There are also more options now for pain management, for example epidural anesthesia. In the past, this procedure was quite rare and even considered risky by some, but now it is a lot more established in everyday clinical practice – and I believe it is a real blessing for a lot of mothers.
Prof Dr Diogo Ayres-de-Campos: In the 1990s, it was widely believed that expectant mothers could not remain fully mobile while being continuously monitored during labor. This led many women to decline continuous monitoring during childbirth, and for the technology to be seen as providing a negative experience. Advances in wireless transmission of signals – driven to a large extent by Philips – now allow women to remain fully mobile during the whole process, while at the same time supporting continuous monitoring of the fetus.
Prof Sir Sabaratnam Arulkumaran: In general, I would say that 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.
Q: What has changed in terms of the way in which obstetrical care is delivered – particularly to support greater freedom in labor?
Prof Dr Ayres-de-Campos: Healthcare professionals have had to adapt to the changing expectations of mothers-to-be for a more positive and relaxed experience during pregnancy and childbirth. In this sense, it’s not just about the technology – it’s about incorporating it wisely into clinical care, and focusing more on adequate communication with patients, as well as effective interactions with other healthcare professionals.
Ms Neye: Public attitudes have certainly changed, with more and more women wanting to experience freedom in labor at their own pace. Movement can be extremely helpful in advancing the birth process and easing labor pains. It is often better to be mobile during labor than to lie on a bed in a fixed position, unable to do anything else.
With that in mind, we strive on a day-to-day basis to help mothers to stay mobile during labor. In certain situations, the mother’s mobility may be restricted – such as if we detect an unusual fetal heartbeat pattern and therefore need to perform continuous monitoring. Unfortunately, this type of monitoring isn’t always possible in every birthing position.
Suzanne Ketchem: We have realized that being confined to a bed is simply not the best way to go through labor. This mind shift was initially driven by the mothers themselves who started saying: “But it feels better to be moving around.” And thanks to evidence-based research and education, we know that they are absolutely right. In the past, we might have been reluctant to let them out of our sight, but with the wireless monitoring technology we have today, we’re happy to let them move around the entire unit freely, because we can still keep track of both mom and baby.
Q: Looking ahead, which advances would you like to see that would improve your job or the mother’s labor and childbirth experience?
Prof Dr Ayres-de-Campos: I would like to see evidence that the quality of fetal monitoring remains high at all times during mobility, without the need for invasive techniques such as fetal scalp electrodes. I also hope that innovations will allow a more objective and non-invasive monitoring of labor progress. Repeated vaginal examinations are uncomfortable and provide very subjective information.
Beyond that, I feel that computer analysis may be of help, allowing a more objective and discriminative method of assessing fetal oxygenation and labor progress. With all major aspects related to safety taken care of, healthcare professionals can focus more on the human side of labor, allowing women to fully enjoy the positive experiences of childbirth.
Prof Sir Arulkumaran: 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.