EBB 391 – Electronic Fetal Monitoring Advocacy Tips with Dr. Jennifer Lincoln, OB/GYN and Author of The Birth Book

Dr. Rebecca Dekker – 00:00:00:

Hi everyone. On today’s podcast, we’re going to talk with Dr. Jennifer Lincoln about how to advocate for yourself during labor when electronic fetal monitoring is part of your care. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. 

Hi, everyone. Today, I am so excited to welcome Dr. Jennifer Lincoln to the Evidence Based Birth® Podcast. Dr. Lincoln is a board-certified OB-GYN who is passionate about helping girls, women, and those assigned female at birth understand their bodies and feel empowered to advocate for themselves. She practices as an OB hospitalist in Portland, Oregon, and also uses social media to educate, advocate, and bust the many myths surrounding reproductive health and pregnancy with her community of more than 4 million followers. In the wake of the Dobbs Decision Link, Dr. Lincoln founded the website threeforfreedom.com. It’s spelled T-H-R-E-E, a hub that spreads awareness about the availability of mail-order birth control, emergency contraception, and abortion pills in all 50 states. She is an author, regular media contributor, president-elect for the Society of OB-GYN Hospitalists, wife to a pediatrician, and mom to two boys. Dr. Lincoln received her undergrad degree from Washington College and her medical degree from Tulane University School of Medicine before completing her residency in OB-GYN at Oregon Health and Science University. Dr. Lincoln first joined us on the EBB podcast in episode 215 when she debunked reproductive myths about birth control and vaginal cleansing in preparation for the launch of her book, Let’s Talk About Down There, that was coming out. And now she’s on the precipice of her second book being published on March 24 called The Birth Book: an OB-GYN’s Guide to Demystifying Labor and Delivery. Dr. Lincoln, welcome back to the Evidence Based Birth® Podcast.

Dr. Jennifer Lincoln – 00:02:26:

Thanks for having me. I’m just in awe of how many episodes you have. I recorded 10 as part of a limited series for this book launch, and I felt exhausted after that. So I want to know what your secret is. Thank you.

Dr. Rebecca Dekker – 00:02:38:

I guess the secret is having a really great team who does all of the other stuff. So I just have to show up and be present.

Dr. Jennifer Lincoln – 00:02:45:

There you go.

Dr. Rebecca Dekker – 00:02:46:

And then I can look forward to it. And we try not to schedule too many recordings at once and also take time off.

Dr. Jennifer Lincoln – 00:02:54:

Yeah, that is the key. Yeah, no, thank you so much for having me. I’m so excited to be back here chatting with you again.

Dr. Rebecca Dekker – 00:03:00:

So to start, can you give our listeners an update on what you’ve been up to since we last spoke? So when we last spoke, I have to double check the date, but it was a couple of years ago and you had 2.4 million followers on TikTok and you had just published your first book.

Dr. Jennifer Lincoln – 00:03:20:

Yeah, I know. I was trying to think that was, I think it was right before the Delta wave of COVID. So it’s in that timeframe, of, you know, the dark times. And yet here we are now still dealing with so much. But yeah, especially in the past year, I’ve had some fun. This time last year, I was not at work. I was on the picket lines. I was part of the first doctor’s strike ever in Oregon and the largest nursing strike, I believe, ever in the state of Oregon. So it was hospitalists, midwives, and nurses who had each individual bargaining unit. We had been bargaining for some of us for a year and a half. And we had to unfortunately strike to finally get some of the fair things that we wanted. That was an eye opening experience. So you know, when the winter comes back, I’m like, I’m so glad I’m inside as opposed to outside right now. I’m also now the current president of the Society of OBGYN Hospitalists, which is super fun. It is just this great organization of people who are hospitalists. And literally what we do every day is think about birth just like you and how we can do it better. And something that’s really, really cool is at our last annual clinical meeting in September, we announced a strategic partnership with the Society for Maternal Fetal Medicine Doctors or SMFM. With the whole goal of how do we work together better and keep patients at the center. So I’m super excited about that. Then, you know, I’m writing this book, The Birth Book, which comes out in March, but you can pre-order it if you’re listening before then. And I wanted to write this book because I realized that there was no book that just focused on the giving birth part written by an OBGYN. And there are lots of great books out there, but some of the top selling ones are not written by people who do this work. And I think it’s really important to be able to offer that perspective. And I see as a hospitalist, people coming into labor and delivery or transferring from home who have no idea the nitty gritty what to expect. And I think it’s that lack of knowing, that lack of understanding that contributes to a lot of the anxiety and trauma that we see. And it’s not because people are not trying. It’s because you’ve got like five, 10, 15 minute visits with us, or you just don’t know where to go. There’s so much stuff out there. Some really awesome. I’m always telling people about Evidence Based Birth®. I’m like, go there. And then some that’s not so vetted and doesn’t have references. And it’s just so much. And I feel for people trying to survive in a broken healthcare system in all aspects, but especially when it comes to labor and delivery care, I think we’re facing some unique headwinds. And so I wrote, I wrote this book for that. And I’m just so excited. It means we get to chit chat again.

Dr. Rebecca Dekker – 00:05:55:

Yeah, exactly. And I’m just out of curiosity, what were some of the things that you and your coworkers were looking for in that strike that you mentioned? Because coming from where I live, don’t really have organized labor in the hospitals, although it seems like that would be a good idea sometimes. So what were some of the things you were organizing around?

