A board-certified neurologist and an attorney, Dr. James C. Johnston serves as medical director of Legal Medicine Consultants in San Antonio, Texas. Dr. James C. Johnston has written numerous articles on topics intersecting medicine and law, including a recent peer-reviewed article, coauthored with Thomas P. Sartwelle, entitled Neonatal Encephalopathy 2015: Opportunity Lost and Words Unspoken, which was published in the Journal of Maternal-Fetal & Neonatal Medicine.
The article addresses the Task Force Study on Neonatal Encephalopathy Second Edition 2014, which recommended the use of electronic fetal monitoring (EFM). In the 19th century, it was believed that cerebral palsy and other conditions such as encephalopathy were caused by asphyxia during birth. EFM machines are intended to monitor the infant’s heartbeat during labor and indicate whether a physician should perform a caesarian section to prevent health issues associated with birth asphyxia.
EFM has never been subjected to a clinical trial, however, and has been shown to have a 99 percent false positive rate. Further, studies have proven that cerebral palsy is not caused by birth asphyxia. The use of EFM greatly increases the rate of caesarian sections, exposing both mother and baby to all of the potential risks and complications of that often unnecessary procedure. More importantly, it does not prevent or reduce the rate of cerebral palsy.
Thus, recommending the use of a test that has been shown to be at best imprecise and at worst harmful by exposing more women to cesarean sections is ethically dubious and goes against the fundamental medical tenet of “first do no harm.” While EFM may be useful in some contexts, it causes more harm than good and, the article concludes, should certainly not be used as legal evidence against physicians.