Heart check failures put babies at risk

Heart-check failures put babies at risk
5:00AM Monday February 25, 2008
By Martin Johnston


Repeated failures in checking babies' heart rates during difficult births have been revealed in hospital figures on serious medical mistakes.

The reports, from the 21 district health boards and dating from 2003, 2004 or 2005, include 15 cases of serious harm or death among newborns or fetuses.

Eight babies died in cases which involved fetal or heart-rate monitoring problems.

They were among the potentially preventable "sentinel and serious" events reported by health boards last week.

They are a tiny fraction of the 60,000 births a year in New Zealand, but the worrying feature is the high proportion of the 15 cases in which electronic fetal heart rate monitoring - called cardiotocography, or CTG - was mishandled.

And two health boards, Hutt Valley and Canterbury, gave staff training, only to have another baby die in similar circumstances.

National Party health spokesman Tony Ryall said yesterday maternity services suffered because many midwives worked in isolation from other health practitioners.

This can't be good for mothers or babies," he said. "Isolation can cost lives in health."

He said this was the first year newly graduating midwives would have a year of mentoring and supervision to improve standards.

Midwifery Council chairwoman Dr Sally Pairman said heart-rate monitoring could be a factor in individual cases, but she was unaware of widespread problems.

"It is not a theme that has come up to the Midwifery Council."

But Associate Professor Jenny Westgate, an obstetrician and gynaecologist at Auckland University, said problems with CTG fetal heart-rate monitoring were well recognised.

"It's a difficult area. If you look at all the reports of bad outcomes or near-misses in the national and international literature, you will find a high proportion of problems with fetal monitoring - whether failure to monitor or failing to act quickly enough or abnormal monitoring."

She had run many teaching sessions for doctors and midwives on the techniques and interpretation of the print-out results of CTG monitoring, work now done by the College of Obstetricians and Gynaecologists.

Ongoing training in fetal heart rate monitoring was mandatory in the UK, she said. In New Zealand, most hospitals would have some kind of fetal monitoring review programme.

Maternity Services Consumer Council co-ordinator Lynda Williams said last night that fetal heart monitoring was an inexact science. Large studies had shown it did not improve birth outcomes overall.


"I don't think it does anything except raise the intervention rate.

"Fetal scalp monitoring [in which a probe is attached to the baby's head] might give you a better indication because you don't lose the heart rate when the baby moves."

Professor Cindy Farquhar, chairwoman of the Perinatal and Maternal Mortality Review Committee, said the monitoring was complex.

"Reading fetal heart monitors is quite technical."

The committee had established a working group to follow up on cases in which babies died after difficult births in which their brains were starved of oxygen, or survived with brain damage.

Fetal heart rate monitoring was intended to reduce the risk of this happening.

Canterbury chief medical officer Dr Nigel Millar said yesterday that monitoring fetal heart rates was a "complex thing".

There was the technical aspect to reading the monitors and then interpreting the information.

Dr Millar said that after an incident, "we always look back to see if something could be done".

SOURCE:
http://www.nzherald.co.nz/topic/story.cfm?c_id=1500859&objectid=10494363

I've had continuous fetal scalp monitoring during both labours and after reading this article I'll definitely be pushing for it again. It does restrict your ability to walk around in labour but I'm with you Flissty, better safe than sorry. Mercedes was monitored externally coz they couldn't put a scalp monitor on her obviously coz Sienna was blocking the exit, and it was much harder to monitor her coz every time she moved the belt would lose track of where she was.