The Surgery Journal recently published a peer reviewed critique of electronic fetal monitoring (EFM) by neurologist James C. Johnston, MD, JD and leading healthcare attorney Thomas P. Sartwelle.

These authors, Thomas P. Sartwelle and Dr. James C. Johnston, along with pre-eminent medical ethicist Professor Dr. Berna Arda, have repeatedly advised that continuous EFM should not be performed in routine labour due to a 99.8% false positive rate, and the fact it does not predict or prevent cerebral palsy or any other neonatal neurological injury.

EFM does increase the caesarean section rate, with an increase in maternal and newborn deaths and birth complications as well as devastating long term complications. In fact, these very concerns have led Australia, New Zealand and the UK to advise returning to intermittent auscultation (IA) instead of EFM, and in 2017 the American College of Obstetrics and Gynecology finally provided a long overdue recommendation that women be given an informed choice between IA and EFM.

Unfortunately, there are EFM apologists continuing to defend the procedure, and journal editors suppressing scientific debate on the topic. This most recent Surgery Journal article exposes one example of these harmful practices, and should raise serious questions about those EFM proponents recommending a procedure that causes more harm than good to mothers and babies alike. But perhaps the more disturbing aspect is a medical journal editor determined to stifle scholarly debate.

This open access article is available through the following link:

The authors have also published their concerns in the Journal of Child Neurology, Maternal Fetal and Neonatal Medicine, British Medical Journal, Neurologic Clinics, Journal of Pediatric Care, Maternal Health Neonatology and Perinatology, Medical Law International, Surgery Journal and several other journals and books. These articles are available at James C. Johnston’s site:

Fetal Monitoring and Cerebral Palsy

An accomplished neurologist and attorney, Dr. James C. Johnston has published extensively on medical malpractice litigation. Dr. James C. Johnston co-authored a paper discussing cerebral palsy litigation and electronic fetal monitoring. It was published in the 2014 Journal of Child Neurology.

Electronic fetal monitoring, used for over four decades after its introduction without any clinical trials, has repeatedly proven clinically ineffectual, with a 99% false positive prediction of fetal distress, thereby increasing C-section rates with resultant harm to mothers and newborns alike. It has not affected the incidence of cerebral palsy, perhaps unsurprising when one considers the vast majority of cases develop before labor.

Nevertheless, electronic fetal monitoring today remains the most common obstretrical procedure, even as evidence against its efficacy countinues to mount. It is the foundation for the continuing cerebral palsy birth injury litigation crisis, increasing malpractice costs and even driving skilled physicians away from the delivery room. Fetal monitoring also compels obstetricians to commit daily ethical breaches, ignoring the principles of informed consent and non-maleficence or ‘do no harm.’

Thomas P. Sartwelle and Dr. James C. Johnston propose a straightforward solution that would change the standard of care, link electronic fetal monitoring to the exclusionary doctrine recognized by all the world’s courts – Daubert – and end cerebral palsy litigation.