News Alert! Printable Practice Bulletin on Fetal Monitoring
News Alert! I have now published a free, printable practice bulletin about fetal monitoring that can be used to start discussion between care providers and consumers.
What is a printable practice bulletin? Printable practice bulletins are short versions of posts from my blog. They are written in the language of healthcare providers. My hope is that consumers can use these handouts to discuss evidence-based practice with healthcare providers. You have my permission to print this content to share with your care provider. If you are a childbirth educator or doula, you have my permission to print this content to use as handouts for your clients. You have my permission to share this content online (un-altered, in PDF format) or links to this content from other websites. I only require that with any use, you reference my name and website as listed on the file (these practice bulletins are copyrighted), and do not alter the contents of the file at all.
What is the take-home point of this newest printable practice bulletin?
In summary, evidence clearly demonstrates that the best option for most women and babies is intermittent auscultation. Continuous EFM increases the risk of C-section and vacuum delivery and does not improve neonatal outcomes. Routine use of continuous EFM and “admission strip” EFM is not supported by best medical evidence.
To download the NEW printable practice bulletin on fetal monitoring, click here!
For a list of available printable practice bulletins (ranging from water birth to IV fluids during labor), click here.
For a testimonial about a first-time mother’s quest for evidence-based fetal monitoring, click here.
For the original Evidence Based Birth article on evidence-based fetal monitoring, click here.
What other printable practice bulletins would you like to see published? What has been your favorite bulletin so far?
CEFM may increase the cesarean risk and it has not been shown to decrease the cerebral palsey rate. But it has decreased the intrapartum stillbirth rate and decreased the neonatal seizure rates by 50%.
Preventing Primary Cesarean Sections: Intrapartum Care. Tekoa King CNM, MPH. Seminars in Perinatology 36:357-364 2012
Interesting observation. The same issue of Seminars in Perinatology had a different article devoted entirely to continuous electronic fetal monitoring. You may want to check it out– The first cesarean: role of “fetal distress” diagnosis. Semin Perinatol. 2012 Oct;36(5):379-83. http://www.ncbi.nlm.nih.gov/pubmed/23009972. Their conclusion was that yes there was a 50% reduction in seizures, but this benefit was only seen in trials where continuous EFM was used together with fetal blood sampling. There is no beneficial effect on perinatal death (that includes stillbirth)– this finding has been confirmed in several meta-analyses. These meta-analyses led the U.S. Preventive Task Force to give EFM a grade of D– the worst grade that can be given. The researchers also concluded that the evidence is overwhelming that continuous EFM causes more harm than good. When discussing EFM, obstetricians often point to the fetus that was “saved,” but how can you say that these fetuses would not have been saved with intermittent monitoring? And how many more women underwent unnecessary procedures, had significant morbidity, or even died as a result of a false-positive interpretation?
Every profession has its sacred cow. Is this one yours? I appreciate your taking the time to comment, and I actually don’t mind your dissenting opinion because you state it nicely and without being mean. But I think you need to support your opinions with some stronger facts.
CEFM is used most often in hospitals. Multiple patients at a time on the unit, sometimes nursing ratios that are not ideal can really benefit by using cEFM. I do not believe cEFM is all that bad, and it is more the interpretation of the tracing that is the problem. IA has its place, and when used right may have safe results. Bottom line is, IA is as IA is used. And too many women in labor don’t want to be monitored according to protocol. Worse, many midwifes allow their clients to space out their monitoring intervals to placate them. I recent Internet blog anecdote on BBC demonstrates this IA with homebirth resulting in a stillbirth. I speculate cEFM in the hospital would have left this woman with a cesarean and a live child.
http://community.babycenter.com/post/a37741663/my_sweet_kaiya_lynn
I am sorry Captain Obvious, but I cannot believe you are using posts on Baby Center as evidence to back up your claims. The whole point of this website is to present evidence based on systematic research, and then present first-hand testimonials of how consumers and care providers put that evidence into practice. I don’t mind dissenting opinions, but the next time you post a “factual” statement such as “IA results in stillbirth” and back it up with a Baby Center link, I will NOT post your comment. I see this space as a kind of public classroom. However, like my university classroom, if a student repeatedly makes irresponsible comments that are not based on evidence, I call them on it and ask them to stop. As this is your second use of Baby Center to back up false claims today, consider this a friendly warning!
Thank you for this informative post. I appreciate your well researched and evidence based approach to the subject of childbirth. This is the kind of information I like to share with my clients.
On a side note – I am amazed at your patience with your “anonymous expert” Captain Oblivious.