i have just finished the 'obstetrics' term of my course and over the 9 weeks i repetitively brought up my disgust with the use of CTGs against all the very high quality evidence that is out there against them, that noone refutes they just ignore. the wonderful obstetrician who was my supervisor (only one ive ever met that i like) agreed and said it is only collective inertia and fear that has led to everyone still using it. the fact that it has sneakily become the best practice standard. in the big cochrane review on the subject the only benefit seen was a reduction in neonatal seizures seen in the CTG group. this was used as evidence that it may reduce the incidence of cerebral palsy in this group also. actually, there was follow up studies done on all the studies included in the review some years later and it actually showed no difference in cerebral palsy rates in most studies. one study amazingly actually showed a higher rate of cerebral palsy in the CTG group !! this has been conveniently forgotten. CTGs are still sold to women as being a safety net to prevent cerebral palsy despite the fact that there is absolutely no evidence whatesoever of this being the case
all that remains to be the benefit of CTGs is for care providers. it makes many people feel safe to have a neat little print off documenting what has been happening. the other thing is that apparently in the court system, parents can only be 'compensated' if a no fault verdict is made and that requires a CTG.
anyway i wrote a huge article about this titled 'the irony of obstetric risk analysis' and handed it in with my end of term work. i am waiting with bated breath to hear the feedback and whether i will fail for being so blatently anti-obstetrics to my obstetric supervisors!!! but i figured theres less harm saying it all now, on my way out :)
the reason im writing this is that the (good) obstetrician wants me to put together my views on social inductions and social elective caesars and how we should respond to women who sometimes demand these things and whether it is ethical to refuse. im really struggling with it because if we all always say inform and then follow the mothers wishes, what right do we have to refuse this? it is often for what i see as ridiculous reasons (ie the woman recently who demanded an induction so she wouldnt birth on 6/6/06 and threatened to kill herself if we didnt) but who am i to judge women's choices like others judge non-interventionalist choices?
id love to know everyones thoughts on this one
love emily
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