NICHD Consensus Development Task Force report: predictors of intrapartum fetal distress---the role of electronic fetal monitoring

A half century of electronic fetal monitoring and bioethics: silence speaks louder than words

Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal monitoring (EFM), which evolved to become the fetal surveillance modality of choice for virtually all women in labor. Autonomy rapidly pervaded all medical procedures, but there was a clear exemption for EFM. Even today, EFM remains immune to the doctrine of informed consent despite continually mounting evidence which proves the procedure is nothing more than myth, illusion and junk science that subjects mothers and babies alike to increased risks of morbidity and mortality. And ethicists have remained utterly silent through a half century of EFM misuse. Our article explores this egregious ethical failure by reviewing EFM's lack of clinical efficacy, discussing the EFM related harm to mothers and babies, and focusing on the reasons that this obstetrical procedure eluded the revolutionary change from the Hippocratic tradition to autonomy through informed consent.

Perpetuating Myths, Fables, and Fairy Tales: A Half Century of Electronic Fetal Monitoring

Electronic fetal monitoring (EFM) entered clinical medical practice at the same time bioethics became reality. Bioethics changed the medical ethics landscape by replacing the traditional Hippocratic benign paternalism with patient autonomy, informed consent, beneficence, and nonmaleficence. But EFM use represents the polar opposite of bioethics' revered principles-it has been documented for half a century to be completely ineffectual, used without informed consent, and harmful to mothers and newborns alike. Despite EFM's ethical misuse, there has been no outcry from the bioethical world. Why? This article answers that question, discussing EFM's history and the reasons it was issued an ethics pass. And it explores the reason that even today mothers are still treated with blatant medical paternalism, deprived of autonomy and informed consent, and subjected to real medical risks under the guise that EFM is an essential safety device when in fact it is used almost solely to protect physicians and hospitals from cerebral palsy lawsuits.

Changing rates and indications for cesarean sections at a community hospital from 1972 to 1979

The indications for all cesarean sections done at Charleston Area Medical Center from 1972 to 1979 were reviewed. The cesarean section rate rose from 4.4% in 1972 to 8.8% in 1975, to 17.2% in 1979. Repeat cesarean sections accounted for 30.3% of all cesarean sections. The increase in the rate of primary cesarean sections was due to more cesarean sections being done for old indications as well as for the additional indications. From 1972 to 1979, cesarean sections performed for indication of dystocia increased threefold, for fetal distress ninefold, and for breech presentation elevenfold. Dystocia, however, remained the leading indication for primary cesarean section. Even though more cesarean sections and fetal surveillance tests were done from 1976 to 1979 than from 1972 to 1975, the perinatal mortality rate during the two four-year periods was not significantly different. Recommendations are made to a more objective and rational evaluation of the need to perform cesarean sections and for a periodic audit of both the operation and cost-effectiveness of the newer technology.