OK, OK, I can't stay out of this either, I agree with everyone who opposes this step. And, have any of you read Ellen Blix' article in the latest issue of BJOG? The risk manager in Joy's unit should read it, and re-read it until s/he understands it, before spending any money on such a system.

Maybe someone could do a calculation on how many midwives they could salary for what the system would cost. That wasn't done in my unit before the obstetricians let the slick HP salesman (yes, it was a man) sell us such a monstrosity, 13 years ago. For some unfathomable reason, no midwives at all were involved in the purchasing decision. Fortunately the quality of the transmission from the rooms to the central monitoring station was so poor that it was impossible to know what was going on without being in the labor room, and then there was always the theoretical chance that the midwife would focus on the woman rather than the monitor. I'm happy to say that this frequently occurred. Also, the system was so noisy that it was unbearable to be at the station if it was on, so either everyone fled to the labor rooms, or it was turned off.

We never, not in 1990 nor anytime since, had any instruction in how to make use of the electronic archiving system in our set-up, so that capability has never been used, though that was the rationale for purchasing it.

Some years later we had a Danish midwife here as a holiday replacement, and she claimed that in her unit, if the baby had 1- and 5-minute Apgar scores of over 7, the CTG trace was not even filed, just simply discarded then and there along with all the other waste paper following a birth. I have been unable to confirm this but found the notion quite charming. Her explanation was that if the baby was fine at birth, any problems later arising could not be blamed on the events of labor and the CTG was of no possible future interest. Why they did not take it one step further and simply not run the CTG at all, I don't know.

I wish we could get a risk manager to come look at our staffing on postpartum, where it would be far simpler than shoplifting baby clothes, to actually kidnap a real live newborn baby. There's a risk I'd like to see managed right out of existence. Every time I have ever brought it up, I get exasperated looks, or laughs, or both, but no action.

Rachel Myr

Kristiansand, Norway

Cathy Walton wrote:

I completely agree with Denis on both counts. A retrograde and, arguably, misguided step!

And Denis Walsh wrote:

I'm deeply opposed to central bank monitoring because at best it gives tacit support a flawed technology, at worst it replaces a human presence with a machine.

In response to Joy, who wrote:

It is proposed in my unit to introduce centralised CTG monitoring for the labour ward. The rationale given by the lead consultant and clinical risk manager (midwife) for this is that CTGs will then be recorded and archived electronically, so will be available for review purposes indefinitely.

For those who have worked with such a system, please would you also let me know your thoughts on whether centralised monitoring empowers or seeks to control midwifery practice and whether there are any other issues we may need to be aware of.