Full Circle Midwifery

From the Cochrane Library, Feb 2012:

Monitoring of the fetal heart rate (FHR) is one of the most common methods for checking a baby’s wellbeing. The two most common ways of monitoring the FHR are by listening to the heart beat using a fetal stethoscope, Pinard (special trumpet shaped device), handheld Doppler ultrasound device (this is known as intermittent auscultation) or by an electronic fetal monitoring (EFM) machine that produces a paper printout of the baby’s heart rate and the mother’s contractions, called a cardiotocograph (CTG). The admission CTG is a commonly used test consisting of a short, usually 20 minute, recording of the FHR and uterine activity that is performed when the mother is admitted to the labour ward with signs of labour. The admission CTG was introduced to try and identify those babies who were at greatest risk of becoming compromised with a lack of oxygen during labour. These babies could be monitored more intensively by continuous electronic fetal monitoring, or they may benefit from an immediate intervention such as being delivered by caesarean section.

This review compared the admission CTG with intermittent auscultation of the FHR performed on the mother’s admission to the labour ward. We included four randomised controlled trials involving more than 13,000 women with low-risk pregnancies in the review. Women allocated to admission CTG were more likely to have a caesarean section than women allocated to intermittent auscultation. There was no difference in the number of instrumental vaginal births or in the number of babies who died during or shortly after labour between women allocated to admission CTG and women allocated to intermittent auscultation. Admission CTG was associated with a significant increase in the use of continuous electronic fetal monitoring (with an electrode placed on the baby’s scalp) and fetal blood sampling (a small blood sample taken from a baby’s scalp) during labour. There were no differences in other outcomes measured such as artificial rupture of the membranes, augmentation of labour or use of an epidural.