Fetal monitoring is used more than any other obstetrical intervention, reported to be used in more than 85% of hospitals in 2010 (ACOG Practice Bulletin 132). However, despite its high rate of use, fetal monitoring has not been proven effective in decreasing infant or maternal mortality or morbidity. This fact makes fetal monitoring a target (and rightfully so) of controversy. Yet, most hospitals “require” fetal monitoring. Even the hospital I went to, which was very baby and mother friendly, “required” getting a “strip” (reading from the fetal monitor) during all three of my labors, despite crowning being imminent. Let us not forget that the US has the highest infant and maternal mortality rate of any developed nation, a rate that has been steadily on the increase for years.
The annual State of the World’s Mothers report reports, “the United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its infant mortality rate is higher than any of those countries.”
Two articles published today by MedPage raise considerable concern for questioning current “standards of practice” in delivery of twins, as well as with fetal monitoring.
A recent Fetal-Maternal Medicine Symposium discussed how fetal monitoring contribute to the increased cesarean rate, despite almost no evidence to support its efficacy. A quote from the proceeding article states, “About a third of women have a first cesarean section based on “nonreassuring” fetal heart patterns seen with the electronic monitors despite almost no evidence for benefit, Alison G. Cahill, MD, of Washington University in St. Louis, explained during a symposium.”
- Read the full article: Fetal Monitoring Often Tips Scales Toward Cesarean
Further MedPage also raised awareness with their article that reviews the latest RCT (randomized controlled trial) supporting that a cesarean section is no safer than a vaginal delivery for twins.
Donna Johnson, MD, and chair of the Obstetrics and Gynecology Department at the Medical University of South Carolina in Charleston states in the article, “Many women think that delivering twins vaginally is very unsafe and the safer mode of delivery by far is a cesarean section,” she said in an interview. “This is not the case.”
- Read the full article: Cesarean Delivery No Safer for Twins
The question remains then, if fetal monitoring is not achieving its original goal of making birth safer and decreasing mortality risk for mother and baby, why are we still using it?