External Fetal Monitoring – is it useful?

I love this article in the Philadelphia Enquirer Test Leads to Needles Cesareans.

Fetal heart-rate monitoring is a screening test. Good tests get several things right; they are cheap, detect a possible problem when there is still time to act, and minimize unnecessary follow-up tests.

The Pap smear is an excellent screening test: By examining a few cells brushed from the cervix – where the vagina opens into the uterus – doctors catch precancerous changes – or even early cancer – when it is easy to treat.

But fetal heart monitoring is an appallingly poor test. The test misses the majority of babies with cerebral palsy, the condition researchers hoped it would prevent. It causes increased rates of a painful and invasive surgery: cesarean section. Even worse, almost all women undergo continuous heart monitoring during labor, not just those at highest risk.

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3 Comments on “External Fetal Monitoring – is it useful?

  1. What of the last few minutes of pushing when the heart rate suddenly drops? I often wonder if women are damaged because they have to push hard at the very end when it might be normal for the heart rate to drop or for it to drop off the monitor.

    I had a birth with a single decel that scared the nurse. I was placed flat on my back for an internal exam and the hr went down to 80. It wouldn’t come back up with O2 IV and left side. I sat up (against nurse’s instruction and she told me she was not okay with me sitting up) and the heart rate jumped to 124. Now, this one decel put me in the bed for the next 4 hours or so, and I wasn’t allowed to go to the bathroom. When I was closer to giving birth the nurse mentioned that it actually might have been my heart rate they were picking up. I was put through a terrible experience, an abusive nurse (long story)…all because of one decel. When I complained to my OB who was off work the day of the birth she said, “but you had that one decel.” Yes, but it was early in the labor AND apgars were great at birth. What was the point of all that punishment?

    My last birth I was able to move though the midwife did hold the monitor on my belly, she said I should do what is comfortable in terms of standing/sitting/rocking/moving despite some decels. Only when I was in the last few minutes did the monitor show the heart rate was not coming back up and she had me push really hard…no vocalization and they were counting I think…I hate that. I believe they quit though because I pushed hard and also took breaths when I needed to. There was a tight cord and baby was OP and also asynclitic (sp?). I believe the monitor did show a true decel, at least I hope so because I really pushed hard and think I may have weakened my rectal muscles because I have issues with stools now. I had only a slight tear since this was baby #7.

  2. the-addition is a latex free pad that allows movement of the laboring woman with minimal adjustment. the-addition decreases the mess with the ultrasonic gel and keeps it contained requiring less gel.

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