Monday, March 19, 2012

Continuous Fetal Heart Rate Monitoring: Hospital Admissions

I've been posting a lot of research lately, but it is because research is just so great :) Really, can you think of a better way to grow and develop as a society? Research teaches us what has been, and maybe what should be. At its best, research results in positive change (there is also research at its worst, but that is a story for another day...)

I came across this recent systematic review from The Cochrane Library. [Side Note: If you don't know what The Cochrane Library is, and you are interested in health care (either personally or professionally), then you should be finding out! The Cochrane Library is an independent organization that conducts high-quality reviews, which provide evidence for health care decision making. Ever wonder why a doctor will prescribe a specific drug for your ailment? It's because of reviews that the doctor is able to read, in one paper, a summary of all existing evidence on a particular drug. If the evidence overwhelmingly shows in favour of the drug for treatment, then bingo! You get a prescription.]

The paper I linked to above is about cardiotocograph (CTG). When you go into labour and believe that it's time to head to the hospital, you will be assessed in triage. You're led to a little room, where the nurse will strap you to monitors which will record your baby's heart rate. This is normally done for about 20 minutes, during which time you will receive a cervical exam, and either be sent home or admitted to a room.

Granted, this is not done at all hospitals. Some will just listen to the fetal heart rate intermittently, quickly check you, and then determine whether it's time to be admitted. But generally, CTG is the way that things are done if you are under the care of a doctor or obstetrician (this blog post states that 76% of Canadian hospitals use CTG upon admission)

Why is this important? The Cochrane review that I linked to above found that c-section rates increase by 20% for women who undergo CTG compared to intermittent monitoring. Interesting, isn't it?

Science clearly shows that low-risk pregnant women should not be monitored continuously. In fact, this is an intervention that Lamaze International recommends you try and avoid, because continuous monitoring shows no benefits - only harm. Harm in the form of abdominal surgery, apparently.

In my experience, women that are strapped to monitors upon admission to hospital generally become agitated and no longer cope very well with their contractions. Not surprising, given that they are forced to lie in a bed, in a tiny clausterphobic room, and listen to the clippidy-clop of their baby's heart.

And yet, despite all the overwhelming evidence that shows that this type of monitoring can be harmful, we're still doing it! As I wrote in a previous post, it's all about the lag time between research findings and shift in practice.

But you know what does change policy? That's right - you dear readers! The women out there giving birth have the right to ask for good evidence-based care. When more women request a procedure (or decline a procedure), policies change over time to accommodate patients' wishes.

What has been your experience with hospital admission? What do you think of this 20% increased risk in c-section?

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