From: ooblick@intercon.com (Mikki Barry)
Subject: Re: Are Fetal Heart Monitors needed??
Date: Thu, 3 Sep 92 14:54:29 GMT
Reply-To: ooblick@intercon.com (Mikki Barry)
Organization: InterCon Systems Corporation, Herndon, VA

From "The Midwife's Pregnancy and Childbirth Book" by Marion McCartney
(without permission)

Continuous Electronic Fetal Monitoring (p181)

The baby's heartbeat and the mother's contractions can be continuously 
monitored by machine throughout labor and recorded by a printout.  The 
monitoring can give the doctor or midwife good information on how well the 
baby is tolerating the stress of labor.  A change in the baby's heart rate 
patterns, especially as they relate to contractions, can indicate that the 
baby is having some trouble.

When you may need this procedure.

For Pitocin-induced labors or for high-risk babies, such as prematures, 
babies of diabetic mothers, or of drug addicted mothers and unusually small 
babies, the monitor's information can be lifesaving.  It can help the doctor 
decide on an emergency C-section when necessary.  On a busy day, with the 
help of a monitor, a nurse can keep track of several laboring mothers at the 
same time.  The coach can look at the monitor screen and predict when 
contractions are beginning, peaking and ending; he can use this information 
to help his partner cope better with her contractions.  In today's litigious 
society, there is one other practical reason for the use of a monitor:  the 
printout can be used as evidence to support either the OB's or the patient's 
care.

Why you might not want this procedure

A fetal monitor confines the mother to bed and makes her feel as though she's 
sick.  This can slow down the progress of labor, since the mother is not able 
to walk around and may feel uncomfortable lying in bed strapped to a machine.  
The slowdown of her labor can lead, of course, to other interventions, 
including an internal monitor, rupture of the membranes, IV, Pitocin, and 
more.

The coach and doctors and nurses sometimes appear more interested in watching 
the monitor than in helping the mother.  Little attention may be paid to the 
mother's feelings or complaints.  Even though we know the monitor is not very 
accurate at predicting the strength of a contraction, caregivers often rely 
more heavily on the monitor than on the mother's own description of how it 
feels.  I sometimes think that the mother could be under the bed instead of 
in it and no one would notice as long as the printout remained good!

Ideally, use of the monitor should lower the rate of medical intervention in 
labor and delivery.  Unfortunately, since the monitor has been in such heavy 
use, medical intervention, specifically the C-section, has been very much on 
the INCREASE.  Furthermore, continuous electronic fetal monitoring has never 
been proved to be beneficial to low-risk women and babies.  As a matter of 
fact, two studies show that nurses listening with fetascopes intermittently 
were able to identify problems as well as monitors were.  The group monitored 
by these nurses also had less Pitocin and fewer C-sections or forceps 
deliveries than the group monitored by machine.  The difference may be due to 
the very basic need we all have to be cared for and touched by a person 
rather than a machine.

How to avoid this intervention

1)  Ask that the monitor be used on arrival and then removed so you can 
continue to labor with freedom of movement.  If necessary, you can be hooked 
up again for another check on the baby later.

2)  Talk to your doctor or midwife about using the monitor only if you fall 
into a high risk category, are having a difficult labor, or are receiving 
Pitocin.

3)  Every fifteen or twenty minutes, have the baby's heartbeat checked during 
a contraction with a hand held Doppler to pick up any problems.  Just because 
you don't want continuous electronic fetal monitoring doesn't mean you don't 
want ANYTHING.  There IS a safe, intermediate step.