Did you know you can refuse constant CTG monitoring?

Published on 18 October 2023 at 09:10

Why would you refuse constant CTG monitoring?

In Spain, as in many parts of the world, constant CTG (Cardiotocography) monitoring during labor has become a common practice. CTG monitoring also called Electronic Metal Heart monitoring (EFM), is the constant (registered on paper) monitoring of the baby’s heartbeat. This type of monitoring uses ultrasound technology. 

The constant monitoring is not compulsory. You have the right to refuse and explore alternative options, but why would you? Many women find it reasuring and assume that with the monitoring they and their babies are safer. But is this assumption true?

In this blog post, I will delve into the reasons why you might want to reconsider constant CTG monitoring and the alternatives available to you so you can make your own informed choice!


Why would you refuse?

  1. Lack of Effectiveness: The use of CTG monitoring became widespread before its effectiveness in reducing the risk of adverse neonatal outcomes was proven.

  2. Doesn´t improve outcomes: Research has shown that constant CTG monitoring doesn't significantly improve outcomes such as reducing neonatal mortality rates or preventing cerebral palsy.

  3. Increased Interventions: Constant CTG monitoring is associated with an increased rate of instrumental vaginal deliveries and caesarean sections (In the Nelson at al study up to 63% more caesarean sections! Holy moly!). This while both procedures come with their own set of risks and can lead to a longer, more painful birth experience.

  4. Limited Mobility and Birth Options: When constantly monitored, your movement is restricted, making it challenging to change positions and rule out options like using a birth pool. This limitation can prolong labor and increase discomfort.

  5. Shifted Focus: Constant CTG monitoring shifts the focus away from your needs during labor to the continuous interpretation of the CTG readings. This distraction can affect the emotional support you receive and your overall birthing experience.


The last two points might not seem such a biggy, but bear in mind that both points can lead up to longer, more painful birth and/or interventions that are not without risks.


So what are the alternatives?

Instead of subjecting yourself to constant CTG monitoring, consider these alternatives:

  1. Establish a base line: when entering the hospital allow 20 minutes of monitoring to establish a base line and then go on with intermittent monitoring.

  2. Intermittent Monitoring: Only allow intermittent monitoring using a special trumpet-shaped device called the Pinard stethoscope or a hand-held doppler device. This allows for periodic checks on your baby’s heartbeat without the need for continuous monitoring. This method enables you to move around freely, change positions, and even use a birth pool if desired.

  3. No monitoring: don´t allow any monitoring. Check in with your baby, make connection, feel if your baby still moves and base your choices on that.


Alternative to ctg monitoring  pinard horn

The choice is yours

Make sure you make an informed decision that feels good for you. Educate yourself about the benefits and risks associated with various monitoring options. Being well-informed empowers you to make decisions that align with your preferences and values.


A consideration to take with you when reading this blog is that all research that has been done on the CTG monitoring states that more research is needed since the quality of the research is judged as poor. 


Open Communication

Have open and honest communication with your care provider about your birth preferences. Discuss your concerns regarding constant CTG monitoring and explore other monitoring methods that are available to you with this care provider. If you don't like your choices here you always have the right to change to another care provider that is more able and/or willing to go with your choices. You always have the right to decline or ask for intermittent monitoring with a Pinard stethoscope. 


Make your own informed decisions for an empowered birth

    Your birth experience is a profoundly personal journey, and you have the right to make decisions that prioritise your well-being and the well-being of your baby. By understanding the limitations of constant CTG monitoring and exploring alternatives, you can approach your birth with confidence, knowledge, and a sense of empowerment. Trust in your body, communicate your preferences, and surround yourself with a supportive birth team that respects your choices.


    An empowered birth is one where you are in control, informed, and able to embrace the transformative experience of bringing new life into the world on your own terms! 


    Any thoughts you want to share? Check the comment box below! Please let me know what you think!

    These pregnancy, birth and postpartum blog stories you might also like:

    Want to delve into the material yourself? Good idea! Here are my sources

    Add comment


    There are no comments yet.