Midwifery Myths - Listening to the baby's heart beat

Myth of the day - Listening to Fetal Heart Tones in Labor Is Beneficial

I'll keep this musing as short and sweet as I am capable of. Even the people in the medical world are uncertain about whether continuous fetal monitoring has any benefit beyond looking good in court in case they get sued. It reduces neonatal seizures, but increases cesarean sections. The benefits do not appear to outweigh the risks (although parents should certainly have the choice if they want it). Here is some initial reading for you to check out if this is a new concept for you. The interpretation, classification and treatment of different FHT patterns is highly ambiguous, and can be complex, so take your time!

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000063/full
http://www.sciencedirect.com/science/article/pii/S000293780271524X
http://www.ncbi.nlm.nih.gov/pubmed/24412117
https://www.nccwebsite.org/resources/docs/final_ncc_monograph_web-4-29-10.pdf

On the other side of the coin though, there are lots of midwives who DO listen in labor, thinking it is beneficial (and their clients think so too even though they usually haven't been given this information about it probably not being beneficial), but they are listening in a way that doesn't even provide any of the (ambiguous) information that they should be interested in (if they are going to bother listening that is). Many midwives listen for 10-30 seconds, get a sense of the baseline rate, maybe listen for variability and then say "baby sounds great". This is just false reassurance and some sort of facade of expertise and "safety" that I assume midwives cling to either knowingly or not. I wouldn't dispute that perhaps very experienced midwives can develop some skill of knowing exactly what to hear and when, and are able to do that with some internal metronome, but to gather the information that perhaps matters (but probably doesn't) they really need to be listening through a few contractions and documenting in some way the baseline, variability, and detailed information about any accelerations or decelerations that are present. This is also not really possible with a doppler that doesn't have a read out on it. I feel strongly that is a case of "do it right, or don't do it at all". That said, I think it is something that should be thoroughly discussed with the parents as far as the benefits versus the risks of listening at all, and what treatment they would want if any category 2 or 3 patterns were heard in labor.

I advocate for another approach that doesn't necessarily include routine listening, but does include thorough and educated listening when more information is needed about a labor that isn't straightforward, and a plan for what to do based on the information gained from listening.

Did your midwife go over these options and research with you? If you're a midwife, what do you do as far as listening in labor goes?

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