Electronic Fetal Monitoring and the dramatic rise in C-sections

I was doing alright in labour, until I was strapped to a bed. I have no doubt, not a single one, that the midwives with me that day were doing everything possible to keep me and my baby well, and as happy as possible.

But I did not feel I could refuse monitoring. It was even implied to me (in pregnancy) that I would be reported to social services and directly responsible for killing my child if I did not agree to monitoring. Even I can't believe that is true now it's written there.

Did my son's irregular heartbeat indicate he was distressed, in danger? His apgar score of 8 after 1 minute, indicates he was alright.  

But would I have risked refusing monitoring, when my consent was not even requested to hook me up? Even going back and doing it again knowing he is very healthy? I don't think so.  Not on my own. That's why I'm hiring a doula next time.

But that is me, and personal anecdotes - although they might form a scarily large part of our knowledge - are not always worth much.  

So, what is really going on?  

Why do we get monitored during labour? Duh. To check if the baby is OK. If their heart rate is normal, they are probably ok. Right? 

Yeah, that is why EFM was introduced and so widespread that by 1976 it was used in 78% of births in the US. To ensure that there were fewer complications at birth and therefore fewer cases of neurological problems caused by lack of oxygen and trauma. Cerebral Palsy is the most cited of these 

But here is the issue with that premise: there has been no drop in the number of births with CP, not even when the lower rate of death rate of premature babies is taken into account. EFM has not prevented or reduced the thing it was meant to do.  

So what has it done? Higher C-section rates? Due to issues being assumed and birth not progressing due to women lying still on their backs listening to their baby's distressed heart rate?  

And of course, given a written record of a baby's heart rate to be used in court if there are any trial proceedings. 

Yes, I am writing this a little flippantly. And I cannot ever prove that my baby, or your baby would have been fine if we'd birthed at full moon, in a woodland glade, with a family of badgers to guide her earth side, as we shot colostrum into a pail nearby from our plentiful breast. I get that. 

But it makes me angry that women are yet again subject to paternalistic compliance, forced into a painful, restrictive and ineffective mode of labour for the convenience of an organisation.

And I think sometimes it's ok to shout another side to a story when all we ever hear is the other. Yes we need balance, yes we need sense and expertise, but we also need to step back and say "why the fuck are we doing this?" every once in a while. 

This is the article that blew my mind: 

A half century of electronic fetal monitoring and bioethics: silence speaks louder than words,

Thomas P. Sartwelle, James C. Johnston and Berna Arda.