Dr. Jennifer Lincoln – 00:06:11:

Yeah. So specifically for the hospitalists, doctors, and the nurse practitioners, and this was internal medicine doctors, OB doctors, palliative care, pediatrics, we wanted the ability to not have our jobs be subcontracted out. So for cheaper labor, and we’re seeing this in a lot of healthcare systems where instead of the hospital continuing to employ doctors, they will sub out to a national group that will bring in people who may not be from the community. Or even if they are, it’s very much venture capitalist based where it’s just get the most for the least pay, you burn people out and they leave. We saw that happen with another group in our hospital and we were dead set. We did not want to be contracted out. And so we were able to get that. This is a really fun fact I think your listeners will appreciate. So the internal medicine hospitalists, which is a much bigger group than my, my tiny group of I think seven. All female doctors and put that in the back of your mind. But the internal medicine hospitalists were getting paid what’s called a night differential. So they get paid a little extra for working the shifts that nobody wants to work, which is nights, which I think is fair. When you work nights-

Dr. Rebecca Dekker – 00:07:12:

They do that in nursing as well.

Dr. Jennifer Lincoln – 00:07:14:

Right. Exactly.

Dr. Rebecca Dekker – 00:07:15:

Yeah.

Dr. Jennifer Lincoln – 00:07:16:

Exactly. And like, you know, when you’re working nights, you’re harming, you know, your fertility, your cancer risk, like your sleep cycle, like it’s not benign. And what’s really interesting is that these internal medicine hospitalists got it. But we as the OB hospitalists who are very much working at night, I’m sure you know a lot of babies are born at night. They refuse to give it to us, even though they gave it to the other group. And I thought is, is this a, you know, as always, women’s healthcare is always reimbursed poorly, but is it because we’re a tiny group of all female doctors, because I wouldn’t see them saying the same thing to a tiny group of male neurosurgeons. So we were able to get that. And then just a bigger ability to have a say in how we do our jobs to speak up and say, Hey, we need some help. We want to bring in a backup. Of course, we didn’t get everything, but that’s what, you know, compromise is. But it was really powerful to see doctors who typically don’t always, I mean, the idea that I’d ever be walking out of my, it’s like insane to me, but it’s so broken right now, healthcare. And when you see executives making millions of dollars and you’re just trying to get something that another person has in the hospital, because you feel like that’s fair.

Dr. Rebecca Dekker – 00:08:15:

Yeah.

Dr. Jennifer Lincoln – 00:08:15:

It’s an interesting state of affairs. And we’re recording this right now while the New York nurses are kind of dealing with the same exact thing. So it’s, I think we’re going to see it more and more because unfortunately I get it. Hospitals are under strain, but at the same time, you can’t cut corners and the people who are caring for the people.

Dr. Rebecca Dekker – 00:08:32:

Mm-hmm. Right. It’s just a setup for failure, essentially.

Dr. Jennifer Lincoln – 00:08:36:

Yeah. Yeah. Nobody wins except for the CEOs, you know, who make their millions.

Dr. Rebecca Dekker – 00:08:42:

Yes. And I know where I live, for example, the University of Kentucky, their healthcare system, you can look up the salaries of anybody who works at the university because they’re paid, you know, through taxpayer funded monies. They’re required by law to be transparent. And it is really fascinating to see, you know, that maybe a certain wing of the hospitals run as a quote unquote nonprofit, but their executives are making these incredibly high salaries that you don’t see in any other field. And it’s like, okay, is it a nonprofit or is a lot of this money going to pad the pockets of extremely wealthy executives? It’s just an interesting dilemma that I don’t think a lot of people realize. So speaking, you mentioned New York. So in the New York Times, there was in 2025, an article published kind of a little bit of an expose on continuous electronic fetal monitoring. And I think a lot of birth workers were simultaneously excited and annoyed by the article because they’re like, we’ve been saying this for more than a decade and nobody’s been listening. And now finally, you know, we’re talking about this, but it stirred up a lot of conversation online. And I was wondering if you could start off with this topic because you agreed to come on the podcast to talk about it. What do you wish more parents understood about electronic fetal monitoring before they go into labor? Like what do you wish they knew prenatally about this procedure during labor?

Dr. Jennifer Lincoln – 00:10:09:

Well, I think, well, before I do that, I will say I loved this article because, but I felt the same as you like, oh, cause now it’s getting published in the New York times. Maybe some people will listen. And so like I internally rage and then I’m also like, well, if this is what it takes and we’re talking about it, amazing, but frustrations for sure. But, and what this article basically said, you know, the headline was great, you know, the worst test in medicine. And I was like, yes. Finally someone is saying it. Idea that electronic fetal monitoring has a lot of issues with it. So what I want people to know, if they’re planning for a hospital birth, especially to even know that this thing exists. And I think a lot of people have this understanding of monitoring, but I’m often surprised that people don’t really know. They’re like, what does that line even mean? And explaining that, you know, the top line is your baby’s heart rate. And what we’re looking at is where it is. And I call how squiggly it is. And if it’s going up or down and the bottom is your contraction pattern or what’s happening in your uterus. And once again, I say that… I am not trying to say, I can’t believe people don’t know this. Like, it’s just that. So I’m solely hospital based now. And I don’t, thinking back to my clinic days, I don’t think I ever sat down and explained to somebody, what a fetal monitor, because in my world, it was just so routine.

Dr. Rebecca Dekker – 00:11:20:

What will happen to them that they’ll be hooked up to these belts. And this is what will be on the screen.

