MAYDAY Series: Ref #3 ~ Data Bite on the Frequent Disagreements btw professionals on Interpretation of EFM strips

by faithgibson on May 26, 2019

in Electronic Fetal Monitoring, OB Interventions: Dubious or Detrimental

Synopsis:

Disagreement btw obstetricians on EFM data whether an emergent C-section is needed and studies in which obstetricians disagreed with their original conclusion when provided with the very same monitor strip 6 months later.

The other ‘elephant’ in the room when interpreting c-EFM data is the incredible lack of agreement between obstetricians over the data being streamed to fetal monitor screens and printed out on reams of graph paper.

All the professional insiders — OBs, L&D nurses, obstetrical department heads, hospital administrators and their attorneys and lobbying groups such as the American College of Obstetricians & Gynecologists ACOG — are each and everyone aware of the “slips twixt cup and lip” when it come to the interpretations EFM data by different obstetricians.

Here is another excerpt from the “Female Patient” April 2011 quoted earlier that reports on studies of this issue that the public is never privy to:

“There is considerable inter- and intra-variability in the interpretation of EFM. Clinicians disagree with each other in their evaluation of FHR about 80% of the time.

Even when reviewing the same FHR pattern several months later, a clinician disagrees with his or her own initial interpretation about 20%of the time.1

One study by Chauhan et al had 5 clinical obstetricians evaluate the FHR patterns of 100 parturients using the traditional intrapartum evaluation (reassuring vs. nonreassuring). Forty-six percent of these patients had an emergent cesarean delivery, and 2% had a fetal pH less than 7.0.

The study found that not only was there poor agreement among clinicians, but they could not even predict which parturients had an emergent cesarean delivery or low fetal pH. [3]

Fetal metabolic acidosis and hypoxic-ischemic encephalopathy are also associated with significant increases in EFM abnormalities, but EFM predictive ability to identify these conditions is low.” [4]

Simply put, the scientific literature has never supported the routine use c-EFM and one of the reasons may well be that the obstetrical profession has never been able to agree on the data.

If they did, the C-section rate would drop like a stone, but instead, the obstetrical profession and the American news media are neither one talking about the big blue elephant that is smack in the middle of the room. And so, the operative motto for American obstetrics is remains: “When in doubt, cut it out

         In 2003, 1.2 million Cesarean surgeries were performed in the US (27.5% cesarean rate) at a cost of $14.6 billion. The Cesarean rate for 2006 was over 31% and for the most recently available stats (2017)  it’s a whooping 32.8 % (i.e. 33%) or one out of every three women who gave birth in 2017. This is equivalent to the number of people that graduate from college every year.

However, C-section stats are wildly different, depending on what state the mother gives birth. For example, stats for first-time mothers in New Mexico, South Dakota and Iowa in 2017 were just 17%, but 31 percent  of first time moms in West Virginia were delivered by Cesarean. Obviously the high Cesarean in the US is not the result of a universal failure of female reproductive biology. 

The use of Cesarean surgery as ‘pre-emptive strike’ has not made the tiniest bit of difference in the incidence of CP and similar neurological conditions. And yet, the public and the press never seem to question how unlikely it is that normal childbirth in healthy women is somehow made safer and better by turning it into an expensive and risky operation.


Thank you reading this MAYDAY Data Bite

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