As a Houston, Texas medical malpractice and birth injury attorney, I monitor practice standards and bulletins published by medical organizations, like the American College of Obstetricians and Gynecologists (ACOG).
From my experience in handling numerous birth injury, brain injury, and cerebral palsy cases, I have heard medical experts describe ACOG as a “political organization” that aims to minimize physician liability or responsibility for mistakes. While it is hard to know for sure what motivates the authors of ACOG recommendations, some of them have left me questioning whether patient safety was a foremost concern.
For example, in February 2017, ACOG released its Committee Opinion 687, recommending that OB/GYN physicians decrease many labor and birth treatments that have become commonplace even to low-risk women. One of the recommendations immediately caught my eye.
The new ACOG committee opinion endorses using a handheld device, like a Doppler or fetal stethoscope, to listen to the baby’s heart tones at intervals, rather than having continuous electronic fetal monitoring (EFM) during labor. The stated rationale for this change in recommendation is that this practice reduces the mother’s likelihood of giving birth by cesarean delivery (C Section) or a vaginal birth with forceps or vacuum extraction.
I have to say up front that I find this recommendation disturbing and believe it does not promote safe patient safety.
Electronic fetal monitoring involves placing two belts on the woman’s abdomen. The first belt has an ultrasound sensor that monitors the baby's heart rate. The second belt has a pressure sensor that monitors the mother’s contractions. The sensors are connected to a machine that produces an electronic and printed record called a fetal monitoring strip.
In my observation, most hospitals routinely use electronic fetal monitoring for women in active labor. Labor and delivery nurses are trained to interpret electronic fetal monitoring data, including drops or decelerations in the fetal heart rate and their significance, based on the timing of the decelerations in relation to contractions.
While OB/GYN physicians certainly have the training to interpret a fetal monitoring strip, the challenge is that these doctors are not constantly in the hospital and monitoring their patients. Therefore, physicians depend on the labor and delivery nursing staff to recognize dangerous, time-sensitive potential problems and to inform them immediately so they can promptly assess the patient and, if necessary, perform an emergency delivery.
As I see it, the idea of transitioning away from routine electronic fetal monitoring for women in active labor is a danger to patient safety. One might view patient care through “rose-colored glasses” and conclude that checking on a patient occasionally with a handheld device might work fine. In my experience, though, listening to the complaints of thousands of patients and family members, labor and delivery nurses are busy, which means that things fall through the cracks. When it comes to fetal emergencies, there is no room or time for error.
With electronic fetal monitoring, though, there is a continuous record of the baby’s heart rate and maternal contractions and audio alarms can demand the attention of the nursing staff if the computer recognizes something out of the ordinary.
What you can do
If you are pregnant, I recommend having a conversation early in your prenatal care with your OB/GYN physician about his or her typical use of electronic fetal monitoring and what is typically done at the hospital where your baby will be delivered. It is important to be on the same page with your healthcare providers.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.