The opening line states that, ‘during labour it is important to check your baby’s heartbeat regularly’, it does not provide insight as to why this is considered important. It further recommends that a midwife or doctor carries out intermittent monitoring with a pinard or doppler ‘every 15 minutes throughout labour but more often in the ‘pushing’ stage’ (Derby Hospitals, 2009). The brochure also outlines continuous fetal monitoring and reasons why a doctor or midwife may think it necessary. Among the reasons listed are many frequently recited concerns that come under the label ‘high risk’ pregnancy, including: high blood pressure, multiple pregnancy, previous caesarean and breech presentation.
By listening to a baby’s heartbeat it is hoped that health care providers are able to identify potential emergency situations before they arise, yet, surprisingly, there is no research to support the idea that continuous fetal monitoring is beneficial. In reality, CFM is actually detrimental to birth outcomes, particularly cases considered ‘high risk’, and it has been linked to the ‘cascade of intervention’ (see fig.2). The guidelines have no solid, scientific underpinning yet they have been adopted as protocol by many NHS trusts. Medical doctor George Macones, who in 2009 was involved in the latest development of fetal monitoring guidelines for the American College of Obstetricians and Gynecologists points out, “Since 1980, the use of EFM (electronic fetal monitoring) has grown dramatically, from being used on 45 percent of pregnant women in labor to 85 percent in 2002.” (Nothrup, 2009) Over this period of time the caesarean section rate has also risen in a similar pattern. The conclusion of the Cochrane study in 2013, summarised that a substantial proportion of births which have undergone monitoring result in unplanned caesarean section or instrumental delivery (Cochrane, 2013) and the World Health Organisation suggest that, ‘The use of cardiotocography (CTG) in primary care centres could not be recommended based on the available evidence.’ (Nardin, 2007)
Labour and birth requires us to switch off our ‘thinking’ brain (the neocortex) and tune into a deeper, more mammalian structure within our mind (Buckley, 2005) During normal, physiological birth, women have an instinctive need for privacy and seclusion, to remain unobserved. Famous obstetrician Michel Odent asserts, ‘To give birth to their offspring…female mammals have to secrete a number of hormones. These same hormones are at work in the delivery of human babies. They are secreted by the brain’s most primitive of structures – those we share with all mammals’ (Odent, 2003, p.7). These theories have been underpinned by a study carried out in the 1960’s by Doctor Niles Newton in her research on labouring mice. She focused on what circumstances increased difficulties during labour to gain an understanding of more efficient techniques in supporting birthing women. In Dr. Newton’s work, some of the factors which hindered the mice included, placing them in unfamiliar environments, moving the mothers-to-be around during labour, and observing them in a cage made of glass. Each of these studies suggest that, during child birth, mammals benefit from privacy and familiarity.
When the environment is disturbed, the neocortex is stimulated, creating adrenaline, a hormone commonly associated with the ‘flight or fight’ reflex. Adrenaline slows down the progression of labour, as renowned doctor Sarah Buckley explains in her article on hormonal response during birth, “If the fight-or-flight hormones are activated by feelings of fear or danger, contractions will slow down. Our mammalian bodies are designed to give birth in the wilds, where it is an advantage to postpone labour when there is danger, and to seek safety.” (Buckley(2), 2005) This evidence suggests that intermittent monitoring causes disturbance or interference with the process.
When adrenaline is produced it causes our body to react – preparing to defend. Scientist Kerstin Uvnas Moberg, who has extensively researched the role of the hormones oxytocin and adrenaline within the body, particularly during birth and breastfeeding, explains, ‘In defensive or stressful situations, the sympathetic part of the nervous system (which regulates involuntary bodily functions) is activated, leading to increased heart activity and elevated blood flow to the muscles involved in movement. The adrenal gland also becomes more active, secreting the stress hormones adrenaline and cortisol into the blood.’ (Moberg, 2003, p.21). Your body focusing energy on reacting to the situation may detract from the effort required in the functions to give birth. To a doctor or midwife this can be perceived as a sign of distress during labour and can lead to the need for intervention. Although research is still pending for intermittent monitoring, it goes against the physiological mechanisms of birth.
Within the ‘Information for Women’ leaflets there is a strong medical bias which does not accurately or fairly reflect the true nature of labour and birth, nor is the content adequately referenced. Through language, it attempts to influence opinion towards strong surveillance and intervention during labour, suggesting that it is important to be regularly checked, without providing substantial evidence to justify the claims; which in other research has been proven to negatively impact upon birth. Decisions made in the context of fear are not free of coercion, this is not informed choice and nor does it offer all of the options or the opportunity to decline.
Overall, the implication and the tone of the text suggest that risk to the mother or baby during labour is inherent. This information is the first point of contact with maternity services and sets the foundation upon which women inform themselves and prepare for labour. Focusing on the aspects of intervention rather than a woman’s capability to give birth is setting a negative tone, putting doubt in individuals self belief.
It is a commonly held belief that advances in technology equal better outcomes. There is certainly no doubt that many modern interventions have saved lives, but with their increasingly excessive use, they also bring disadvantages where the full implications remain unknown. Rachel Reed, an independent midwife who now practises in Australia and writes the well researched blog Midwife Thinking, summarises in this succinct paragraph, ‘in the 17th century when men used science to re-define birth, the body was conceptualised as a machine and birth became a process with stages, measurements, timelines, and mechanisms. This belief continues to underpin our approach to childbirth today ‘ (Reed, 2011) If we are basing all our medical research, training of midwives, information for textbooks and much more of our understanding about birth, on this model, what vital information are we missing? We are removing the power from women by using false claims which lack any evidence to support them, abusing the basic trust many of us have in a system that promises to look after our interests. By trying to control an event which, in it’s very nature, is uncontrollable, we are damaging the truth about birth.
References and reading:
Buckley, S(2)., 2005 [online] At: http://www.sarahbuckley.com/pain-in-labour-your-hormones-are-your-helpers/
Buckley, S. 2005 [online] At: http://www.bellybelly.com.au/birth/ecstatic-birth-natures-hormonal-blueprint-for-labor#.Uflz39K2Y-M
Cochrane, 2013 [online] At: http://summaries.cochrane.org/CD006066/comparing-continuous-electronic-fetal-monitoring-in-labour-cardiotocography-ctg-with-intermittent-listening-intermittent-auscultation-ia
Derby Hospiatls, 2009. Information for Women: Listening to your Baby’s Heartbeat in Labour. P0596/1301/11.2009/VERSION4
Gaskin, I.M., 2004. [online] At: http://www.midwiferytoday.com/articles/teachrespect.asp
Krista, 2012 [online, blog] At: http://www.mamamuse.com/2012/05/how-cervical-dilation-checks-undermine-the-imaginal-power-of-birthing-women/
Moberg, K. U., 2003. The Oxytocin Factor. Pinter and Martin
Northrup, C., 2009 [online] At: http://www.huffingtonpost.com/christiane-northrup/c-section-or-natural-birt_b_323422.html
Nardin, M. J., 2007. [online] At: http://apps.who.int/rhl/pregnancy_childbirth/childbirth/routine_care/jnguide/en/
Odent, M., 2003. Birth and Breastfeeding. Clairview
Reed, R., 2010 [online] At: http://midwifethinking.com/2010/07/29/listening-to-baby-during-labour/
Reed, R., 2011 [online] At: http://midwifethinking.com/2011/09/14/the-assessment-of-progress/
Sartwelle, P.T., 2012 [online] At: http://www.bmpllp.com/publications/376-electronic-fetal-monitoring-bridge-far%22
