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External Fetal Monitoring – is it useful?

Posted May 20 2010 1:34pm

I love this article in the Philadelphia Enquirer Test Leads to Needles Cesareans .

Fetal heart-rate monitoring is a screening test. Good tests get several things right; they are cheap, detect a possible problem when there is still time to act, and minimize unnecessary follow-up tests.

The Pap smear is an excellent screening test: By examining a few cells brushed from the cervix – where the vagina opens into the uterus – doctors catch precancerous changes – or even early cancer – when it is easy to treat.

But fetal heart monitoring is an appallingly poor test. The test misses the majority of babies with cerebral palsy, the condition researchers hoped it would prevent. It causes increased rates of a painful and invasive surgery: cesarean section. Even worse, almost all women undergo continuous heart monitoring during labor, not just those at highest risk.

I find this very telling.  Studies have shown time and time that EFM is not helpful in reducing negative outcomes in birth.  But it certainly does lead to higher cesarean rates.  I think that for certain moms (high risk) it can be helpful certainly, but to insist every mom who births a baby in a hospital have continuous EFM is not necessary and can lead to unnecessary interventions.

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