I, Robot?

As if being strapped down by continuous electronic fetal monitoring, and standard IV, and constantly blood pressure monitoring wasn’t bad enough, enter BirthTrack! This handy-dandy device clips onto your cervix while you’re in labor, so that it can continuously monitor cervical dilation, as well as fetal descent.

Check out Rixa’s blog for one take on this, especially the avenues for infection that are opened up as a result of this device.

Here is a kinder perspective by “mamablogess”, noting some positives of this machine. For one thing, this blogger had a lengthy conversation with a representative of the country, and noted that this machine is not being marketed in the U.S., nor are they planning on starting at any time. Here is why, “The reason given for this is that the US is much more conservative, they have a much higher rate of cesareans, and the representative told me this was due to the financial gain that cesareans provide to them. A machine that may reduce the rates of cesareans and provide a printout of legal evidence that a labor was progressing and the baby was fine, is not something doctors in the US are very excited about. Europe is actually looking to avoid cesareans and therefore they welcome tools that allow them to do so. The US is not interested in a tool that would help them avoid cesareans.”

That was interesting. I agree with Rixa’s take on this, because there is little doubt in my mind that U.S. hospitals, doctors, and nurses would do exactly what she predicts, the company that is manufacturing BirthTrack says that it may actually reduce C-sections, because it more accurately measures dilation, and even minimal progress is progress. Most of you have probably had a vaginal exam of some sort by now, and you know that without a speculum, everything in your vagina is hidden from sight, therefore cervical dilation in labor is determined by a person’s blind touch. People have different-sized hands, and it’s possible for a woman to measure 3-4 cm by 1 person, while another person may say she’s only at 3. This machine would eliminate any of that inaccuracy. Also, think about how big 10 cm is — take out a ruler and measure it. If you’re progressing even a millimeter, I’m assuming that this machine will be able to accurately measure that, while a human’s touch would not.

However, the mamablogess post — please read the whole thing because it’s extremely interesting — pointed out that the manufacturer is assuming that the women who would have this machine used on them will have a standard hospital experience, complete with being in bed, having an EFM belt already on them, and having an epidural; so for them, having one more contraption inside them where they can’t feel it, but will keep them from having to spread their legs for a vaginal exam every hour or so, may actually be preferable for them. Although the blog post didn’t point this out, I wonder if the reason for some of the reduction in C-section or other interventions, or the increase in birth time, was possibly due to “the power of positive thinking” — that is, that women could see that they were dilating, that they were progressing. When a typical home-birthing midwife is attending a laboring woman, she brings this positive thinking to the forefront of a woman’s mind, assuring her (even without frequent vaginal exams) that she is progressing, and that every contraction is bringing her one step closer to having and holding her baby. There is also the fact that some contractions serve to turn the baby to the optimum position, so “lack of dilation” does not necessarily translate into “lack of progress.”

Besides, the World Health Organization’s guidelines say that normal women with normal labors have no need of vaginal exams more than every 4 hours. We’re already not doing that, but instead insisting on hourly exams. Why? To see if women are progressing according to the standard, without regard to treating the woman like an individual, and without regard to the fact that deviating from “average” or “the norm” is not necessarily a bad or dangerous thing.

To sum up, I can see where this machine may have benefits, when used properly, which I highly doubt would happen in the U.S. It’s like the Dublin study that introduced “active management of labor” into the U.S. — we got all the technology and drugs that the study had, but not the human aspect of a one-to-one labor companion. Instead of achieving the same success that the Dublin study had (fast labors with few C-sections), we have had a skyrocketing rate of C-sections, and still going up. This machine may be able to stem the tide of that increase, but I doubt it would be used for that. Instead, there would probably be a diagnosis of labors too slow, even though they were still progressing, and yet more C-sections.

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