Tuesday, March 12, 2013

Two Personal Thoughts on Electronic Fetal Monitoring

As mentioned in my last hiatus-breaking post, I am pregnant! This pregnant:

Which is pretty darn pregnant. It's neat! I have had a really easy, enjoyable, and interesting pregnancy this far, and I want to write about it more generally sometime soon.

For the moment, though, I have two thoughts to share about electronic fetal monitoring (EFM). Until yesterday, EFM was a topic I was familiar with only from second- (third-, fourth-) hand knowledge and my professional interest.

Close to 90% of people laboring and delivering in American hospitals have continuous or near-continuous electronic fetal monitoring (1). The practice persists despite evidence showing that intermittent fetal monitoring accomplishes the same good effects without the negative side effects (higher cesarean section and instrumental delivery rates as well as decreased mobility, increased discomfort, and a shift in focus from the person in labor to the machine and its output) (2).

Like many aspects of pregnancy, experiencing EFM myself has given me a richer and different kind of understanding. My primary caregiver here is a midwife. However, I needed a prescription for Rhogam, so I went yesterday for a brief visit to a Frauenärztin (OB/GYN).

After peeing in a cup and a brief stint in the waiting room, the nurse brought me back to a pleasant exam room with "CTG" on the door and said they'd be taking about 10 minutes of CTG recording (me: huh? turns out, electronic fetal monitoring = Cardiotokographie auf Deutsch).* I don't actually know if this use of EFM is common in US prenatal care or not. Anyone?

She strapped on the two monitors while I was semi-reclining and left the room. I had gotten my book out to read, but I was very distracted and uncomfortable. I noticed two aspects of being hooked up to the EFM that either I had never read or heard about (or more likely had never really thought about until it was my own body):

1. I was uncomfortable lying flat on my back, but afraid to shift around too much and mess up the recording.
Obviously, I wanted a good recording so as not to create false worries. Rationally, I can't imagine that slight shifts in my position would have made a difference, but the thought remained and thus so did I. In labor — hypothetically, as I will be having periodic doppler checks rather than EFM — I have to imagine that what I know about the benefits of moving around would overcome my fear of messing up the recording. Still, it was interesting to me just how constrained I felt, and I imagine this feeling is hardly unique to me.

2. I couldn't touch my own belly.
My favorite part about this stage of pregnancy is holding onto my belly and communing in this way with my fetus. I cannot ever get enough of feeling it kick and squirm around. When Aaron is talking loudly, it often starts moving around wildly, and it seems like it sometimes responds to my voice too. When the EFM process was stressing me out a bit, I wanted nothing more than to calm us both down by holding and stroking my belly, but I couldn't because of the straps and monitors (and the transducer goop). It was incredibly frustrating being held at length from my own body in this way, even for a short period of time. I can't imagine how much worse that would be in labor.

*When we were talking about the upcoming visit, my midwife said they would definitely offer a full ultrasound, and possibly also an internal exam. She encouraged me to accept or decline these and other proffered care based on my personal feelings and clarified that I would not be required to accept them in order to get the prescription. I really appreciated this information as I know next to nothing about patient rights in Germany (especially compared to my understanding of that topic in the US, which is a source of generic confidence for me in receiving medical care there). I had decided ahead of time to decline both of those options, and was caught off guard by the expectation of sitting on the EFM for 10 minutes. Would I have declined if I'd thought ahead about it? I'm not sure. Maybe? Fetus Turon had been blorping about all morning and my next midwifery visit (at which she listens to fetal heart tones with a doppler for 30-45 seconds) is next week, so I was not short on other ways of knowing that everything was fine. If I had to make another OB/GYN visit for some other prosaic reason (e.g. not reduced fetal movement or something where EFM would be important and useful) I would decline it.

(1) http://www.childbirthconnection.org/pdfs/LTMII_report.pdf
(2) http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006066/full

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