The TRUTH about Continuous Monitoring (CTG)

So what is the CTG?

CTG stands for Cardiotocography and is sometimes called EFM (electronic fetal monitoring ) or sometimes just "the trace". It is a way of monitoring the baby's heartbeat during labour and can also monitor the contractions of your womb.

Routine practice in most Irish hospitals is to put you on the CTG to do an admissions trace when you get into the labour ward in order to "establish a baseline.” This is supposed to take 20 minutes but in reality they need 20 minutes of a continuous heartbeat so it can take much longer. And for many women this is left on then for the rest of their labour if they don't specifically request to have it removed.

Some units are mobile so you can move around with them after the baseline trace has been established. But others are not which means you are restricted to being on the bed for your labour if you opt to have CTG monitoring.

If you are induced or at high risk ( for example risk of uterine rupture after a previous cesarean) then a CTG is recommended to detect fetal distress. Induction is a known risk factor for fetal distress which is why CTG monitoring is recommended if you are induced or if you get syntocinon later in your labour (augmentation). But please know that having a risk factor is different from being high risk. Age of mother is a risk factor for example but does not mean you are high risk and that you need a CTG.

However if you are not induced or in the high risk category you may want to think carefully about having a CTG. CTGs are notoriously inaccurate and research has shown that using this type of intervention increases your risk of both C section and instrumental birth. In fact the HSEs own guideline recommends not using as CTG on low risk women for this reason. CTGs can also restrict your options in labour. You can be less mobile and also most CTGs can't be used in water so using a shower or bath is not an option. Many women often feel it causes them distress in labour. I know in my first labour the belt would often slip and the machine would start to alarm and I would be totally stressed out until the midwife would find the babies heartbeat again. Not what you want in labour.

So why are CTGs used?

CTGs were brought into hospitals based on the theory that continuous monitoring would be better at detecting when babies oxygen levels were compromised. Low levels of oxygen can cause cerebral palsy and ultimately fetal death. However, there was no research done at the time to validated this theory. We do have the research now shows that CTG use can result in a reduction in neonatal seizures there has been no reduction in cerebral palsy or neonatal death rates in births where CTG was used. But CTGs have become such a routine practice and the paper trace printed out by the machine can be used in legal cases so they are very much the preferred option in most hospitals.

So what is the alternative?

The alternative is intermittent monitoring using a doppler usually every 15mins but more often if necessary. A doppler does not carry the same risks as a CTG and as it is so mobile you should not need to change position in order for your care provider to listen to your baby's heartbeat.

If you are low risk and a CTG is offered to you, use your B.R.A.I.N analysis to determine if it is right for you and your baby.

As always any questions feel free to get in touch if you have any questions.

Wishing you a magical and positive birth

XO Emma