I appreciate the honesty of the obstetrician in this article. The fetal monitor became common practice before any research demonstrated it's effectiveness. When I started working in labor/delivery (I am dating myself) the monitor was just becoming available. I attended laboring women and observed their progress using the old-fashioned fetascope. Nurses could pick up changes in the fetal heart rate--we knew when we had a problem from a variety of observations.
The electronic fetal monitor was used only for induced labor. Labor was induced for strictly defined situations. But as time went on the fascination with technology led to electronic fetal monitoring for every woman. We need a fresh look at this and some common sense. I applaud the transparency of the doctor in this article!
Great article. I'm starting to wonder if it's the Fetal Monitor that is increasing the heart rate in some babies. If the baby is being bombarded with constant doppler frequencies then couldn't that be a stress to the baby? If I was a baby, I wouldn't necessarily like the sound waves coming from a high frequency machine placed right above my head. Would we place a doppler on a full grown adult's head for 24 hours? Probably not.
I thought this article was interesting and forwarded it to my midwife. She was a little less than thrilled with it, but for reasons I hadn't thought of. She, too, believes EFM is critically overused, but felt the examples used by the doctor in the article were poor, and could be quickly attacked and picked apart by other "experts", thus actually weakening the argument.
I'll cut n' paste what she had to say; let me know what you think! (All in all, however, I thought the article was a good start in the right direction!) Midwife response:
Okay: Please let me preface this by saying that I agree with the point of this article. EFM without a doubt causes a multitude of unnecessary Cesareans and puts far too many mothers and babies at risk from surgical complications. That said, Dr. Friedman gives a less than compelling argument for his case by presenting the particular labor and birth that he did.
The mother in question had already had a seizure. Her blood pressure was dangerously high. Yes, the baby came out of the C-section pink and screaming despite a bad EFM tracing, but in this particular case, that may have been because the C-section was the least stressful thing that baby had been through that day. Maternal seizures and eclampsia (which this mother had) and contractions (whch Dr. Friedman decided to induce) each dramatically reduce blood and oxygen flow to a baby. When they occur together, the reduction is even greater than the sum of its parts. The tracing Dr. Friedman saw may very well have reflected that this baby had a hard time tolerating labor. Fortunately, it did not reflect permanent, long-term damage to the baby. But does that mean that the tracing was the bad, evil thing that caused the C-section? No. Eclampsia was the problem here. It pushed Dr. Friedman into inducing a woman whose body might not have been ready to labor. It gave Dr. Friedman very little time to get the baby out because of the ongoing fear of another seizure (which can do permanent damage to mom and kill baby). And it probably stressed the baby just enough that he or she would not tolerate labor, either induced or spontaneous, under any circumstances. A pink baby at the time of C-section most likely reflected a baby with improved blood oxygen levels because contractions had stopped and mom's blood pressure dropped as a side effect of anesthesia.
We in the birthing community have a lot of reasons to oppose unnecessary EFM. But there are times when external monitoring and even C-sections are necessary. Not the easy way out and not quitting, but lifesaving. Dr. Friedman takes away from the strength of his argument against fetal monitoring by citing a case where a C-section was probably necessary, or even long overdue.