From: bwolfe@trentu.ca (BEN WOLFE)
Subject: Re: Are Fetal Heart Monitors needed??
News-Software: VAX/VMS VNEWS 1.41    
Organization: Trent University Computer Services Department
Date: Mon, 31 Aug 1992 14:45:00 GMT

In article <1992Aug31.125334.2765@crd.ge.com>, millerj@belize.crd.ge.com (Julia K. Mille

>	However, when I started to push the babies heart rate  really
>dropped and stayed  down.  They made me lie down on my left side between
>contractions and the rate would come back up  immediately.  If they hadn't
>had the monitor on they probably wouldn't have caught this and I don't
>know what the result would have been.  The cord was wrapped around the
>babies neck which caused the problems.   With the monitor they could  tell
>it was rebounding so didn't even think of a c-section.  Without  it, I 
>don't know if they would have picked up on the drop and just done a c-section
>or what.  For me, I think the monitor turned out to  be good tho it was
>annoying to have it attached the whole time.
>	Here, they have it on for 15  minutes every  hour for a normal
>labor.  I can't say whether I think that is useful or not since you could
>have the nurse do it manually.

Fetal heart monitors are one of the best examples of the problems with
modern obstetrics. The World Health Organization has described them as "a
model of the inappropriate use of technology." The inventor of the
monitor, Dr. Edward Hon, has made a point of saying that most doctors are
not using monitors correctly, and as a result are performing many
unnecessary caesareans.

A slew of reputable studies published in the most prominent obstetrical
journals, involving many tens of thousands of women, shows that fetal
heart monitors do *not* improve birth outcomes. They do, however, increase
the caesarean rate dramatically. They do this partly because using them
requires that your freedom of movement in labour be severely restricted.
If you have an internal monitor, you have to lie down through labour in the
classic stranded beetle position (the *worst* for you and your baby).

But beyond that, there's a nasty legal angle involved. If you have a
monitor on, the tracing it prints out forms a record of your labour
which can be used as evidence in court. As a result, if there is any sign
of anything that could be interpreted as a problem by a defence lawyer,
the tendency is to leap in with the knife, believing that he/she is less
likely to be sued for doing a caesarean than for not doing one.

The American College of Obstetricians and Gynecologists (ACOG) has an
official policy stating that periodic auscultation (listening to the
heart with a fetoscope -- essentially a variant on a stethoscope) is every
bit as effective at detecting problems in labour as the monitor, without
the complications the technology adds to birth. The unfortunate problem
is that North American medicine is so hooked on technology that most of
the doctors who were trained over the last couple of decades know how to
plug a woman in to a monitor and leave her lying there by herself, perhaps
coming back to check the tracing occasionally, but few have been trained
in the low-cost, highly effective and lower risk alternative. And perhaps
few are willing to actually stay with their clients in labour either.

In Ontario, midwifery has just been formally recognized and is being
integrated into the health care system. Midwives have the non-interventive
skills needed if you want to avoid the monitor. (Some doctors, of course,
do as well. This is a good question to ask when you're choosing your
doctor. It'll show whether she/he is Dr. High-Tech or the type who actually
believes women's bodies were meant to have babies.)

Did you know that an *internal* fetal heart monitor requires breaking the
waters and screwing an electrode into the scalp of your baby? (I am *not*
making this up.)

Ben Wolfe
(coauthor of a forthcoming book on birth options in Ontario, and father of
Noah, 3 3/4, and Emma, 15 months)