The Good The Bad And The Ugly Of Internal Fetal Monitors During Birth

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 The Good The Bad And The Ugly Of Internal Fetal Monitors During Birth


                   photo by DFID - UK Department for International Development is licensed under CC BY 2.0

So my personal opinion is to definitely research this prior to birth because when you are in labor you only have probably at most 15 minutes to mull this over before making a decision and let’s be honest, that just isn't enough time for a true informed, educated decision. Look up the pros and cons and write it down. Speak to your doctor about it and then together you can decide the reasons to or not to use an internal fetal monitor. Then you both can be prepared during labor if anything were to go sideways. You have already made the decision together and you know what you both are in for.


Fetal scalp electrode (internal monitor)


I am not 100% against these because There are times where I feel that yes it would be best to use these in situations that really are life or death for the infant. I want you to be educated and understand what your doctor is talking about during labor when they mention using one. They do not take the time to explain the risks/ benefits the majority of the time and I personally feel we as mothers need to know what we are getting ourselves into when we agree to internal monitoring. I wouldn’t say deny it completely, but ask in depth about any complications that could happen. 


Fetal scalp electrode (FSE) is a spiral wire placed directly on/into the fetal scalp. Internal monitoring provides a more accurate and consistent transmission of the fetal heart rate than external monitoring because factors such as movement do not affect it. Internal monitoring may be used when external monitoring of the fetal heart rate is inadequate, or closer surveillance is needed. In women who had non-operative vaginal delivery, FSE was associated with increased risks of individual neonatal complications including injury to scalp due to birth trauma. In women who had non-operative vaginal delivery cephalohematoma, and neonatal sepsis was increased compared to the no FSE group.


“After controlling for these and other variables in the model, the odds of death for the infants with scalp electrode monitoring was 8 times greater (95% CI = 1.1,56), compared to those who had the GBS septicemia but no intrapartum fetal scalp electrode monitoring. In conclusion, the association we found between neonatal fatality from early GBS septicemia and invasive fetal scalp electrode monitoring is plausible and needs further study.”


Warnings:

Because the tip of this electrode is designed to penetrate the fetal epidermis, the possibility of trauma, hemorrhage and infection exist. It should be used only under aseptic conditions.


Contraindications: The electrode should NOT be applied to a malpresentation, when placenta previa or excessive vaginal bleeding is present, when genital infections (e.g., herpes, Group B strep, gonorrhea) or blood borne diseases (e.g., Hepatitis B carrier, HIV carrier) exist, or when it is not possible to identify the fetal presenting part.




So let’s get into how it is administered.


 Firstly you will have a cervical check to determine if your cervix will be open enough for the procedure to be done. The monitor itself is inside of a flexible tube that will be inserted into the vagina and into the cervix and rotated into the baby's scalp. If your water hasn’t broken this is when it will be broken so that they can attach the wire electrode to the top layers of the baby's scalp. They will remove the tube that the monitor is in and only the wires will be left. This is very similar to how an epidural is placed in mom. I will speak on epidurals in another post. So then the wires are plugged into a port which is taped or banded to the mothers inner thigh. You may or may not be allowed out of bed after the monitor is placed so be sure to ask you dr prior and again when you are in labor to the nursing staff on duty. Once the baby is born they will rotate the monitor out of the scalp and will then be inspected for any skin abnormalities. Hat the baby and then hand your baby over to you


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899296/


https://pubmed.ncbi.nlm.nih.gov/9029383/


https://anmc.org/wp-content/uploads/ANMCWomensHealthGuidelines3-13-2018/16-30/Fetal%20Scalp%20Electrode%20Placement.pdf
Location: North Carolina, USA

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