Dr. Jennifer Lincoln – 00:11:25:

Right. Like we’re talking about other things, like we’re going to do your group B strep swab. You might get an epidural. And I just really like, that just never comes up. Just like, you don’t mention you’re going to check your blood pressure. Like you just assume. So it’s just part of that same cycle of, you know, where our education is. So I would want people to know kind of what it is and what happened. Like you said, the literal logistics of it, that it’s plugged in and you’re hooked up. I want people to know the story behind it, that it is this nonspecific test because. Not knowing anything about it, I think, can really leave you in a lurch if somebody comes in and we go, oh, we’re looking at that monitor, we see a decel and we’re worried about what does that mean? And so having some empowerment of knowing what this test is and also maybe like how not so great it is because then you can speak up and say, well, I thought, you know, I’ve heard that this isn’t like the end all be all test. It’s not like a flu swab. You either have the flu or you don’t. You know, it’s more squishy than that. But I really want people to know too, is that they have a choice. And we’re going to talk about that. How do you advocate? I know. But that just because somebody says, we’re putting you on this or we’re doing this, it doesn’t mean that you just have to be a good soldier and say, well, of course we are. And I’m not saying here, if my colleagues are listening, like, oh my God, what is she telling people? But you’re allowed to ask questions. You’re allowed to say, can you tell me what that is? And I’ll guarantee you, your nurse has more time to explain this to you than your doctor and midwife who’s got 37, 40 patients booked in their clinic. So understanding that you do have a choice and that you might even be able to talk more about intermittent monitoring versus continuous, which I know we’ll go into. And I also want to the last thing I want people to know about, too, is that the answer to all of this stuff that we’re talking about or us saying, oh, is this worst test in medicine? It’s not automatic. That means that no monitoring is the answer and it’s the best. It’s not like we should just get rid of everything and go in the other direction from monitoring, tracking everything to monitoring, tracking nothing. But I would want people to know that. There’s oftentimes an individualized assessment and a plan that we should make. And you should feel like you have some agency, even if your provider ends up recommending it and you are plugged in. I don’t want you to feel like you’re just nailed down to the bed. So I think all of those things are important.

Dr. Rebecca Dekker – 00:13:37:

So where did it come from then?

Dr. Jennifer Lincoln – 00:13:40:

The 60s where some really good stuff came out of it, but not everything. So the whole backstory of fetal monitoring was that we wanted to be able to predict and prevent preventable deaths in labor. So things like stillbirth. And we thought, you know, this technology, which is tracking your baby’s heart rate. The idea is that what we see on that monitor can help us know the acid-base status of what your baby’s experiencing in the uterus right now. We’re not going to get into the chemistry, but having too much acid in your blood is not a good thing. And if that happens, that’s telling us that you’re not getting enough oxygen. And we can sometimes see certain signs on the monitor when that happens, whether it’s more of a flatter line or we see certain dips in the heart rate that have concerning aspects to it. And so this whole idea was you’d be monitored and then doctors could swoop in and we could do things and either deliver you emergently by C-section or stop Pitocin medicine or move you around or do whatever to prevent that. The bummer of it is that that never materialized. The one thing that fetal monitoring has been shown to decrease are neonatal seizures, but it has not decreased the chance of having a stillbirth or long-term complications. You might be listening to that and go, WTF, why do we use this technology then? Well, the problem is that it’s technology. Even back then, not now, when we have everything technology-wise, apps and AI and whatever, even back then, something new and shiny felt great and hospitals bought into it. And, once you have this and you could have this data, I call it the test we’re kind of stuck with and now we have to figure out how to use effectively or not use in certain situations because I don’t think it will ever go away. I have a feeling we’ll talk about that. So that’s where we are.

Dr. Rebecca Dekker – 00:15:28:

Yeah. And I think it was also thought that it would bring an end to cerebral palsy, which it did not.

Dr. Jennifer Lincoln – 00:15:35:

Correct.

Dr. Rebecca Dekker – 00:15:36:

And then it was marketed as a scientific breakthrough before there were randomized trials showing if it would be really useful or not. So it’s just kind of adopted as the new standard.

Dr. Jennifer Lincoln – 00:15:47:

Yeah. And it’s, you know, I’ve heard people, it’s like the Pandora’s box. It’s opened up and it will never get put back in. So then how do we do it more thoughtfully?

Dr. Rebecca Dekker – 00:15:53:

How do you take away that information if you think, well, I can see the contraction pattern really easily without having to ask you, without having to put my hands on you.

Dr. Jennifer Lincoln – 00:16:02:

Right.

Dr. Rebecca Dekker – 00:16:02:

I can see the baby’s heart rate really easily and keep a constant eye on it without having to put, you know, a fetal stethoscope to your belly and actually listen or without having to hold an ultrasound wand to your belly.

Dr. Jennifer Lincoln – 00:16:15:

Right.

Dr. Rebecca Dekker – 00:16:16:

And then I can watch you from even outside the room or even outside the building. Correct?

Dr. Jennifer Lincoln – 00:16:21:

Right. Exactly. And so these were all touted as these great advances. And you can think of it, especially if you are a labor nurse or you’re a manager and you’re thinking, how can I do more, more efficiently? So like you said, the nurses can sit at the nurse’s station and now she can take care of multiple patients because she can sit outside that room as opposed to back in the day when you did. You had to put your hand there and you had to chart when the contractions were happening. Or I could be in the clinic and my nurse can call me and say, hey, can you look this up? And then I can pull up that strip on my computer and I can see it and make decisions. And so it makes logical sense, you know, why you would think people would get excited about it. You know, hindsight is always 20-20. But when you think, like you said, that this got released before any randomized control trials and what it ultimately did, which is it didn’t decrease rates of cerebral palsy or stillbirth. And what did it do? It increased rates of C-section and operative vaginal deliveries because now we have this information. And what are we supposed to do with it? Exactly. Yeah.

Dr. Rebecca Dekker – 00:17:23:

So talk to us about some of the drawbacks. You mentioned the one benefit is it decreases the rare risk of your baby having a seizure after birth. But what are the drawbacks then? Like, why would we not want this information?

