Fetal monitoring 50th anniversary

Perspectives on 50 years of fetal monitoring from clinical leaders around the world

Prof. Sir Sabaratnam Arulkumaran
Prof. Sir Sabaratnam Arulkumaran
Professor Emeritus at St George’s University of London, UK.

1. How have advances in technology changed the way you work?
I think that obstetricians have been greatly assisted by advances in fetal and maternal monitoring technology. Compared to when I first entered obstetrics, the clinician is now better placed to reassure the mother by promptly detecting and monitoring issues that could arise.
There has also been real progress in information technology. As clinicians, we are very conscious that women can search for information online and come to us with pre-prepared questions on the care they will receive. In that sense, I think we have a duty to steer women towards reliable sources of advice and information, so that we can better support them in making informed decisions about their pregnancy and birth.

2. Which developments have surprised you the most during your time in the field of obstetrical care?
I would highlight the significant advances in diagnostic capabilities. In particular, I have been pleasantly surprised by the huge progress in non-invasive pre-natal screening. Now, it is possible to take a small sample of maternal blood and perform a range of incredibly valuable assessments, such as chromosome analysis for trisomy 21, 13 and 18.
The progress in obstetrical care has fed into other areas of medical science, too. Non-invasive pre-natal screening of maternal blood was initially developed to help clinicians detect fetal problems, but similar techniques are now used in the diagnosis of cancer. Ultrasound monitoring, too, is now used in a far wider range of clinical applications than obstetrics alone.

3. How has the labor experience evolved from the mother’s perspective?
In the past, it was more typical for a midwife to look after three or four women, but now we strive to provide one-to-one care if possible. Labor and delivery is a very anxious moment; a mother doesn’t know if she or the baby is going to be all right at the end of the process, so having someone to reassure them throughout the experience is quite crucial.
At the same time, the technology has helped mothers by allowing them to choose what is most comfortable for them – with ambulatory epidurals and monitoring, for example. And if the mother wants to get into a pool, we can use waterproof transducers so that she can still be monitored without any difficulty. My own teaching and research actively advocates increased mobility in labor, so I certainly see these as very positive developments.

4. How have public and clinical attitudes changed with respect to mobility in labor?
Women are playing a far more active role in the labor care decision-making process. They know more about their options than in the past, and they know that there is advanced technology available that can assist in monitoring, so they are more likely to request ambulatory monitoring than previously.
In turn, there is a more liberal attitude among clinicians; more and more people feel that mothers should have the opportunity to ambulate, and there is scope for this more liberal approach because we can keep an eye on the mother and the baby using advanced technology that is not as invasive as in the past.

5. What future advances would you like to see in the field of labor and delivery that would improve your job or the mother’s experience?
Firstly, we need to make further progress in artificial intelligence and machine learning for the interpretation of CTG – finding out whether computers can assist in providing a better level of knowledge to both the clinician and the mother. Secondly, it would be valuable to develop a technique to measure pH or lactate in fetal blood using minimally invasive techniques; again, this data would provide a great deal of insight and reassurance.
Finally, we should strive to make the labor and birthing environment as unintimidating, welcoming and natural as possible; a calm, clean, low-tech environment with ample space to move. When a woman, her partner or her family or friends enter the labor room, it is so important that they have a positive impression from the start. Even the color scheme, access to natural light or the ability to see through a window will make the room more natural and less stressful.