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:

Legal and Forensic Medicine

Legal and Forensic Medicine pic

Legal and Forensic Medicine

Dr. James C Johnston is a board certified neurologist and barrister with three decades of experience. In addition to his consulting practice and charitable work through Global NeuroCare, he is a prolific author who has published peer-reviewed articles for a number of medical and law journals. Dr. James C Johnston has also contributed to over a dozen books including a chapter for the seminal authoritative text in legal medicine entitled Legal and Forensic Medicine, edited by Roy Beran and published by Springer Publishing (ISBN 978-3-642-32339-3).

A comprehensive multi-volume reference book, Legal and Forensic Medicine examines various aspects of legal medicine and ethics that define the fields of the 21st century. Topics addressed in this publication cover the full breadth and depth of legal and forensic medicine around the world, with practical applications in various international and intercultural frameworks. The text analyzes what the fields of legal and forensic medicine share and how they differ in terms of necessary qualifications and professional applications.

Contributing authors to Legal and Forensic Medicine hail from a number of countries and cultural backgrounds. There is a growing interest in the development of health law and legal medicine institutes around the world, and Legal and Forensic Medicine comes in on the ground floor of this burgeoning discipline to provide the foundation textbook for many courses, both undergraduate and postgraduate. It defines the place of legal medicine as a specialized discipline.​