Just Another Cog in the Baby-Birthing Machine

*sigh* What will they come up with next? As Rixa reports on her blog, the race to dehumanize birth has passed another milestone with the invention of the BirthTrack. Now, instead of just having to fight off unnecessary IVs, vaginal exams, Pitocin, and the cesarean-increasing Continuous Fetal Monitoring, the 21st century American mother who hopes to have a somewhat-natural hospital birth will have to fight off this marvelous monstrosity.

What is BirthTrack? According to the maker, Barnev, Inc, BirthTrack "monitors cervical dilatation by transmitting ultrasonic waves from transducers (placed on the abdomen) to receivers affixed safely and painlessly to the mother's cervix. Thus cervical dilatation is monitored continuously and automatically with a high degree of accuracy, reducing the need for manual examinations." And how does BirthTrack do this? By affixing sensors to the right and left side of the cervix, as well as to the top of the fetus' head "as soon as it is accessible." Never fear, though, the manufacturer's website assures those of us who might question such things by stating, "These clinically proven and safe disposable sensors were designed for ease of use and minimal disruption of patient comfort." Um, yeah. Try telling that to a birthing mother who wants to walk during labor.

So let me posit a question or two here. Why exactly does dilatation need to monitored so closely? According to the BirthTrack website, there are 4 benefits to the system:

1. "Early decision making...Precipitous and non-progressing labor may be detected earlier and appropriate actions taken for improved outcome." *snort* Excuse me while I scoff! As a woman who has had a precipitous labor (under 2.5 hours from first alert to crying, peeing baby), let me say that if you, as a health provider, need a MACHINE to figure out whether a woman is having a precipitous labor, then you probably shouldn't be in this field. And as for detecting non-progressing labor earlier, um, excuse me? In spite of what some may believe due to the Friedman Curve, a birthing woman's body does not follow a timed schedule. Some women (like myself) go from 0cm to 10cm in no time flat, while others go in spurts, hitting peaks and plateaus, before reaching 10cm. Most women WILL hit 10cm, given the time, support, and space to do so. Detecting "non-progressing labor" sooner just means that that number more women will have their natural progress interfered with, and unfortunately, even stalled out.
2. "Efficient labor room- Allows staff to utilize their time with patients more productively, in the absence of repeated digital vaginal examinations. Staff time spent on digital examinations is potentially utilized better elsewhere. Better use of personnel resources leads to cost reduction and more." Allow staff to utilize their time more effectively? Doing WHAT?!? From the stories I've heard from my fellow hospital-birthing moms, in many cases, the ONLY time they saw their doctors or nurses was for a vaginal exam.
3. "Increased patient comfort- Limiting the number of intrusive, vaginal examinations provides the mother-to-be with the comfort and privacy she desires. The partner becomes an informed participant. The displayed data allows them to follow the labor process together minimizing anxiety and contributing to a relaxed atmosphere in the labor room." Ooh, I know a way to limit "intrusive, vaginal examinations" - don't do them! As for the partner "becoming" an informed participant, excuse me if I sound too preachy, but the partner should have been participating by supporting and helping the laboring woman from the word go and should have been informed by reading and/or taking classes before ever setting foot in the hospital. The BirthTrack sounds more like another "Machine that goes Ping!" and will only redirect attention away from the woman and onto a readout.
4. "Support tool during litigation- BirthTrack provides full documentation of cervical dilatation and fetal head descent during the labor process" Ahhh - finally, we hit the crux of the issue and the real reason that BirthTrack will be coming to a birthing unit near you.

Elsewhere on the BirthTrack site, the makers state the reason that such a machine needed to made: "Despite advances in modern childbirth technology, it is still impossible to obtain accurate measurements of key variables needed to identify the approximately 1/3 of labors that require intervention." You know, I think Ina May Gaskin (amongst others) might take issue with that "statistic." The site goes on about the negatives that occur as a result of poor estimation of cervical dilatation and fetal descent: "Hours of unnecessary suffering on the part of the mother;
Risk of infection for mother and fetus; Substantially increased rate of labor complications;
Significant waste of hospital resources including caregiver time, administered drugs and equipment usage." Ok, and rushing to inject pitocin and/or do a c-section is going reduce the "unnecessary suffering" or the rate of complications? If so, then how do so many countries in Western Europe that have fewer interventions manage to have far better maternal and infant outcomes than the US with far fewer c-sect - Ohhhh. Nevermind.

Helpfully, the BirthTrack website has a FAQ section. Here are some a nuggets:

"8. How can it reduce C-Section rates?
We do not yet have proof that the use of BirthTrack will reduce CS rates yet. However, there are several ways it may help to reduce CS rate. It is well known that oxytocin receptors down regulate their numbers and therefore earlier detection and management of dysfunctional labor are likely to reduce CS rate. It is also possible that the displayed information showing the effect of individual contraction on dilatation and station may be useful in titration of oxytocin. In addition, an earlier management is likely to result in earlier recognition of a need for CS and earlier performanceof CS may ,in its turn, eliminate difficult CS and fetal distress that is linked to prolonged labor." Earlier "management" of "dysfunctional" labor will lead to fewer c-sections? Because the research shows that women with earlier and more interventions have fewer c-sections, right? Yeah. Anyone who thinks the BirthTrack will lead to fewer c-sections rather than more, please raise your hand. Didn't think so.

"1. What about my mobility ? Will the sensors disturb my walking around?
No. You can walk with the sensors. However you need to realize that the system will not collect information on the progress of labor while you are walking" But wait - I thought one of the points of the BirthTrack was to provide continuous information. So, while the sensors won't disturb your walking around, chances are the staff, whose time is now being better utilized more effectively, and the hospital policies probably will.

"2. Must the membranes be ruptured to use it?
The membranes need to be ruptured to apply the fetal electrode (to monitor the progress of head descent). " And we all know what a ruptured placenta means, right? That clock to deliver or be sectioned starts ticking...I wonder whether that will help a woman's labor to progress?

And finally, a word about the remarkable company that brings you the BirthTrack. "Barnev, Inc. is a Delaware based medical device company dedicated to improving Women's Healthcare through the development, production and marketing of cutting-edge, real-time obstetric monitoring devices." Does anyone else see a contradiction betwee wanting to improve women's healthcare by developing obstetric monitoring devices? Just me? "The company was founded in 1998 by a team of biomedical engineers, perinatologists and industrialists." Engineers - ohhhh. Say no more. As the wife, daughter, and sister of engineers, that explains it all.