Can you birth without the machine that goes “ping”?

Continuous fetal monitoring in labour?  An ingenious invention that has saved countless lives?  Well, no actually……..

As the relevance of cardiotocographs (CTG’s) are coming more and more into question, we encourage you to ask –  “Is your unit still “offering” a routine admission trace to low risk women?”

If you don’t know the answer then perhaps you might consider asking at your next appointment, or on your hospital tour.  “Does this hospital insist on a routine admission trace for all women?”

I was delighted to see the overuse of Continual Fetal Monitoring (also known as CTG – cardiotocography) highlighted yesterday in a report by the Academy of Medical Royal Colleges identifying 40 top treatments that bring little or no benefit.

Since 2014 the NICE guidelines for Intrapartum care  for healthy women and babies has very clearly recommended that care givers should “NOT routinely perform CTG on admission for low-risk women in suspected or established labour in any birth setting as part of the initial assessment.

And yet a small number of units across the region continue to insist that a “routine admission trace” (RAT) is carried out on all women as soon as they arrive at a labour ward.  Just to clarify a point here – the majority of units follow national guidelines and only use it when there is an existing concern for the baby or mums health.

So why does it matter and does it do any harm?  Well yes, it really DOES matter!!  And yes, it can potentially harm the outcome of your labour, putting your and your baby under unnecessary procedures and interventions that carry risks to your emotional and physical health.

Despite being low risk, and clearly documenting their wish to avoid a RAT if possible, women tell us time and again that they felt obliged to “do as they were told” – leading to them feeling that they were not being listened to and respected at the most vulnerable moments in their lives.

We hear frequent stories of women being co-erced, manipulated and even bullied into agreeing to this procedure – even when they are considered to be low risk upon arrival.

Have you heard any of the statements below?

“We don’t know if your baby is okay until we listen in”

“You want to know your baby is alright don’t you?”

“It’s what we do at this hospital – everyone else has it done”

“The doctor has told us we have to carry this out”

Of course for medium/high risk pregnancy continuous monitoring can be a valid option that may offer reassurance to both parents and professionals alike.  Therefore we teach all of our clients to ask two questions before all others…

“Am I alright?”

“Is my baby alright?”

If your midwife can answer yes to both of these then it is reasonable to ask for a full and frank discussion before labour that enables you to make an informed decision in regard to routine admission tracing.
What difference does it make?

From a couples perspective

To immediately place a woman on a machine to “check if your baby is okay” gives a subconscious suggestion that the baby probably ISN”T okay.  This is birth!! This is what women have been doing since the beginning of humankind – LITERALLY!!!  And yet we put more faith in “the machine that goes ping” (or badump, badump, badump with flashing lights) – as if it were a genius that understands our healthy body better than we, or our midwives do.

If the mum agrees to monitoring, the adrenalin surges caused when a baby moves away from the monitor (appearing to the parents as if the heart has stopped) are negative intrusions upon the natural course of hormones required for labour which may cause it to slow or even stop.

Women should be embraced and encouraged to believe in themselves and their bodies ability to birth and care for their unborn child – until such time that there becomes a REASON to consider otherwise.

Low risk women are encouraged to stay at home until they are in established labour – with contractions that are powerful and regular.  For most women they will naturally find themselves bending over, swaying and rolling their hips during each contraction – and yet when they reach a  unit “offering” RAT they are asked to lay down still for at least 20 minutes.
Inevitably the partners attention shifts from supporting the mum to the machine.  There is something vaguely hypnotic and beguiling about a machine that allows a supporter to feel “involved” in the labour – the numbers and graphs tell them when a contraction is coming – sometimes before the mother herself feels it.  I regularly observe partners interacting with a machine reading rather than reacting to the mother’s needs.

From a medical perspective

The majority of midwives are very aware of the latest research that suggests they should not carry out RAT’s – however, their hospital policy may be that they must “offer” it to all women – effectively obliging them to “tick a box” by asking women to agree.  Women must be reminded that it is entirely their decision, and they can calmly explain that they have chosen not to be continuously monitored whilst remaining low risk.

When CTG was first introduced in this country in the 70’s. It was hoped that it would reduce the incidence of Cerebral palsy and infant mortality – and yet research persistently shows us that in over 40 years the rates of those affected have not changed with it’s introduction.

A Cochrane review in 2012 found no evidence of benefit for the use of RAT’s on low risk labours and furthermore they found the probability that such a trace increases the caesarean section rate by approximately 20%.

What are the alternatives?

Women should be observed upon arrival at the unit, allowing the midwife to use her experience and judgement to understand how the woman is coping with her labour and to then support her in the most appropriate way.  When Midwives are supported to use their skills in this way they are able to build a personal relationship with the couple that is based on personal understanding and communication – without a machine becoming the focus of attention for care.

Current evidence suggests that low risk pregnancies, home births and midwife led centres regular intermittent monitoring of the baby is recommended with either a Pinard Stethoscope or Doppler (hand held device) every 15 minutes during first stage of labour.  This will increase to approx every five minutes during second stage.  Should any concerns arise with these methods during the labour then your labour will be re-classified as medium/high risk and continual monitoring may become appropriate.