Are ‘early’ and ‘late’ fetal heart rate decelerations extinct? A survey of British midwives and analysis of controversies, facts and fiction

Abstract

An anonymous survey of 56 midwives from different NHS hospitals revealed a major change in the categorisation of fetal heart rate (FHR) decelerations after the National Institute for Health and Care Excellence (NICE) (2007) guidelines on intrapartum care were implemented. The survey showed that the midwives currently categorise hardly any decelerations as ‘early’ or ‘late’ (median 0%, mean < 1%), the majority being ‘variable’ (median 100%, mean > 99%). A high proportion (40–70%) of the cardiotocographs (CTG) were classed as ‘pathological’ without any intervention required. In the survey, 33 midwives who had worked for more than 5 years stated that the vast majority (50–70%) of decelerations were ‘early’ (p < 0.0001) before the NICE guidelines (2007). The paradox of near extinction of early FHR decelerations (head compression which is a very common phenomenon) is not just a theoretical matter but leads to increasing numbers of false positive pathological traces. Midwives may be increasingly disenfranchised by having to rigidly adhere to the NICE categorisation of FHR decelerations.