Dr. James C. Johnston is a board certified neurologist and attorney with three decades of experience. Dr. James C. Johnston actively participates in clinical research and recently published two articles in the Surgery Journal concerning the ethics of teaching electronic fetal monitoring (EFM) to physicians in training.
Clinical trials to look at the effectiveness of EFM for preventing cerebral palsy started in the 1970s. Between 1976 and 1995, 12 trials were conducted, none of which found any benefit of EFM when compared to auscultation. Ultimately, EFM was proven to have a 99-percent false positive rate, and does not predict cerebral palsy, acidemia, stillbirths, neonatal encephalopathy or neonatal neurological injury of any kind. Since the introduction of EFM, cerebral palsy incidence rates have not fallen at all.
Research has also shown that EFM is subject to human interpretation and that experts would disagree not only with each other, but also with themselves; when shown the same strip months later, experts would often contradict what they originally stated. More recently, the INFANT study published in Lancet demonstrated that even the use of computerized interpretation of cardiotocographs in women who have continuous EFM in labor does not improve clinical outcomes for mothers or babies.
The real concern is that EFM leads to dramatically increased rates of Cesarean sections, which pose serious risks for both the baby and the mother. Between 1970 and 2013, C-section rates in the United States increased from 6 to 33 percent. Much of this increase is attributed to the 99-percent false positive rate of EFM.
Dr. James C. Johnston is a co-author with Dr. Thomas P. Sartwelle and Professor Berna Arda on a number of articles discussing the improper use of EFM, which have been published in various peer-reviewed journals including the Journal of Child Neurology; Journal of Maternal, Fetal and Neonatal Medicine; Neurologic Clinics; Journal of Pediatric Care; Journal of Childhood and Developmental Disorders; Surgery Journal as well as the American College of Legal Medicine textbook Legal Medicine and Medical Ethics.
