When monitoring was first introduced (in the late 1960's to early 1970's) it was embraced enthusiastically by caregivers as a way to 'save babies' and pick up problems sooner. It's widespread use was implemented long before any research was done to evaluate its' effectiveness.
While continuous monitoring continues to be widely used, there can be considerable problems with the different interpretations of read outs or 'traces' from the machine. Extensive research has been unable to prove any real benefits for continuously monitored babies, compared to babies monitored intermittently. (That is, babies whose heart rates are monitored for 30 seconds to 1 minute, straight after a contraction by your caregiver, at least every 1/2 an hour, or more often, in the 1st stage of labour and about every 5-15 minutes in the second stage or when you are pushing).
The main issues surrounding monitoring include:
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The original belief that the use of CTG's would save the lives of babies 'at risk' and prevent cerebral palsy. No study has shown this to be the case. There is some evidence that the incidence of newborns having fits or seizures soon after birth may be marginally less in groups that were continuously monitored, when compared to groups who were intermittently monitored, but follow-ups of those babies up to 4 years of age have shown no long term affects after these seizures. |
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Agreements between experienced caregivers about what a baby's heart rate pattern can mean, may be as low as 42%. Readings have a tendency to be biased towards the baby having a problem, when one does not really exist. |
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The overuse of monitoring. This is especially the case for women who are experiencing a normal labour. Monitoring has done little to improve the health outcomes for babies, but has increased the Caesarean and forceps rates.
This finding has led to the American College of Obstetricians and Gynecologists (ACOG) recommending that monitoring be restricted to women with complicated labours. A 'complicated labour' was defined as premature labour, thick meconium stained amniotic fluid, the use of a Syntocinon drip or Prostaglandin gel for induction of the labour, epidural anaesthesia, or the detection of an abnormally low heart rate of the baby through intermittent monitoring. The College goes on to recommend that routine monitoring of a normal labour should be negotiated between the woman and her caregiver, in an attempt to reduce unnecessary interventions. |
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Many women dislike continuous monitoring, because it restricts their freedom to move in labour and potentially increases their perception of the labour's intensity. The inability to move can increase the woman's need for pain relief.
External monitoring can also be 'fiddly'. Even shifting in the bed can make the machine 'lose contact'. This usually requires the Doppler lead to be manually adjusted to pick up the heartbeat accurately. Continuous monitoring also rules out using the bath or shower for pain relief. Lying in bed for the whole labour can be extremely uncomfortable, often leading to the early use of pain relief. If you have an epidural in place, continuous monitoring will probably not bother you. |
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Some women feel continuous fetal monitoring takes away their personal attention and contact. At times the caregiver will just sit at the desk, monitoring the labour 'from afar' (as a screen at the desk will show the readout). The focus can often shift from the woman to the machine as everyone, including her partner, becomes mesmerised with the paper read out, rather than how the woman is fairing. If the woman requires monitoring, her partner and / or support people should be aware of this. |
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Some women like to be monitored and find the continual sound of their baby's heartbeat very reassuring. Women who have had a previous stillbirth will often request that their baby be monitored more regularly, or even continuously, during the labour of a subsequent baby. |