Fetal Monitoring: Creating a Culture of Safety With Informed Choice

Abstract

The dominant culture in labor and birth is the medical model, not the midwifery model of woman-centered care. Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM). Barriers impact the laboring woman's ability to give informed choice regarding fetal monitoring. Lack of informed choice denies a woman her right to be in control of her birth experience, and is in opposition to a woman's right to autonomy and self-determination.

Assessment of foetal heart rate monitoring devices in referral hospitals in Tanzania: Towards improved quality of intrapartum care

“…58,59 Morover, these guidelines recommend a 1:1 midwife-to-woman ratio, which is not feasible in LIC. 60,61 Even those guidelines that have been developed for global use have not been adapted to respond to local needs. Most of the recommended techniques are feasible in HIC, and few studies have been completed in LIC.…”

Cerebral Palsy and Electronic Fetal Monitoring: Rearranging The Titanic’s Deck Chairs

“…Out of the hundreds of thousands of words BRPOs wrote about EFM, none addressed the autonomy issue. This silence continued even when a few tiny voices labeled EFM a classic autonomy issue begging to be addressed [77][78][79].…”

Electronic Fetal Monitoring, Cerebral Palsy Litigation, and Bioethics: The Evils in Pandora’s Box

“…When EFM entered clinical practice obstetricians comfortably operated on the Hippocratic principle of making all choices for mothers in labor without asking or explaining [38][39][40][41][42]. Literally the doctor knew best.…”

“…Bioethicists, the champions of autonomy, were silent regarding the obstetrical community's EFM postmodern ethical relativism [5,10,26] This bioethical silence is curious since pointed reminders appeared in the literature over the years, including as recently as 2015 [38], that mothers were entitled to informed EFM choice [39][40][41][42]. None of these reminders, however, came from bioethicists [5,10,26].…”