I have found in my practice that things come in three to make me reflect on my practice, this time it is the use of fetal scalp electrodes (FSE) – the lesser of evil perhaps than rushing labour with an instrumental delivery because the fetal heart cannot be heard properly or at all.
I was in three delivery rooms today of three quite varied cases and reasons. First the woman whom I was caring for; initially loss of contact on the continuous electronic fetal monitoring (EFM) due to the position of the woman who was standing in second stage labour. A clear case for FSE so that woman could continue to labour in the position that suited her. In my opinion it was felt that the doctor was being too trigger happy to deliver the baby as baby came out in excellent condition following a ventouse delivery which in turn had required a small episiotomy cut. The fetal cord bloods taken showed that this baby was not a distressed baby at all.
The second delivery I attended was when I answered an emergency bell. Fetal heart rate was not being heard at all on the EFM as very small and the baby was actually coming down the birthcanal. It had apparently been hard to get a good trace throughout, so again a clear case for an FSE due to the difficulty of the EFM. Again a ventouse delivery and episiotomy possibly unnessesary as baby came out in excellent condition.
The third delivery I attended happened very quickly and as there was a lot of very loud screeming I thought I should see if the midwife needed some help in calming this very distressed woman. In this particular case there was no need for a FSE but had it gone slower then maybe it would have been justifiable, as there really wasn’t much of a trace to go on as it were.
The failure to use them is probably due to a history of not enough equipment in general and a continued lack of all equipment actually offering FSE monitoring. Because of this we are in general not very good at siting them, and in my experience it becomes a very stressful intervention due to the need to run around finding and puzzling together the equipment needed, but I think it may be time to address this issue to improve to the practice in the unit, maybe it would reduce what seems to be unnessesary instrumental interventions. The lesser of two evils I think perhaps.
- more accurate fetal monitoring help make better clinical decisions (rather than make them blindly)
- active positions for mother can be encouraged as there will be no loss of contact when secured
- infection risk to both baby and mother