From: lisa@watson.ibm.com (Lisa Leutenegger)
Subject: Re: Use of drugs during labor - and electronic monitoring
Date: Mon, 27 Jul 1992 19:58:37 GMT
Disclaimer: This posting represents the poster's views, not necessarily those of IBM
Organization: IBM T.J. Watson Research Center

In article <LOWRY.92Jul27141802@rotor.watson.ibm.com> lowry@watson.ibm.com (Andy Lowry) writes:
>I'm talking about the nonintrusive kind that they
>simply strap to your stomach

I would hardly call those straps nonintrusive - they restrict movement 
and require the woman to lie on her back - or maybe (with luck and an
understanding attendant) she may get to sit down or stand up.  But basically
she has to stay still with very little movement.   I want to lie on my 
side (almost on my stomach) when I am lying down.  I want to be able 
to walk around.  I want to be able to do pelvic rock exercises if I have
a posterior baby.  I want to be able to take a shower....

>There are a number of upsides to my mind, the most
>important of which is that it allows the delivery team to notice and
>respond to conditions that could lead to disaster and would otherwise
>go unnoticed.  

I did not say I did not want the fetus to be monitored - we will
have the nurses monitor the fetus with a fetascope every 15 minutes
during 1st stage and every 5 during 2nd stage.  This is in fact the 
current recommenation from the American College of OB & Gyn (ACOG) for 
low-risk pregnancies - they do not recommend using EFM in such cases.  
There have been several studies that show EFM is no better than just 
listening to the fetal heart beat periodically.

If the midwives thought they couldn't detect fetal distress by simply 
listening to the heartbeat they would use EFM throughout the entire labor. 
They only want to use it for 20 minutes - but the baby could go into distress 
at anytime - not just the first 20 minutes I happen to be in the hospital.
If they want to make sure the baby is okay when I arrive I assume their
skill at picking up distress signs later on is just as good as during the 
first 20 minutes I am in the hospital.


Based on numerous studies showing EFM was unnecessary, in 1988 the ACOG 
was considering reversing its guidelines that currently calls for use 
of EFM in high-risk pregnancies.  I do not believe they have actually 
done this - and my understanding is that it is mostly legal issues that 
have stopped them.  There are just too many lawyers in this country.

As one member of ACOG said in an article I read (from ObGyn News in 1988)
"we had come to terms with the accumulating literature showing that
fetal monitoring was not only NOT superior [to periodic monitoring]
but may even be dangerous".

A woman who is electronically monitored is more likely to have a
cesarean or a forceps delivery than one who is not.  The problem
is that doctors simply don't have a clear idea on how to interpret 
the data they get from these machines.

As a final note - EFM uses ultrasound technology - which in itself is 
possibly harmful to the fetus.  I for one do not want to expose my fetus
to hours of a technology that has not been proven safe and from the 
1 or 2 articles I have read it is quite possibly unsafe.


>Another upside is that the coach knows before the
>mother-to-be when labor pains are beginning to subside.  

I want my husband to pay attention to me - not a machine.  


---lisa leutenegger
   lleut@watson.ibm.com

Newsgroups: misc.kids