FHR monitoring

[MandaRN94]

I just finished an article in "The Female Patient" about Fetal Heart monitoring. 85% of the 4 mill births in the US use electronic FM. They have found that since the invention and use of EFM there has been no decrease in CP, no effect on perinatal mortality or neurologic morbidity. But there has been an increase in c/s. They also found clinicians disagree 80% of the time of evaluation of EFM with each other. The article also discussed it won't be long before computers are doing the interpreting for us. Great article -thoughts or comments?

[miss81, BSN, RN]

I plan to take a longer, better look later, but that algorithm on S16 appears to be for NST's, not labor. I, for one, would be very happy to not have to remember multiples of classifications. It's getting out of hand.

Sorry, I meant to quote pg. S37 for the table. Fetal Surveillance in Labour starts on pg. S27 of the JOGC article.

[tntrn, ASN, RN]

The answer is for moms to educate themselves and and make informed decisions before labor starts, discuss their goals and desires with their doc and be willing to go to someone else ot to a different hospital that will be supportative of their desires. If they live in a rural area with no choice of hospitals, they have to be willing to be assertive in getting what they want. If a patient refuses. The usual procedures ( IV or saline lock), a nurse cannot force her to have one. That would be battery. In my hospital if they refuse treatment ordered by the doctor, we. Ask them to sign an " against medical advice" form after explaining risks and benefits of the refused treatment and risks and benefits of not having the treatment. For instance a previous C/S who comes in in labor and refuses a repeat section or transfer to a facility that does do VBACs (the nearest one is 4 hours by car from us and would involve a helicopter or fixed wing plane ride which costs a lot and probably wouldn't be covered by any insurance.

And part of taking responsibility for those decisions, the patients must also take responsibility, at least in part, for any negative outcomes.

[ischialspines]

continuous EFM is all about lawsuits. In 18 years, they'll be a monitor strip to prove the nuances that you did/didn't see. Also, docs like being able to watch their pts from the office now --- a tad frustrating for the nurses sometimes :)

Our policy is cEFM unless the pt has made a previous agreement c doc otherwise. And if at any point we use pitocin, epidural, sedation, or otherwise the pt becomes high risk - then cEFM.

I really do think that obstetric cases need to be handled differently. Perhaps a separate filing system similar to the vaccine injury compensation program that allows for payouts without lawsuits being filed (and the enormous cost of filing them). There will be injury and death with birth sometimes. It's inevitable. But having a different system in place could really limit the reactive obstetric climate at the moment and perhaps improve patient outcomes.

[MamaCJRN]

I encourage my patients that are low risk with a reassuring FM strip to walk, use the birthing ball or sit under a warm shower and use intermittent monitoring. Unfortuantely, many choose to stay in the bed or get the epidural ASAP and are on the monitor continuously. We even have a portable monitor that works by telemetry so they can ambulate with the monitor on, if necessary.