By Shawn Kennedy, MA, RN, interim editor-in-chief
Last week, the New England Journal of Medicine (NEJM) reported (abstract available here) on a Dutch multi-center randomized trial comparing internal versus external monitoring of uterine contractions during induced labor on rate of cesarean or instrument delivery. Among secondary outcomes they examined were use of analgesia, oxytocin and antibiotics, adverse neonatal effects, and complications from the intrauterine catheter (hemorrhage, sepsis, among others).
What caught my eye was the first sentence of the paper, which read, “The monitoring of uterine contractions by means of internal tocodynamometry during induction or augmentation of labor is advocated by professional societies in obstetrics and gynecology.” Yet, as this study points out, there has been little data to support the societies’ recommendation for internal monitoring. And, lo and behold, the results of this trial “do not support the routine use of internal tocodynamometry for monitoring contractions in women with induced or augmented labor.”
This reminds me very much of electronic fetal monitoring. In the June 2007 issue of AJN, we reported on two separate studies showing little evidence to support the use of either central fetal monitoring or fetal oxygen monitoring. Yet, how many hospitals continue to spend hundreds of thousands of dollars on these systems?
What’s especially galling is that unproven practices like these continue and consume resources while proven measures – like the positive effects of safe nurse–patient ratios on reducing complications and mortality rates (see abstract of JAMA article), and the high quality, cost-effective care of NPs and nurse midwives (see abstract of 1995 Nursing Research metaanalysis or the summary in the Cochrane Database of Systematic Reviews in 2004) – are ignored. Why don’t hospitals fund these evidence-based practices—instead of technology that hasn’t proven itself or, worse, has shown not to be of benefit?