Journal of Legal Medicine
Thomas P. Sartwelle, LL.B, B.B.A.
September 19, 2012 –
Publisher’s synopsis:
The most common obstetrical procedure in the United States is electronic fetal monitoring (EFM) during labor. Approximately 85% of the 4,000,000 annual births are EFM monitored. EFM is the standard of care in virtually every community. Hospitals have invested multiple millions of dollars in electronic fetal monitoring since its acceptance into clinical practice in the late 1960s. Hospitals and physicians have billed and been paid many millions of dollars for EFM use.
Despite its ubiquity and acceptance in daily clinical obstetrical practice, there are and always have been some important, esoteric EFM secrets: its scientific foundation is feeble; inter-observer/intra-observer reliability is poor; the false-positive prediction of fetal distress rate is greater than 99%; it has substantially increased the cesarean section rate with attendant mortality and morbidity; and it failed completely in its initial stated promise—reducing byhalf the incidence of cerebral palsy (CP), mental retardation (MR), and perinatal mortality. Any other medical procedure with such an abysmal pedigree would have gone the way of bleeding by medieval barbers. But rather than abandon EFM, medicine elevated it to rockstar status. And in the last four decades more babies and mothers have probably suffered harm from EFM than have been helped.
Electronic fetal monitoring was also used as a courtroom truncheon by self-designated EFM “experts” across the United States as they assaulted their supposedly less intelligent colleagues in cerebral palsy and other neurologic birth injury trials. These experts delivered courtroom babies with perfect results, branding their unenlightened colleagues negligent because they failed to recognize the alleged EFM evidence that a child was being asphyxiated in labor. Thus the negligent miscreants sentenced the child to a lifetime of cerebral palsy or other neurologic devastation. The experts made millions of dollars kibitzing as it were. The trial lawyers sponsoring the experts made even more millions of dollars convincing juries that physicians, nurses, and hospitals caused cerebral palsy. It was, and is, junk science. But it continues unabated even today. Strangely, organized medicine stood mute to these assaults, and still does today, allowing EFM to masquerade as science. This strange litigation–junk science dance is even more confusing considering that EFM had its origins in the most important and recognized symbol of medicine’s reliance on science—the stethoscope.
This article examines EFM’s beginning, its history, its rise to ubiquity, and its use today, as well as EFM’s intimate connection to cerebral palsy and other birth-related brain maladies. It also examines EFM’s use and abuse in birth injury litigation and the international malpractice crisis that EFM spawned. The article explores the reasons why physicians and the public believe in EFM technology in spite of its known flaws, defects, and shortcomings, and why the American Congress of Obstetricians and Gynecologists (ACOG) and related worldwide professional organizations have not only failed to curtail EFM use but have actually allowed it to be elevated to the status of deus ex machina.
Finally, a suggested solution is offered for overcoming the still persistent mouth that physicians are in control of the birth process and that asphyxia is the sole cause of cerebral palsy and other neurological birth injuries.
EFM_a-bridge-too-far_10_02_2012 (quite long but good and worth your time to read!)