Just a quickie to get onto happier topics, and this may be the perfect post for that because I’ve had a note on my desk for a while now reminding me that I wanted to send kudos, hugs and a big glass of cyber-wine to Paul Lewis for his recent article addressing the lack of robust evidence to support the notion that it is beneficial to monitor the fetal heart in labour.
Yes, not just via continuous electronic fetal monotoring (CEFM) but even via intermittent auscultation (IA), of which he says
“this relatively innocuous but frequent intervention may impede the natural process and progress of labour. It might be better than CTG monitoring, but that in itself is not reason enough to advocate its use.” (Lewis 2013: 386)
Here’s my absolute favourite paragraph, though, which deserves to be quoted in full rather than paraphrased, because I don’t think it could be said any more eloquently:
“Although CEFM is associated with a reduction in neonatal seizures compared to IA, this appeared to have no long-term significance. There are also no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal wellbeing. CEFM was, however, strongly associated with an increase in cesarean sections and instrumental vaginal births (Alfirevic et al 2007). If there are no positive benefits of CEFM in labour and clear adverse consequences, why do our guidelines continue to advocate its use, and why has it become so embodied in our practice? The Cochrane review states that ‘the real challenge is how best to convey this uncertainty to women to enable them to make an informed choice without compromising the normality of labour’, but this clearly misses the point that the use of this ‘rubbish technology’ is itself compromising the normality of labour and birth, and the only thing that keeps it going is likely to be vested interests.’ (Lewis 2013: 386)
Lewis P (2013). Room 101 – The only place for fetal monitoring in labour. British Journal of Midwifery 21(6):386.
The Cochrane review referenced in the above quote was updated in May 2013 (albeit with no change to the conclusions) and that more recent version can be found here.