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Monday, February 22, 2010

Mini fetal monitor "saves lives"

While researching my last blog post, I read this article on Science Daily : a new (as of January 2009) portable fetal monitor was 'helping to save lives' in high-risk pregnancies. 

The device, which looks a lot like a cell phone, includes strapping five electrodes to mom's belly to monitor things like fetal movement, mother's heart rate, and the baby's heart rate, as well as baby's position. The monitor is capable of collecting data over a 24-hour period and stored "on a USB that doctors can access at any computer - allowing them to note any signs of danger early on."

While I'm all for helping to save lives in truly high-risk pregnancies, this kind of technology makes me raise an eyebrow. The effectiveness of EFM has been debated, and often leads to more c-sections because doctors can misinterpret the signs of true distress and freak out, often for no reason. 

The article states that "ultrasound is not a perfect technology" when doctors are monitoring high-risk women, therefore justifying the use of the new monitor in high-risk pregnancies. 
"[Ultrasound] It doesn't tell you very much about fetal movement, it doesn't tell you anything about maternal well-being and it doesn't monitor the uterus," said Ahmet Baschat, M.D., a high risk pregnancy specialist at University of Maryland Medical Center in Baltimore, Md.
The irony in this statement is that it surely seems "perfect" or accurate when doctors are trying to induce because of a baby's size, failing to admit that ultrasounds can often be off by a pound or two either way. The monitor, the article gushes, "can spot danger signs earlier, giving doctors time to intervene and help save lives."

And if this monitor tells doctors about the 'state' of the uterus, then perhaps this means more OB's would be comfortable "letting" their patients attempt a VBAC?

Oh, if only. I mean, that's what they originally said about Pitocin, ultrasounds and c-sections. They were only done in desperate measures (theoretically) and to save the mother and baby. People are still under the impression that doctors, by and large, will 'not induce you unless there is something wrong with you or your baby.' Based on the induction rates of some doctors, we know this isn't exactly true.

The article continues:
In the future, doctors intend to use the monitor for home use to wirelessly transmit health information on mother and baby to doctors' offices.
Oy. This sends up a huge red flag. How 'perfect' is this science? How much is the room for error? And if you refuse, well heck, they know where you live. They know, by reading their monitor, that you must be doing something, it sounds like. If you fail to come in by their definition of a timely manner, then they could just dispatch the police , which hospitals seem to be doing in some areas, in order to get you to comply.

I can totally see this wonderful technology being overused and abused, applied to every pregnant woman in the future rather than just those who are truly high-risk. Other interventions in pregnancy and birth that once were reserved for 'emergency' cases are now commonplace, so why not this one? And based on what we know about the sketchy credibility of EFM as it is already, there might be something to the theory that 'some day, every baby will be born by cesarean.'


Elizabeth A. said...

This fires me up too. Just one more intervention to add to the slew mothers already have to understand and try to regulate for themselves. A friend I know is pregnant and I'm ready to take on whoever if they try to force interventions on her while she's in the throws of labor.

What do you think is the best way to keep interventions at bay if a hospital birth is the only option?

The Deranged Housewife said...

Have someone with you who is a strong advocate for you, and who understands the risks and benefits of what you might be offered/encouraged/talked in to doing. I had a doula during my second labor, and from that experience, I was a better advocate for myself during my last labor (which she could not attend). If you are a birth support person for your friend, just having been through it yourself and having knowledge to back up your decisions can help her.

During my third pregnancy, I developed the same minor complications that were addressed totally differently in my second pregnancy. Therefore I felt my doctor was being alarmist and I refused a c/s when it was initially offered to me. It's a hard call, though. You don't want to ignore advice that will likely save your baby's life, nor do you want to be talked into something that's totally unnecessary and puts you through way more than needs to be. Having a good nurse on your side can help too - someone who knows the business, knows the medical side of it, but is also an advocate for you, too. And if you get someone nasty, you can always request that someone else care for you!

AtYourCervix said...

I think that the key with this "new technology" (which is not new, by the way, it's just reinventing the wheel), is that it's use is for inpatient hospitalized high risk pregnant women who need continuous fetal monitoring. If the pregnancy is at risk, she would not be at home for this monitoring, in case a quick intervention is required.

The Deranged Housewife said...

Is this a case, then, of the media misrepresenting the whole thing? Or the doctors doing so? I feel like the article did not make that clear at all. I agree, the technology behind it isn't so much new as the method of delivering that technology. Like the same old thing but in a new package.

Do you agree that perhaps this is going down a familiar road of eventually putting everyone in that 'high risk' category now, much like regular EFM and inductions, which used to be only reserved for true high-risk patients?

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