The Beatnik Turned Natural Birth Expert
Risks of the Electronic Fetal Monitor
Journal article by Margaret Lent; Stanford Law Review, Vol. 51, 1999 The medical and legal risks of the electronic fetal monitor.
by Margaret Lent
Electronic fetal heart monitoring (EFM) is the most widely used method of monitoring the fetal heartbeat for possible signs of distress during delivery. Soon after its development in the 1960s, EFM replaced intermittent auscultation as the standard of care in the obstetrical community. However, Margaret Lent argues that the widespread use of EFM is both medically and legally unsound Lent points to a series of clinical trials that demonstrate that EFM does not reduce fetal mortality, morbidity, or cerebral palsy rates. These studies suggest that EFM has a very high false positive rate, and that EFM usage correlates strongly with a rise in cesarean section rates. Similarly, EFM provides no protection in the courtroom. Though obstetricians believe that they should use EFM because its status as the standard of care will protect them from liability, Lent argues that it may in fact expose them to liability given its failings. Instead, she argues that auscultation is equally, if not more, safe and effective, and is more likely to protect physicians from liability. Lent concludes that obstetricians have an obligation to their patients and to themselves to adopt auscultation as the new standard of care.
The medical profession depends on the latest medical technologies to provide top quality care and to extend that care to a greater pool of patients. This dependence is all well and good where the method, drag, or device is tested in clinical trials that establish its efficacy and safety. But what happens when new technology diffuses rapidly into mainstream medicine well before it has been adequately tested? more...
DOULAS FEATURED ON THE TODAY SHOW
Expecting parents: What is a doula?
A trained birth assistant can help provide support for women and families
By Marisa Belger TODAYShow.com contributor updated 11:57 a.m. ET, Thurs., Nov. 20, 2008
By the eighth month of my pregnancy, I had become accustomed to the blank stares and raised eyebrows I received at each mention of my doula. Maybe it was the “doo” or maybe it was the “lah,” but there was something about the tone and feel of the term that rendered the uninitiated people in my life either instantly confused or quickly judgmental.
The former were usually unfamiliar with the concept of a doula, or trained birth assistant, while the latter often held a preconceived notion of what it is that a doula does — one such person going so far as to ask if my doula would be dancing around me with a rain stick while I breathed through my contractions.
If a rain-stick dance is what I felt I needed to enhance my birth experience, there’s a good chance that a doula would deliver. But my reasons for enlisting the services of a doula were much more simple, going back to the origin of the word...continue reading here
Birth Doulas Make a Difference
The value of providing laboring women with continuous emotional support, physical comfort, and encouragement has been recognized worldwide. (Taken from www.DONA.org)
Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement. Hodnett, E.D. Support from caregivers during childbirth (Cochrane Review) in Cochrane Library, Issue 2. Oxford Update Software, 1998. Updated Quarterly.
A doula provides support consisting of praise, reassurance, measures to improve the comfort of the mother, physical contact such as rubbing the mother’s back and holding her hands, explanation of what is going on during labour and delivery and a constant friendly presence. Such tasks can also be fulfilled by a nurse or midwife, but they often need to perform technical/medical procedures that can distract their attention from the mother. Care in Normal Birth: a Practical Guide. Report of a Technical Working Group. World Health Organization, 1996.
Facing unprecedented pressures to reduce expenses, many hospitals are targeting the largest single budget item – labor costs… (An) unintended consequence of nursing cutbacks may be an increased cesarean rate; the inability of pared down nursing staff to provide continuous coverage to laboring mothers (has been) shown to increase the chance of a cesarean…Doulas clearly improve clinical and service quality; they provide an absolutely safe way to reduce cesareans and other invasive birthing interventions. Coming to Term: Innovations in Safely Reducing Cesarean Rates. Medical Leadership Council, Washington D.C. 1996
Professionals have paid much attention to innovative technology and the many new options for monitoring and managing labor. While the technology is important, it can become so prominent that clinicians ignore both the natural aspects of labor and the non-technical needs of women in labor… Changes that support the patient in labor and reinforce the natural, physiologic process…. Includes providing one-to-one psychological support for patients using nursing staff or doulas. Reducing the Cesarean Section Rates while Maintaining Maternal and Infant Outcomes. Bruce L. Flamm et al. Institute for Healthcare Improvement, Boston, 1997
The continuous availability of a caregiver to provide psychological support and comfort should be a key component of all intrapartum care programs, which should be designed for the effective prevention, and treatment of dystocia (non-progressive labor). Guidelines on Dystocia. Society of Obstetricians and Gynaecologists of Canada, 1995.