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How Electronic Fetal Monitoring Can Prevent Cerebral Palsy

By Howard A. Janet
Originally published in Cerebral Palsy Magazine, February 2006

Knowledge is power. As the parent of a child who suffers from the effects of cerebral palsy (CP), you are well aware of this old adage. That’s why you spend countless hours reading, searching the Web and poring over new sources of information about CP, its symptoms and advances in treatment. You tirelessly seek any shred of knowledge that may help maximize your child’s abilities and strength, improve his health and enhance his quality of life. When it comes to your child’s well being, you don’t rely solely on your doctor; you are proactive. You do your own homework.

You recognize that there is more new and emerging information about cerebral palsy available than any one treating physician may know. And you understand that your doctor is focused on treating patients. He has only a limited amount of time to spend with you.

So, you burn the midnight oil. You leave no stone unturned.

The intent of this article is to help parents better understand issues surrounding one cause of cerebral palsy – oxygen deprivation during labor (intrapartum asphyxia), which can lead to brain injury. A lot of conflicting information is available about the prevalence of intrapartum asphyxia, how to prevent it and how to lower the risks of it occurring in future pregnancies.

There is a myth that intrapartum asphyxia is rare—a myth that has its roots in outdated research that has been disproved in recent years. And there is a second myth that electronic fetal monitoring (EFM) is an unreliable way to assess the well-being of fetuses during labor, and therefore, it doesn’t help reduce the incidence of CP. The research and opinions of many respected physicians tell a different story.

By learning more about EFM, parents can make an informed judgment about whether this technique was used properly during the labor and delivery of their own child. More importantly, those armed with this information can take knowledgeable, proactive steps to not only ensure the safe, healthy delivery of their next baby, but may also help ensure the baby of a friend or acquaintance has the same chance of good health.

Let me be clear: CP can be prevented in many births. We don’t have to wait for medical science to find a way to prevent every CP occurrence. We can save many babies from developing this heartbreaking, debilitating condition today Brain injuries during the intrapartum period that result from decreased oxygenated blood flow to the fetus often can be detected through accurate interpretation of EFM tracings and prevented by timely, appropriate action.

A problematic EFM pattern may require something as simple as giving intravenous fluids or oxygen to the mother, turning or repositioning her, discontinuing pushing, or stopping the administration of Pitocin (intrauterine resuscitative measures). On the other hand, certain EFM tracings may require more serious action, including an emergency Caesarean section.

Generally speaking, the public is unaware of electronic fetal monitoring issues. Soon-to-be parents devour every bit of information they can find about prenatal nutrition, exercise, birthing centers and labor techniques. However, they often have no understanding of the critical role that electronic fetal monitoring can play in the outcome of their delivery.

Just as parents are encouraged to enroll in Lamaze-type classes to learn how to ease the pain of labor and delivery, every parent also should be schooled in the meaning of certain EFM patterns. It is important for parents to know enough about EFM to be aware of the right questions to ask their obstetrician and labor room nurses about their baby’s EFM tracings and how they relate to events that may occur during labor.

Remember, knowledge is power.

Research Barriers
Generally, though, parents don’t seek, nor are they encouraged to learn this kind of information. When it comes to getting the facts about how doctors and nurses use EFM tracings to monitor fetuses during labor and delivery, and the proper responses to those tracings, parents are encouraged to rely on their health care providers.

Unfortunately, too many physicians and physician organizations are generating misinformation about this topic. For example, even official obstetrical documents such as Practice Bulletin No. 62, published by the American College of Obstetricians and Gynecologists (ACOG), contain inaccurate data and downplay the prevalence of cerebral palsy caused by intrapartum asphyxia, which in some instances is quite preventable.

In fact, so much outdated research data and distorted information is in circulation that it drowns out the voices of anyone who tries to call attention to data that proves EFM can prevent many cases of cerebral palsy. The truth about EFM is so buried in misleading medical literature that parents seeking an accurate, complete picture must dig deep to find it.

Why the Confusion About EFM?
Popularized in the 1970s, EFM is a method for examining the condition of an unborn infant in the uterus by noting unusual patterns in its heart rate. EFM is a dependable measure of how the unborn child is withstanding the changes in environment and stimuli that it experiences during the birthing process. By monitoring the baby’s heart rate and graphing it on strips of paper, called “tracings,” doctors and labor room nurses have a real-time, and an overall, picture of the baby’s condition throughout labor.

Statistics compiled for 2002 indicate that EFM was used to monitor 85 percent of all births in U.S. hospitals. Many of the other 15 percent involved natural childbirth, where the parents opted to use midwives or to deliver their children in birthing centers. Even in natural settings, however, when a troublesome heart rate pattern develops during labor, those assisting with the birth usually move the mother immediately to a facility where EFM is available.

So, why would the medical community refute the reliability of EFM in publications and statements, while using it so widely and consistently?

Unfortunately, many in the medical field have an agenda that focuses more on shielding themselves or their colleagues from accountability for malpractice than with educating patients and reducing the risk of CP.

Clearly, their concerns are misguided. These physicians and organizations should be a beacon of truth and knowledge for their patients. They should be a source of facts for patients and, indeed, a fountainhead of leading-edge information for parents who want to be proactive in their health care.

But, a growing number of well-credentialed obstetricians, labor and delivery nurses, and midwives are speaking up. These preeminent members of the medical community, who use EFM every day to assess the well-being of fetuses during labor, say that EFM is viable and effective in reducing the incidence of CP, and fetal mortality as well. The efficacy of EFM is demonstrated further by the continuous increase in the percentage of births in which it is used: 45 in 1980, 62 in 1988, 74 in 1992, and 85 in 2002.

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