Google+ Authentic Parenting: New guidelines for fetal monitoring

Monday, February 1, 2010

New guidelines for fetal monitoring

A July article in the New York Times brings the new guidelines for electronic fetal monitoring (US) to our attention.
You can find the complete article here

Electronic fetal monitoring was designed to reduce occurrence of cerebral palsy (which is basically a catch-all term for a series of physical disabilities due to brain injury) and fetal death, but has proven to make no difference in those areas. Moreover, electronic monitoring has often proven to be a good resource to prove malpractice in court and has considerably augmented cesareans and the use of forceps.
"Today, more than 85 percent of the four million babies born alive in this country each year are assessed by electronic fetal monitoring, amid continuing controversy over whether it does more harm than good."
Furthermore, research as early as 1990 has shown that there is little or no advantage in the field of neonatal outcome to using electronic fetal monitoring in stead of intermittent auscultation. (full article)

The new guidelines are designed to reduce misinterpretations of readings, but will probably fail to reduce the rate of cesareans or the occurrence of cerebral palsy. It might not even reduce the rate of malpractice cases based on fetal monitoring tracings.
In the case of cerebral palsy, research has shown only few cases (1 in 10) occur during childbirth. (more on cerebral palsy)

With previous guidelines, fetal monitoring tracings could read either reassuring or not reassuring, in the second case, it was left up to the OB to interpret the results and act accordingly. The new guidelines create three possible categories and a series of steps to be taken accordingly.



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