Dr. Jennifer Lincoln – 00:17:37:

Well, The biggest drawback of using this and having not a whole lot of great data to show that it has a great positive predictive value, which means that when we see something concerning, we’re actually going to see something on the monitor. We’re actually going to see something concerning your baby. So it does not have a great positive predictive value. But yet we have this information. And one of the biggest things is the medical legal environment that we’re in. So. I’m an obstetrician. I am the number one sued specialty in medicine. And people might not know this, but we’re not just talking about like in the first year after birth. Patients have up to 18 years to sue for an adverse birth outcome. And if that scares you, like imagine the people do it. Like that’s a real thing that we have to think about. So what does that mean on the ground? It means that our insurance premiums are super high. It means that we have to kind of be thinking in a defensive way. And so it is very easy to sit at home and say, well, they shouldn’t use this technology at all because, you know, it’s so bad. Like, just ignore it or whatever. It is a very different thing when you see some of these patterns and you go, well, I’m stuck here. This is the best information I have. I can try these tricks to see if I can figure out other ways if this baby is doing okay to assess that acid-base status. But if this is all I have… I’m kind of stuck between a rock and a hard place because if I don’t offer this person a C-section and there is a terrible outcome. We’re talking about a million dollar lawsuits. And I’m not sure if people listening know that when it comes to medical legal malpractice lawsuits, so many of these lawsuits never make it to court where you would hope that based on the data, they would show and you’d be like, oh, actually, you know, they did an amazing job. Like sometimes bad things do happen. But the thing is, the hospital settles it. So they’re like, you know what? It’s going to be cheaper if we just cut you a check for $4 million or $5 million or $10 million just to have this go away. And that destroys you as an OBGYN. And that also means that your premiums shoot up. It means that maybe you’ll be let go of that group. Like it has huge implications. And so when people say you shouldn’t practice defensive medicine, as somebody who’s in the practice of it, I can tell you there, you can overdo it for sure. And unfortunately, we have to think about the system in which we’re in. We could spend all day. And maybe you’ve got other episodes about the whole medical legal aspects of birth because it can be terrifying.

Dr. Rebecca Dekker – 00:20:01:

I don’t think we do. But I do have a close family member who is in the medical malpractice industry and who actually… Is the one at the insurance company deciding if the healthcare group should settle or not.

Dr. Jennifer Lincoln – 00:20:16:

Right. And it’s all an economic decision, right?

Dr. Rebecca Dekker – 00:20:19:

It is. And they occasionally do think tank. And they occasionally do take things to trial, but it’s pretty rare. Usually it’s a negotiation. And like you said, you don’t have a chance to prove yourself in court. And I imagine even if you do, that can be a traumatic experience as well.

Dr. Jennifer Lincoln – 00:20:35:

Oh, yeah.

Dr. Rebecca Dekker – 00:20:36:

With being deposed and all the evidence gathering and everything you have to go under.

Dr. Jennifer Lincoln – 00:20:42:

Yeah. I mean, we’re talking multiple years. It takes multiple years to go to court. And what will happen is, you know, everything will get shown and each side will pay their own medical expert who will say whatever, again, because this can be squishy and you can say, well, I look at this and that is what is some of the problems of electronic fetal monitoring is that you can have two independent people looking at it. And they’ve done studies to show this where look at the exact same strip and you have a totally different interpretation of it. It’s like looking at modern art and you’re like, what do you see? And you’re like, I don’t know. I see a duck. I see a dog. And so imagine that with like… Your career on the line in front of a judge, then being decided by a jury that’s not really of your peers because they’re not practicing medicine. It’s just, it’s so hard. So that in and of itself, I think is the biggest problem I see with electronic fetal monitoring, you know, continuous, but there are others too. That’s not the only one.

Dr. Rebecca Dekker – 00:21:32:

Well, and I think one of the sad things is I think you said this was introduced in a way in a defensive way. And, physicians saw it and hospitals thought, well, this will prove that we were in the right. You know, if we have this continuous record of what the baby’s heart rate was doing. But research has shown that the introduction of electronic fetal monitoring actually had the effect of increasing the rates of medical malpractice suits. Like families were more likely to sue because they thought they had a case because they thought they could use, like you said, it’s squishy. So both sides think they can use it to make their case.

Dr. Jennifer Lincoln – 00:22:06:

Yeah. So I work within the system. I advocate as much as I can and we’ll talk about ways to do that. And, you know, for me, it’s about documenting my thought process or, you know, saying, well, I see this, but here’s why I think we’re okay to continue. And, or if I don’t. And, and so it’s a, you know, so the people who are listening to this and like, oh my God, I’m never going into obstetrics because it sounds like a nightmare. There are ways I think to do the very best you can with the information we have, but it’s a real takeaway that. More is not always better. And I think we live in a society, all of us, where we think more is better. I mean, I used to have my Aura Ring and I’m like, how did I sleep last night? I don’t know. How do I feel? That’s not what I wanted to know. I want to know what my score was and we’re tracking and there’s apps and we are in a world of information overload. But has it made us healthier? Has it made us happy? I don’t know. So this is just another example of more information may not be better. And in fact, we know that it’s increased C-section rates. It hasn’t done these other things, but it’s very much, you know, I joke like American exceptionalism. We always think new and shiny and more has to be better. And sometimes I wish, I was like, I wonder what it was like to practice before we had this monitor.

Dr. Rebecca Dekker – 00:23:18:

I’ve talked with labor and delivery nurses who lived the before and after, and they said it completely changed the way they took care of their patients as well. And I think one of the most things that got drilled into my head as a nursing student was look at the patient, not the monitor.

Dr. Jennifer Lincoln – 00:23:34:

Yes.

