You say “Fetal heart rate tracings do have a lot of meaning. They do tell us about intrapartum events such as cord compresssion, head compression, fetal hypoxia, and fetal acid/base status. Whether this information is useful in a low risk labor is up to some debate, but that information is present in the strip.”

No, there’s really no debate: there’s actually a mountain of evidence that routine continuous monitoring has NO salutary effect on birthing moms and their babies. The only effect, in study after study, is an increase in c-sections. Given that a c-section carries many risks that a normal vaginal birth does not, this can explain some of the increase in maternal mortality and morbidity we’re seeing in the United States.

That information may well be unambiguously present in the strip; I’ve never learned to read one. But if it is, then that information is *not* helping doctors determine which babies need to be “rescued” through their mother’s stomachs. What seems more likely is that we have misidentified the range of normal for those readings.

Now, the merits of direct listening via fetoscope are not so clear-cut, as you rightly point out; a doctor *still* has to be trained to interpret such monitoring properly, and right now, few of them are. But as a passive method, it cannot possibly cause harm to the baby, at least. It also seems less likely to mislead doctors into unnecessary c-sections. But, whatever method used to monitor, it’s clear that continuous EFM is at best of no use for the majority of pregnancies.

This is psueodoscience nonsense. We can argue about the meaning of the fetal heart rate tracing, but saying that listening with a fetoscope is somehow better than using a doppler is just ridiculous. The “skill” involved is being able to interpret the strip, not being able to count the heart rate. The EFM machine actually does that better than any human could do.

Fetal heart rate tracings do have a lot of meaning. They do tell us about intrapartum events such as cord compresssion, head compression, fetal hypoxia, and fetal acid/base status. Whether this information is useful in a low risk labor is up to some debate, but that information is present in the strip.

I can see EFM as a way to increase lawsuits in at least a few ways — not only does the strip guarantee that there will be evidence to be used against the hospital in a court of law (because as the above points out, there will always be plenty of people who will attest that the doctor should’ve performed a C-section at *this* point on the strip; I don’t have a link, but I remember reading about a study done in which doctors analyzed EFM strips, and when they were told that the labor ended negatively they were more likely to say they’d have done a C-section than doctors who were told that the labor ended positively — even though it was the same strip). But of course, if you have no EFM strip, then you have a lawyer indicating that that was beneath the “standard of care” since “everybody” does EFMs. [And if everybody jumped off a bridge...?]

Also, EFM by its very use and existence is a constant signal to the laboring parents that “this machine keeps your baby safe and guarantees a live birth and healthy outcome.” Then, when that apparent promise doesn’t materialize — i.e., the baby has cerebral palsy or some other condition — they feel defrauded or cheated out of the healthy baby they expected. And more likely to sue.