Saturday, October 08, 2005

Implications of Cerebral Palsy Litigation

The Journal of the American Medical Association has an excellent editorial on Cerebral Palsy Litigation (subscription required, but you can read it here). The author points out important facts about Electonic Fetal Monitoring (EFM), such as:
EFM as compared with monitoring by intermittent auscultation is associated with no decrease in perinatal deaths, no fewer admissions to neonatal intensive care units, no fewer Apgar scores below 7 or below 4, and no less incidence of CP. All randomized trials of EFM to date have shown that such monitoring is associated with a higher rate of interventions into the process of birth and, in the United States, with an increased rate of surgical delivery.
Which begs the question, doesn't it, which advocates of evidenced-based obstetrics have been asking for years - if continuous EFM increases the risk of interventions, has few if any benefits, and creates a record which could be used in litigation (and given the EFM's high false-postitive rate, more likely to be used offensively than defensively), then why is it still being used? Some have suggested it is due to inadequate levels of nursing staff:
Studies that show intermittent auscultation to be equivalent or better than EFM had 1:1 ratios of nurses to patients and fetal heart tones were assessed every 15 to 30 minutes during the first stage of labor and every five minutes in the second stage. In one study, a university hospital center attempted to use intermittent auscultation as the primary method of monitoring without increasing the number of staff. Auscultation was only successfully completed in 31 of 862 patients in labor with viable fetuses. Intermittent auscultation was abandoned for most patients because the staff was not able to maintain the required 1:1 nurse-patient ratio.
Which leads to yet another question: if there is not enough nursing staff available to cary out intermittent fetal monitoring, is there enough nursing staff available to provide optimal care to the patient?


I am a Milliner's Dream, a woman of many "hats"... said...

Have you seen doulicia's blog? You can link from mine to it. She's a lawyer and doula!

I am a Milliner's Dream, a woman of many "hats"... said...

Of course, you do--I didn't notice the next post mentions her!