Dr. Rebecca Dekker – 00:23:34:

Look at the patient, not the monitor. And I think all the monitors can be helpful. You have to like lay your eyes on someone or, you know, touch them to assess them, to see what’s going on, to listen to what’s going on. And I think monitors can sometimes give you a little bit of a false sense of security because you think everything’s going on fine in that room, but the birthing person might be going suffering or something else might be going on that you’re not tracking. So.

Dr. Jennifer Lincoln – 00:24:01:

I totally agree. Mm-hmm.

Dr. Rebecca Dekker – 00:24:04:

Yeah. And I think I’m curious from your perspective as a hospitalist and OBGYN, like how does electronic fetal monitoring when it’s done continuously affect things like movement, position changes, and just the overall labor experience?

Dr. Jennifer Lincoln – 00:24:19:

Yeah. Well, I mean, you know, if you’re hooked up to continuous fetal monitoring, the kind that plugs into the little machine. You kind of are on a short leash. I tell people, I’m like, this kind of feels like it’s the thing that you’re stuck to. And so we know that movement in labor can be very helpful for folks who are unmedicated or for labor progress. And so being kind of strapped into that thing can really limit it. So I think it’s really important if you do end up on these monitors, whether it’s because you prefer it. And I think, you know, we should talk about that, that for some people. Like the idea of intermittent monitoring, like not knowing can cause more stress and anxiety than the potential increased risk of a C-section from continuous monitoring. And I’m not here to tell people there’s only one way. So if you are hooked up to it to let people know, hey, just because I’m putting this on and I asked you to sit still. For 20 minutes for that NST, that brief monitoring when you first came in, it doesn’t mean you need to be like this the whole time. And in fact, here’s ways that you can move around. And, you know, it means that I may have to come into the nurse may have to come into the room and adjust you. And so that can definitely limit you a bit and play with the psyche if you’d rather be moving around. But there are wireless options that do exist, kinds that can stick to your belly. So then you’re not hooked up to anything. And that can be nice to have a bit more freedom, or if you want to be in the shower or the tub, sometimes those can work well. Although so many people I see have those like reactions to the stickers of those you can tell a couple days later. You had the Monica on I can tell. But to know to expect that. And so I think it’s important to note too, that once you’ve got those belts on, it means that we’re collecting information and it means that you might do something. So if we come in the room and we say, oh, I don’t love your baby’s heart rate in this position. I’d like you to move this way. That’s it’s because we’re seeing something on there. And the idea is that a position change could help a little bit with that.

Dr. Rebecca Dekker – 00:26:06:

Okay. And, with the wireless monitor, some of the things I’ve heard people talk about are like, they walk away, they get lost and you think your hospital has wireless monitors, but there’s not one available. Can you talk a little bit about artifact and what that is on a fetal monitor and how that might affect even wireless monitoring?

Dr. Jennifer Lincoln – 00:26:28:

Yeah. Yeah. So sometimes, and we see this more in the wireless monitor, we’ll see like a doubling or a halving. So the heart rate that’s actually getting traced is not the actual heart rate. And we want to confirm that because if it’s artificially high or low, that would concern us. So sometimes we still will come in with the ultrasound or we might periodically want to double check with the wired one. When it comes to artifact too, and this is important with any kind of monitoring, because just like you said, you know, you think you would monitor, you’d see something. There are cases and these are the tragic cases. And please do not take away that I’m against any lawsuits because there are just sometimes where there’s negligence. So we think we’re tracing the baby and we’ve been tracing mom’s heart rate the entire time because her pulse was 110 because her pulse was a little high. Turns out that baby’s heart had stopped a while ago. And those are some really, really tragic, avoidable cases. But there can be sometimes artifact where it’s breaking up or we’re not sure who’s, you know, is that a real deceleration or is it that it was broken up? Exactly. Or baby’s moving or you’re moving. And so- Sometimes it can be based on where your placenta is, the shape of your belly, how many babies you have in there. I joke, you know, the whole idea is that continuous monitoring made nurses’ lives easier because then they could have multiple patients and they could be doing different things. And sometimes I laugh because you see that one nurse who’s like just sat down, got the baby on the monitor, moved, have to go back in there. And I’m like, you know, I think it actually would be less work for you if we did intermittent auscultation because you would be in there actually less time. So sometimes it can be really difficult and that can be especially frustrating if somebody is having a long induction, you know, a three-day induction, they’re not getting good sleep because we’re constantly coming in. And that’s why I wish that we would reserve this monitoring for some of those higher risk cases because it can have negative consequences for sure.

Dr. Rebecca Dekker – 00:28:12:

Hmm. Okay. So there can be false positive results, but there can be true positive results. And so it’s, it’s tricky to know which is which, and then there can also be confusing results where you have to verify what’s going on.

Dr. Jennifer Lincoln – 00:28:25:

Right. Right. Exactly.

Dr. Rebecca Dekker – 00:28:27:

Okay. And talk a little bit about the alternative. You mentioned intermittent monitoring. You mentioned intermittent auscultation. Can you talk about the difference between those two?

Dr. Jennifer Lincoln – 00:28:36:

Yes. So this is kind of what it sounds like. You’re just intermittently checking in. And so it might be done using the little fetal Doppler, which is like what you’ll have during your prenatal visits. Or it might be that the actual, the belt that we use for continuous monitoring, but we’re just putting you on every so often. There’s no one agreed upon protocol about how often and for how long you should listen. But one that I’ve seen and that I believe we use at my hospital is the AWON protocol. I’m trying to remember exactly what it is. I think it’s listening every 15 to 30 in active labor and then like every five minutes while pushing. I believe that’s it. That’s an important thing when you’re at the hospital is making sure that your hospital actually has a policy. So when somebody comes in and asks for it and you might not know because you’re new or you don’t use it so often to be able to reference a policy and say, oh, yeah, we can do that. But it’s this idea that you’re intermittently listening. And if you hear something concerning, then you’re going to default to listening longer or continuous. And concerning might be, tachycardia, heart rate’s too high or bradycardia is too low or the kind of heart rate dip that might worry us during a contraction. And that can be really nice because it’s in between then you’re kind of doing your thing, you know, and this can be really great. Exactly. You’re free to be on the ball. And it’s not that you can’t be on a ball or be in a chair on continuous monitoring. Just the distance might be different or, you know, the amount you might need to readjust it can certainly be frustrating.

