RCM and RCOG publish joint statement on electronic fetal monitoring

By RCM on 27 July 2017 Electronic fetal monitoring

Today the Royal College of Midwives (RCM) and The Royal College of Obstetricians and Gynaecologists (RCOG) has published a joint Consensus Statement on Electronic Fetal Monitoring (EFM).

The statement lays out the RCMs and RCOGs position on EFM and outlines the current guidelines and recommendations around it.

The official evidence based guidance* around EFM says that it is not routinely recommended for healthy women at low risk of complications in established labour. The fetal heart rate is instead measured intermittently during established labour using a handheld monitor.

EFM is most commonly recommended where there are complications, such as where a baby is compromised through poor placental function and the baby is growth restricted.

One of the key messages in the statement is that the results of EFM are often difficult to interpret and should not be used alone to make clinical decisions. Referencing the RCOG Each Baby Counts report, the statement says that key management decisions during labour should take into account a number of relevant factors. These include the mother’s history, stage and progress in labour, any antenatal risk factors and any other signs the baby may not be coping with labour. EFM is one part of an often more complex picture.

The report also recognises the importance of the ‘fresh eyes’ ** approach to EFM, whereby a midwife or obstetrician regularly reviews a fetal heart trace with a colleague. This is now accepted good practice and helps to reduce the chances of misinterpreting fetal heart trace results. The ‘fresh eyes’ approach is used when a decision has been made for a woman in labour to have continuous EFM.

Commenting on the RCM and RCOG Consensus Statement, Cathy Warwick RCM’s Chief Executive, said; “The safety of both mother and baby is the highest priority for midwives and obstetricians and nothing should compromise the delivery of the safest possible care. There has been a lot of focus and public discussion around EFM in recent months, some of which I think has not been useful or productive.

“Focusing on EFM in isolation, which too often happens after something has gone wrong, is not helpful and will not get us to the root of the problem.  It is also important to recognise that EFM results can be difficult to interpret even for experts. Our day to day practice has to take that into account. A culture of multidisciplinary working which ensures ease of referral and immediate access to a second opinion will enhance safety.

“It is also the case that midwives and obstetricians often work in highly pressurised and busy environments where there may be inadequate numbers of staff. In these circumstances poor decisions can be made. The wider health system has a responsibility to ensure individuals work in systems that support them to provide care of the highest possible standard.”

Mr Edward Morris, vice president for clinical quality at the Royal College of Obstetricians and Gynecologists, said: “Electronic fetal monitoring is an essential part of our toolkit for monitoring the wellbeing of a baby during labour, but the evidence doesn’t support its use for all women, and the results must never be interpreted in isolation of other factors that may influence how well a baby is coping with labour.

“Problems with accurate assessment of fetal wellbeing during labour, including interpreting fetal heartrate patterns, have been cited as a factor in many of the term stillbirths, neonatal deaths and severe brain injuries we reviewed as part of our Each Baby Counts programme.

“To ensure the safest possible maternity service, we recommend all units formally assess low risk women on admission in labour to determine the most appropriate fetal monitoring method, NICE guidance on when to switch between intermittent and continuous monitoring during labour is followed and all staff have documented evidence of appropriate annual training in fetal monitoring.”

 

View the RCM / RCOG consensus statement on Electronic Fetal Monitoring (EFM)

 

To contact the RCM Press Office call 020 7312 3456, or email [email protected].

 

Ends

 

Notes to editors

 

* NICE (2017) Intrapartum care for healthy women and babies. Clinical guideline [CG190]. https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#monitoring-during-labour

** Donnelley and Hamilton (2012) A ‘fresh eyes’ approach

The RCM is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources. For more information visit the RCM website at https://www.rcm.org.uk/

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