Birth can be a hazardous journey: electronic fetal monitoring does not help

Intrapartum fetal health surveillance, in particular electronic fetal heart-rate monitoring (EFM), is a perinatal issue that has sparked much debate both nationally and internationally. Prevention of cerebral palsy is a major objective of all health-care providers when assessing fetal health in labour. The Fetal Health Surveillance Working Group of the Society of Obstetricians and Gynaecologists of Canada (SOGC) should be commended for its efforts in presenting and discussing the literature and for raising important issues in EFM in the SOGC's Clinical Practice Guideline on Standard Fetal Surveillance in Labour, published in JOGC in March 2002, the first half of the SOGC document Fetal Health Surveillance in Labour. These, as all, SOGC Clinical Practice Guidelines are widely used by hospitals and health-care providers when evaluating practices in their own environments, and we believe, as practitioners of and investigators in fetal health surveillance, that there is not good supporting evidence for recommending continuous intrapartum EFM for pregnancies in which there is an increased risk of perinatal death, cerebral palsy, or neonatal encephalopathy, or when oxytocin is being used for induction of labour, and that if we recommend that the fetal heart be electronically monitored while the nurse is elsewhere, we are on a slippery slope. We encourage reopening discussion regarding these recommendations in the document.