Dr. Rebecca Dekker – 00:29:58:

Okay. You mentioned that there are certain high-risk situations where you think, definitely the continuous electronic fetal monitoring is helpful there. Can you talk a little bit about, when it’s more beneficial?

Dr. Jennifer Lincoln – 00:30:11:

Yeah. And I think it’s really important, and I’m sure you know this because you’re a data geek and I love that about you, is that there’s no randomized control trials comparing people in high risk scenarios. So having higher risk issues to using continuous monitoring versus intermittent monitoring. So everything that I’m saying is based on observational stuff and is really based on the fact that it’s just a different risk benefit calculation. So for the average low risk person. We know that continuous monitoring does not decrease the risk of stillbirth. However, if you’ve got other things going on where your baseline risk of stillbirth is higher, theoretically, it kind of makes sense, right, that continuous monitoring, if you’re already at a higher risk. That, you know, those predictive values might be a little more accurate, but can I-

Dr. Rebecca Dekker – 00:30:57:

Or if you’re on medications that might be like causing certain complications.

Dr. Jennifer Lincoln – 00:31:04:

Right. Absolutely. Yeah, absolutely. So it’s just this idea and, and we’ll, we’ll never get this study because nobody will ever consider it as a goal-

Dr. Rebecca Dekker – 00:31:13:

I mean, the studies on electronic fetal monitoring are really old. Nobody’s, you know, very few people are studying it. I haven’t done a lit review to see about the wireless, but the last time I checked, there wasn’t really evidence on that, even though that’s a big hot thing right now. And maybe there are studies I’ll have to check. And if I find any, I’ll put them in the show notes, but you’re right. We don’t have a lot of data. So this is where you’re getting into like more your expert opinion. So tell us your opinion on the situations where you’re like, I definitely want to continue this monitor.

Dr. Jennifer Lincoln – 00:31:39:

Yeah. So, and again, it’s my expert opinion based on that increased risk of stillbirth and complications, things that could be preventable. So things like abruption, that kind of stuff, and the medical legal background, which is always in the back of my mind, but knowing that these are different creative apples than the ones that are just low risk. So I think of it as issues in the birthing person, the fetus and the placenta. So when it comes to the pregnant person, we know that certain medical conditions put you at a higher risk. So if you’ve had a previous stillbirth before, you have medical issues such as severe preeclampsia, or preexisting or very poorly controlled diabetes. If you’re in diabetic ketoacidosis, or you’re, you know, hypoxic, because you have pneumonia, that’s not great for your fetus and definitely makes labor a bit riskier. And so in those situations, we’re going to talk about continuous monitoring. And you kind of already hinted at this too. Like once we talk about induction, Pitocin and misoprostol medications that we use every day in labor, these are remarkably dangerous medications if not used appropriately. And I would not want to be asking my nurse to continue your Pitocin and getting you into a good contraction pattern and not know what’s going on with your baby because I am making that uterus contract. And if I’m doing it too much and that baby is not tolerating it, and I don’t know that, that I could be causing harm. So that’s a situation where we are going to want to monitor, which leads into a whole thing of, you know, the ARRIVE trial. And if you want to have an induction at 30 a week.

Dr. Rebecca Dekker – 00:33:04:

Yeah, and then we have like, there’s new randomized trials on outpatient induction, which would mean you’re doing it without continuous fetal monitoring.

Dr. Jennifer Lincoln – 00:33:12:

Yeah, we offer outpatient Foley balloon induction, not yet with any of the pharmacologic methods, but that’s another thing of like, yeah.

Dr. Rebecca Dekker – 00:33:19:

A whole another can of worms.

Dr. Jennifer Lincoln – 00:33:20:

Whole another episode. And then in fetal indications, and I think the perfect example of this is intrauterine growth restriction. So let’s say you’ve got a baby who is not only just tiny, because of course there are tiny babies who do fine, but other signs that maybe that fetus or also that placenta aren’t doing so great. So not a lot of amniotic fluid or what we call oligohydramnios. You might see a very calcified placenta on ultrasound. We might actually see in the blood flow from the umbilical artery. That oxygenated blood is not getting to your baby and deoxygenated blood isn’t getting away. So these are already high risk situations where we’d want to do monitoring, but for the reasons that we talked about preventing bad outcomes. But I also think it’s important to note that continuous monitoring can also allow us to labor longer than or at all somebody might not want to. So let’s say you’re pregnant, you’re 35 weeks, you were diagnosed with intrauterine growth restriction, no fluid around baby. Something we called reversed and diastolic flow, where that blood flow is not great. Your obstetrician might say, you know, it’s your first baby. Well, we’re just going to do a C-section because it’s going to take you days to get into labor. And this fetus isn’t going to tolerate labor. And that might be true. But because of continuous monitoring, we can try. And we can reassess and we can see if your baby seems oxygenated. So I’ve definitely seen signs where having monitoring allows us to be in a higher risk situation as opposed to just throwing in the towel and just doing an automatic C-section. And then, you know, other conditions where, you know, if you’ve, you know, had a known placental issues such as, you know, concerns for, you know, subchorionic hemorrhage. I’m just trying to think of some other things. So there are reasons-

Dr. Rebecca Dekker – 00:34:54:

My sister-in-law came on the podcast. She had partial placental abruption and, you know, they were monitoring her.

