Monday, November 7, 2011

Don't tie me down: CFM vs. IA

When you think of a woman in labor, what do you picture in your mind?


(me in labor with my son in 2007)

Or this?

(Me in labor, August 2011)

Most would know nothing but the first.  If you're reading this blog chances are that you know more than most.  In picture number one, you see the typical hospital birth; Hospital gown, chux pads, IV, white sheet, bright computer screens and continuous fetal monitoring, or CFM. (CFM is defined as using a device strapped around the belly of the mother to continuously and simultaneously monitor fetal heart rate and contraction of the uterus)  CFM is standard practice in hospitals.  It was thought that by continuously monitoring the fetal heart rate along with contractions, a care provider would better be able to assess whether or not the baby is in distress.  We have learned, however, that this is not the case .

In 2009, the American College of Obstetrics and Gynecology (or ACOG) released this article.  I'll use an excerpt from the article and you yourself can interpret the meaning.

One of the problems with FHR tracings is the variability in how they're interpreted by different people. The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22% of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings.

So let's start with this:  There are no guidelines as to how to interpret the CFM results.  This means that your physician is free to interpret them as he/she pleases.  This also means that if there happened to be an adverse outcome, there are no guidelines to hold your physician accountable for misreading or purposely misinterpreting results for personal convenience.

Moving on, there have been numerous studies concerning continuous fetal monitoring versus intermittent auscultation, or IA, (which is the monitoring of the fetus, usually using a handheld doppler, at certain intervals such as every 10 minutes or every 2 contractions) and none of them have concluded that CFM is any more effective at assessing fetal distress.  In fact, CFM has been proven to increase cesarean and medical intervention rates1 but not decrease perinatal mortality2.  

So, CFM increases your rate of cesarean section and medical intervention yet does not effectively evaluate whether or not your baby is in distress.  ACOG does not endorse CFM used on normal pregnancies.  CFM is proven to decrease the rate of normal, vaginal birth and therefore compromises the health and wellbeing of mother and baby.  Although it is obviously proven to be a disadvantage to women in labor, most hospitals require it.  So, why, if it is no more effective and actually causes disadvantages to mom and baby, is it so routinely used in hospitals?

IA is proven to be just as effective at determining whether not a baby is in true distress.  Using IA instead of CFM allows mom to be mobile in labor which not only helps progress labor and cervical dilation (which reduces her chances or receiving pitocin3 or other labor augmentation drugs), but allows her to be in a comfortable laboring positions to better handle the intensity of contractions.  If she can better handle the intensity, she is less likely to request an epidural4.  Mom can also choose from multiple birthing positions including pushing on her hands and knees or while squatting which both help by opening the pelvis and easier allowing baby to come through.  There is no need for mom to change positions or even move at all during IA.  (They even stuck the doppler underwater when I was in labor!)

There are so many things wrong with this picture.  Knowing that CFM is causing moms to be subjected to unfair and unnecessary intervention and that many care providers use it despite all of this, I start to wonder whether or not we actually care about moms and babies.  If we did, wouldn't it be different?  Don't hospitals do what the people want?  They are businesses.  If nobody paid them to do what they do, they wouldn't do it.  So to me, the responsibility rests on you, moms.  I'll say it once and I'll say it a million times.  We understand not being educated... but now you are.  So what are you going to do about it?  If birthing your first child was a traumatic experience , are you going to proceed to have your second child in the same place, under the same thumb of the same care facility and just hope it's better this time around?  I, unfortunately have seen this situation many, many times.  You were failed by people you trusted.  You were lied to.  And it is not your fault. But do you want to know the best part of it all?  You have choices. You have a voice.  You have people you don't even know who want you to be able to birth without fear.

You decide for yourself.  I can only give you the have to be the 99% that change the way it works.


LINK; Page 8-9

LINK Page 8-9



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