Excerpted from Birth as an American Rite of Passage

Internal Electronic Fetal Monitor

Description and Official Rationale

Because it uses ultrasound waves to penetrate into the woman's uterus and record the baby's heartbeat, external fetal monitoring is subject to various forms of inaccuracy, which include the confusion of the mother's heartbeat with the baby's, and the possibility "that the fetal heart rate may double at low rates and can be halved at high rates" (Cetrulo and Freeman 1975). Therefore, when the medical staff desires increased accuracy in the recording of the fetal heart rate, they will insert an electrode (a needle) up through the birth canal and directly into the baby's scalp.

Physiological Effects

The physiological risks of internal monitoring to both mother and infant are severe, extending far beyond the contraindicated supine position that this procedure necessitates. The insertion of the electrode requires the rupture of the protective membranes, whereas the electrode itself provides a convenient route for the entry of bacteria and viruses into the amniotic fluid and the fetal scalp (Cunningham et al. 1989:301). Consequently, the fetal infection rate in internally monitored women is double that in those who are externally monitored only:

When monitoring continues more than 4.5 hours, the risk of infection is 50%. If it were not for antibiotics, the death rate from monitor-produced infections would be staggering....The baby is also at risk of infection from the scalp-implanted electrodes ...of all internally monitored babies, 4-5% suffer scalp abscesses, lacerations, hematomas, and hemorrhages. -Brackbill et al 1984:11

Possibly the greatest risk to the infant comes from the sharp increase in the risk of prolapsed cord (a condition in which the cord delivers before the baby is born) which is often the direct result of the amniotomy which must be performed (if the bag of waters is intact) so that the electrode can be inserted (Cunningham et al. 1989:301):

Many mothers leave the hospital firmly convinced that electronic monitoring saved their babies from otherwise certain death caused by cord prolapse when in fact it was the monitoring (and prerequisite amniotomy) that caused the prolapse in the first place. (Brackbill et al. 1984:11)

Women's Responses

Anything that they said would be good for the safety of the baby was okay with me.
-Debbie Lawson

We let them put it on, and they had to do it twice before they got it in. And then he had these little scabs on his head - I really wish I hadn't let them do that. I really don't see how they could possibly think that it didn't hurt him.
-Clara Riley

Ritual Purposes

To the profound message of the external monitor, the internal fetal monitor adds an equally profound footnote: your baby is a technocratic artifact too. And as such, it is the institution's product, not yours. In fact, your machine is so defective that society's product may be in danger from its potential malfunction, so it is necessary to apply a special machine to more exactly monitor the product's progress in order to protect it from potential harm caused by you. Here we can see clearly how conceptually essential is this metaphorizing of the baby as a mechanical product--to stick an electrode into an infant's scalp must be an easier job if one holds a belief that, being an object, the not-yet-born does not feel any pain:

At Doctor's Hospital I learned to screw a monitor lead into the scalp of a baby not yet born....Was the baby frightened? Is this baby curious anymore? Does this baby still want to be with us? What have we taught this new person about what life is like? At Doctor's Hospital I attached the woman to the monitor, and no one looked at her any more. Held in place by the leads around her abdomen and coming out of her vagina, the woman looked over at the TV-like screen displaying the heartbeat tracings. No one held the woman's hand. Childbirth had become a science. -Harrison 1982:91

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