Dr. Jennifer Lincoln – 00:35:00:

Right.

Dr. Rebecca Dekker – 00:35:01:

Because she was hospitalized and they didn’t want her to go into labor. So they were keeping an eye on it.

Dr. Jennifer Lincoln – 00:35:05:

Right. Yeah. So there are reasons for sure where at baseline, your risk in labor is slightly higher for some of these things. And it’s not always the clinical signs that we see like a fever or bleeding. Sometimes you don’t see these things. And the first thing that you see is on that monitoring that baby’s heart rate is now really high. And you’re not going to get a fever till an hour later. So it’s not to say that all of this technology is not bad. It’s just, we need to think about how we use it more thoughtfully. And explain this to patients so they can understand. So then if they don’t have any of this, they’re like, well, wait, why do I need this? And that’s, I think, the really beautiful moment where you can say, you’ve got a totally low risk pregnancy. I see this is important to you. We have this other option because if our goal is a vaginal birth, let’s talk about how we optimize that. And we know that continuous monitoring isn’t the answer. And again, the opposite, no monitoring at all. Again, people can choose what they want, but if you’re in a hospital, we’re probably not going to be too excited about that. But we know we have studies to show that no monitoring at all is also not good. It’s thinking and it’s documenting so that you can do some of these things that maybe in a hospital might be a little, oh my gosh. And it can be uncomfortable as a provider, especially if you work in a place where they’re like, what do you mean intermittent monitoring? Like there are just some places where that’s just not part of the culture.

Dr. Rebecca Dekker – 00:36:19:

They just don’t do it and they don’t do the listening with the handheld Doppler.

Dr. Jennifer Lincoln – 00:36:22:

Yeah.

Dr. Rebecca Dekker – 00:36:23:

They would look at you and be like, what in the world are you talking about?

Dr. Jennifer Lincoln – 00:36:27:

Yeah. So, and then that’s also part of why I wrote my book was, you know, I started out writing it for patients and I was like, we need to do better too. And here’s the data and use it, use it to say, well, here’s why I do want to change things. Here’s why I do want to make sure we have a policy on intermittent monitoring. And I want to make sure we have safe staffing so that our nurses can do it. And I want to make sure it’s in the prenatal education. It can feel really scary to be the voice out there doing it. But the more that we talk about it and the more that patients know it’s an option and they’re asking for it. They know it’s better, then the more likely people like hospital administrators are to listen to them and to us and think, oh, well, if we don’t do this, we don’t offer this, then word’s going to get out, you know, out in the city that we’re not the place to be, which at the end of the day, money talks. So if that’s how we have to motivate people by saying, you’re going to lose your market share of people who want low risk hospital births, if you don’t do this, it can change things. I mean, we weren’t doing skin to skin, right? Remember skin to skin was so crunchy and crazy and delayed cord clamping and all those things.

Dr. Rebecca Dekker – 00:37:25:

I was telling people, some people the other day that 15 years ago, like a lot of hospitals weren’t doing any skin to skin. So change can happen and it takes time. You mentioned, you know, educating families. And one of the things that I was thinking about while we’re talking is that a lot of parents have no idea what the different types of categories of like the fetal monitoring strip, what they mean and what does it mean to be reassuring or non-reassuring? Can you talk to us a little bit about that?

Dr. Jennifer Lincoln – 00:37:53:

Yeah. I think we could go down a rabbit hole of explaining categories one, two, or three, or what we use at my hospital. We use the five colored tiered system. The take home message, and I think it’s most help for patients who want to be able to communicate with their team is like reassuring, indeterminate, or non-reassuring. So reassuring category one or green-blue, things are good. We love it. Your baby looks well oxygenated. I have no concerns. Keep on trucking. Non-reassuring, which should be a very tiny part of strips is definite sign something’s not right. You know. baby’s heart rate is down for 10 minutes or something like that. Although, again, how many of those do we see those babies come out? Fine. I don’t want to talk about that. And then the majority, which are these indeterminate. And that’s really, I think, the best way to phrase it is. Things might be fine. Things we just don’t know. There’s things, some things look good. Some we’re not quite so sure, but here’s ways that we can reassure ourself. And so I think being able to use that vocabulary with your providers can be helpful. You know, are you reassured by how my baby looks? Are you not reassured or are you just not sure? And then they’ll say, well, I’m not totally sure. We’re going to try and move you on this side or we’re going to try and put some more fluid into your uterus because I think that umbilical cord is getting compressed. And knowing that sometimes your provider is out there at the desk looking at it, squinting at it, you know, calling, you know, as a hospitalist, I often get called and can you be a second pair of eyes? What do you think about this? And that’s that squishy part of it sometimes where those indeterminants you’re trying to figure out is it indeterminate, like more concerning or less concerning. And this is where I just, I wish that we could just order like a flu swab. Are you okay or not okay? And then we would all sleep better at night. But that does not exist yet.

Dr. Rebecca Dekker – 00:39:31:

So what are some of the things you mentioned turning on your side and putting fluids on your uterus? Is there anything else, you know, or what is the typical protocol if it doesn’t look that good on the fetal monitor, but you’re trying to see what else can be done before going to surgery?

