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Season Health is a psychiatric practice, but I am a labor and delivery nurse by experience and training – 25 years worth. I am switching hats for a minute here, setting aside my psych NP hat (but am I, really?) in favor of my midwife hat. The birth world s is where I learned the values of patient autonomy and evidence-based practice. People who have worked with me probably got tired of hearing “well the research says….” I have always practiced outside the box from “this is how we’ve always done it.” To justify my care decisions, I had to know the research so I could do what was best for the people I was caring for.

One of the things that I did was increase the use of intermittent auscultation (IA) as a bedside labor and delivery nurse. Today, I went hunting for old research because I wanted to see how far back it was determined that electronic fetal monitoring (EFM) did not do what it was expected to do (ie. decrease rates of cerebral palsy) while increasing interventions like vacuum assisted birth or c-sections, both of which come with additional risks to both birthing person and baby. I found a study published in 1994. It was huge with over 8,000 participants. I remember hearing it takes an average of 17 years for new research to be considered standard practice. I also remember thinking at the time, I bet it’s much longer for OB.

Here we are, 30 years after this study was published, and webinars like the one pictured are still being presented. I think it’s important to examine why we are so hesitant to adopt a practice that has been shown to be safe and effective in low risk labors. Why do I see social media posts, in 2024, asking for help developing an IA policy for their unit? It is baffling to me that patients in labor continue to be tied to beds or outright lied to and told they “have to be on the monitor” for the safety of their baby. Are we ignoring the harmful effects of continuous EFM in favor of soothing personal fears? What happened to informed consent? What would happen if a patient was told the risks, benefits, and alternatives to EFM? What if we allowed them some personal autonomy and choice?? Food for thought.

Because I try to aways bring receipts:

The answer is 17 years, what is the question: understanding time lags in translational research

Intermittent versus continuous electronic monitoring in labour: a randomised study

Register for the AWHONN webinar: Integration of Intermittent Auscultation into Clinical Practice

Always feel free to ask me questions about evidence based practice and patient autonomy; a couple of my favorite topics!