to labor, both physically and mentally, without being tied down to a monitor. For some women, the heart rate is picked up fine while they are moving around, but for most movement caused distortion in the heart rate. This makes that reading invalid or picks up the wrong rate rate which throws everyone into a frenzy.

Yet, the efm has become sort of a religious ritual. Many doctors gasp at the thought of not using one. It certainly does allow them to think that they are in control of a force that is very uncontrollable.

Really the question should not be why wouldn't we use the efm, but why would we? I don't think anyone could truly give me a good answer.