Wednesday, 9 October 2013

Hazards to a Pain Free Labour - 4

Cardiotocographic (CTG)  monitoring of the fetal heart rate was first introduced in Germany in 1968. It was seen as a way of reducing fetal demise and cerebral palsy rates. In practice the false positive rate for cerebral palsy is as high as 99%. That is, out of 100 non reassuring CTG traces, only one will go on to suffer from cerebral palsy or other neonatal encephalopathy. Research has also shown that use of CTG monitoring in labour is more likely to result in an instrumental or caesarian section birth.
The British National Institute for Clinical Excellence (NICE) guidelines clearly state that women who are in good health and with an uncomplicated pregnancy do not need to be monitored continuously on a CTG machine. Instead, low risk women will be offered intermittent monitoring. That is, a midwife will listen in every 15 minutes during the active first stage of labour and every 5 minutes during the second stage. The active first stage is from 5cm dilatation till your cervix is 10 cm dilated. The second stage is from 10 cm dilated till the baby has been pushed out.
Some midwives see CTG monitoring as an easy option. They only have to comment on the trace every half an hour and so it is less labour intensive.  As previously discussed in this blog, lying down in labour leads to painful contractions. In order to obtain an optimal CTG trace it is best to have the mother lying down on the bed with the back of the bed slightly raised. This position is not upright enough for a pain free labour.
A compromise can be made if you can sit on a birth ball or chair beside the monitor or a mobile monitor is available. With mobile monitors you are free to mobilise, or sit down where you are upright enough for a pain free labour. If these positions do not produce the trace that the midwife would like then that is his/her problem. They may have to press the transducer onto your abdomen in order to pick up the fetal heart, this is time consuming and only a dedicated midwife will put in the extra effort. Remember, you are the client and we are merely offering a service, you are the boss. If you do not get what you want then get your birth partner to complain. You however, have to remain calm and upright so leave the negotiating to someone you trust.
My third labour was spoiled by a midwife who forced me to lie down on a bed with a CTG running throughout the labour. I was low risk. If I had known better I would have refused the CTG and been able to sit and have my planned pain free labour. I hope you are stronger than I was and able to negotiate monitoring with a flexible midwife who has you and your baby's welfare at heart.

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