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Accepted Paper:
Who is watching the watcher? Induction of labour, safety inquiries and the curious case of central electronic fetal monitoring
Christine McCourt
(City, University of London)
This paper will discuss the impact of a centralised form of electronic fetal monitoring in labour globally, despite lack of evidence of benefit and concern about potential harm. I will discuss the drivers and layers of surveillance shaping the emergence of this technology and practice.
Paper Abstract:
Who is watching the watcher?
Centralised electronic foetal monitoring (CEFM) involves use of a an electronic monitor (CardioTocoGraph) in labour care to trace the frequency, length and duration of uterine contractions and the heartbeat of the fetus. Use of CTGs has been spread globally, despite evidence that they do not lead to improvement in neonatal outcomes and are associated with some harms for maternal health. CEFM is a further step in this form of surveillance – a central screen is placed outwith the labour room at a central station where it can be viewed by other professionals not attending the birth. There is no clinical evidence to support its use and some evidence that it may have unintended harms, yet a recent inquiry report into safety in maternity services mandated its use in the UK.
CEFM was introduced, arguably, in response to the failure of CTGs to improve safety. It thus proposed a further technical solution to a technological surveillance problem, while introducing new layers of third party surveillance: first, the professionals who observe the central screen without any role in attending a particular labour, any relationship with the labouring woman/person or knowledge of other observational signs of labour progress or wellbeing; second, external bodies such as the Care Quality Commission which have powers to sanction professionals for errors, and service insurers, concerned to avoid or reduce litigation claims; third, the mainstream and social media discourse which may frame the response to poor outcomes in terms of deficiencies in surveillance.