What Gives with Fetal Monitoring?

In 2011, six years ago, ACOG published in their FAQs for patients a section about fetal monitoring. In it they supported ALL the different methods used for assessing babies' heart rates; continuous monitoring with external or internal monitors, AND intermittent auscultation with hand held doppler or old fashioned noninvasive fetascope. Here is what they tell women about YOUR choices (not the doctor's or hospital's choices), "If you do not have any complications or risk factors for problems during labor, either method is acceptable." In a recent ACOG committee opinion they stated that, "The widespread use of continuous electronic fetal heart-rate monitoring has not improved outcomes when used for women with low-risk pregnancies."

Here's my question. Why then in the last 6 years have none of my clients laboring in our local hospitals EVER been offered to be monitored using a hand held doppler? Not once. 

Please consider printing out the linked pages from ACOG and sitting down with your doctor or nurse midwife while you're pregnant, long before labor begins, for a heart to heart on this issue. Find out what perameters your care provider uses to define low risk or complications that would place you out side the group of women this recommendation applies to. Questions might be: After 40 weeks or between 41 and 42, between 36 and 37 weeks, what pre-existing conditions, what medications, what if your bag of waters has ruptured and you are in active labor versus broken waters in early labor or no labor? Get a feel for how comfortable or uncomfortable they are with this protocol; how wide or narrow their boundaries will be. 

Remember if they agree to have the hospital staff use a doppler write this into your birth plan, have them sign the plan, initial this part and initial the printed page from ACOG where you have highlighted the pertinent info. You might also wish to include something about having had a conversation about what does and doesn't constitute low risk.  (If you don't agree or are not comfortable with your care provider's views about low risk then if at all possible you should find a doctor or midwife who is a better match rather than attempt to force a provider to provide care in a way they don't believe in.) Staple your plan and your printed pages together and don't forget to take them to the hospital!

http://m.acog.org/Patients/FAQs/Fetal-Heart-Rate-Monitoring-During-Labor

http://m.acog.org/Re