Cerebral Palsy and Intrapartum Fetal Monitoring

MacDonald, Dermot

doi:10.1056/nejm199603073341011

Cited by 31 publications

(32 citation statements)

References 7 publications

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“…Other researchers confirmed Hon's work [26][27][28][29][30] and by 1970 EFM machines were in demand in hospitals around the world [1][2][3][4][5]28,30]. Although EFM entered clinical practice without clinical trials, with no instruction manual, no clearly defined parameters for use [31], based on a catastrophic misunderstanding of fetal physiology [32], and based on a non-existent scientific foundation [1][2][3][4][5], it was nevertheless routinely used in all labors and was labeled by physicians as a mandatory safety device.…”

Section: Introductionmentioning

confidence: 69%

“…Albert Haverkamp, a Denver obstetrician, wanted to prove EFM's worth to a few skeptical obstetricians and mothers but was surprised to find EFM was no better than intermittent auscultation but significantly increased the numbers of C-sections [1,4]. Between 1976 when Haverkamp's RCT was published and 1995 eleven more RCTs found essentially the same results [1][2][3][4][5]10,14,18,[28][29][30].…”

Section: Efm Naysayersmentioning

confidence: 99%

“…Nevertheless, these birth myths were the foundation of Hon's effort to automate fetal heartbeat counting, which was the essence of fetal surveillance in labor [1][2][3][4][5][26][27][28][29][30]. This untested theory, still prevalent today, claimed that when a fetus's heart beat was out of the presumed normal range, that indicated the beginning of asphyxia, and there was a limited amount of time to rescue the fetus with forceps and later by Csection before brain damage became irreversible [26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

“…This untested theory, still prevalent today, claimed that when a fetus's heart beat was out of the presumed normal range, that indicated the beginning of asphyxia, and there was a limited amount of time to rescue the fetus with forceps and later by Csection before brain damage became irreversible [26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

“…Hon classified various EFM patterns by comparing them to outcomes using Apgar scores and published what became a universally accepted classification of normal-abnormal fetal heart rate patterns [26][27][28][29][30]. Other researchers confirmed Hon's work [26][27][28][29][30] and by 1970 EFM machines were in demand in hospitals around the world [1][2][3][4][5]28,30].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Electronic Fetal Monitoring, Cerebral Palsy Litigation, and Bioethics: The Evils in Pandora’s Box

TP¹,

JC²

2016

J Pediatr Care

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Pandora opened the box releasing death and all other evils into the world. She hastened to close the lid but the whole content had escaped except for one thing at the bottom of the box -HOPE. Paraphrase of the Greek Myth in Hesiod's Works and Days.Edward Hon opened the Electronic Fetal Monitoring (EFM) Pandora's Box in the 1950s. Although perhaps noble in original purpose, the unintended EFM consequences over the last half century resulted in more harm than good to mothers and babies in most of the industrialized world. EFM became the standard of care not because it was scientifically efficacious, but because it was promoted by physicians with undisclosed conflicts of interests and because obstetricians desperately wanted to believe that a machine would solve the age old cerebral palsy malady and at the same time protect physicians and hospitals from the then new and costly cerebral palsy birth injury lawsuits. EFM became the standard of care at the same time that bioethics became medical reality replacing the medical profession's Hippocratic paternalistic ethic with patient autonomy and informed consent in virtually all aspects of medical practice except for the use of EFM. The use of EFM without informed consent has continued for fifty years with no outcry from the bioethical world. This article explores this ongoing medical and ethical calamity, and discusses why even today EFM use continues disguised as a safety device when in fact its use is primarily as protection for physicians and hospitals from cerebral palsy lawsuits.

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