Dr. Jennifer Lincoln – 00:39:46:

Yeah. Well, it’s important to know that your team will recommend different things based on what they think is causing the issue. So if we think that umbilical cord is getting squished and kind of getting clamped off, we might try to move you to kind of help that cord move around, or we might put a little catheter into the uterus. It’s called an intrauterine pressure catheter. It allows us to measure the strength of your contractions, but it also lets us put a little bit of fluid back into the uterus to make more of a cushion. And I always laugh. People are like, but you just broke my bag of water. I’m like, or your bag of water just broke. And you’re like, wait, I thought that was the point, but it just gives a little bit more of a cushion. We may, you know, and that may, it may be more than just going on your hands or on your side. It may be hands and knees, and it may feel very like, wait, you want my naked butt in the air. Yeah, we’re just, we’re really trying here. It also, we have to think what’s causing this. Is it because there’s not enough blood flow to the placenta? So if your blood pressure just dropped because you just got an epidural or you’re super dehydrated, giving you fluids. And I know there’s a lot of concern about overdoing IV fluids in labor, but sometimes it’s really important to get your blood pressure up or to give you medication to help your blood pressure go up. Or it could be related to other medical things. If we just treated your super high blood pressure because you’re preeclamptic and now it dropped too low, whoopsie daisy, let’s bring it back up. So it’s thinking about what is the cause of it? And I bet people listening who’ve had babies before, like, why isn’t she talking about putting oxygen on? Because that’s what they did every time. And it’s funny-

Dr. Rebecca Dekker – 00:41:10:

That to me- Yeah.

Dr. Jennifer Lincoln – 00:41:11:

Only stopped that during COVID. When we were concerned about airborne stuff. And then we realized too, that it never has been shown to work. And you would think like, well, if I want to get more oxygen to the baby, then I just give the mom oxygen. Your body is already shunting it. Your placenta is already sucking away the good oxygen. So putting more on does nothing unless you are not breathing well, like you have pneumonia or something like that. And I feel like that’s finally died out. Although I bet you there’s still hospitals that do it, but there’s no data. And I think ACOG and SMFM both came out and said, needed-

Dr. Rebecca Dekker – 00:41:41:

And I think there were randomized trials showing it was not helpful and in some cases harmful, but you’re right. It didn’t really come into practice until the pandemic.

Dr. Jennifer Lincoln – 00:41:49:

Yeah. And all of a sudden we’re like, oh, wait, we can make a change. I remember as a resident, I was like, get the oxygen on. And now it’s kind of nice. I’m like, oh, we don’t get the stupid mask that everybody hates, you know, the smell. Yeah. And so the other thing too, and I think it’s kind of a lost art is acoustic stimulation or trying to get your baby’s heart rate to go up if we just, you know, kind of push on their head a little bit and acoustic stimulation. It’s so funny because it’s like taking a vibrator and putting it on your belly and it makes this really loud noise. It sounds like a taser. I learned as an intern to warn the patient before you press the button. Cause it’s like this really loud, like, and what it does is it think of it, it like if your baby’s well oxygenated, they hear that and they go like, just, they hear that and they jump around and then we go, cool, you’re good. But if they don’t, then that’s a more, you know, concerning sign of potentially not being well oxygenated.

Dr. Rebecca Dekker – 00:42:41:

Okay. And I’ve heard that called, I haven’t heard about the acoustic stimulation, but scalp stimulation where you kind of press on the baby’s head.

Dr. Jennifer Lincoln – 00:42:49:

Yes, that’s scalp stimulation. Yes. And then acoustic stimulation or vibroacoustic stimulation is where we take this little vibrator looking thing and put it on your belly. And that’s really great if like, you don’t want to be doing a vaginal exam or patients tolerate it. And you know, it does the same sort of thing. And, but yeah, you really do have to warn people. And then sometimes the siblings try to steal it and play with it. And you’re like, no, no, I need that back.

Dr. Rebecca Dekker – 00:43:14:

And then there’s internal monitoring of the fetus as well, correct?

Dr. Jennifer Lincoln – 00:43:17:

Yeah. So yeah, so you’ve got these external monitors, which we’ve talked about, which are these belts that you wear outside. But sometimes, like you said, it gets broken up, or you’re moving, or it’s not so great. And we might want to do internal monitoring. And so there is something called a fetal scalp electrode, which is what it is. It’s like a little twisty spiral electrode that we twist and it goes under your baby’s scalp. So when I hear people, you know, I used to describe it like it’s a clip that goes, it’s not a clip, because the hair clip is a clip, but it goes under your baby’s skin. But the way I describe it to people, it’s like when you kind of would like, when you were weird in middle school, and you would take like a paper clip or a safety pin and like put it under your skin. So it’s not like it’s going in super deep. But that is giving, you know, that we can now directly know that we are monitoring your fetus’s heartbeat, not yours. And it’s still plugged into the machine. So it still means that you’re tethered to something. But because it is such a direct measurement, it often allows for greater movement while in bed because you’re not having to readjust these external belts. So that can be another option as well.

Dr. Rebecca Dekker – 00:44:16:

Yeah. Interesting. I know we cover all these things in detail in the childbirth class and in our Pocket Guide to Interventions, but it’s so fun hearing you describe it like you would to anybody. I had a couple random questions. I’ve heard that the baby’s heart rate can change if you’re dilating really quickly or the baby’s dropping further into the pelvis. Can you talk about that?

Dr. Jennifer Lincoln – 00:44:37:

Yes. Yeah. So it’s kind of called like the dive reflex where they just, you know, you drop down super quick and you look up on the monitor and it’s usually somebody who’s like, it’s their fourth baby or third baby. They were five centimeters. And then you see it, that it goes from like, whatever, 120 down to 80. And everybody who’s new, you know, the intern and the new nurse, everybody freaks out. And you’re like, the baby’s probably at the perineum and you go in and you check that. That is what it is.

Dr. Rebecca Dekker – 00:45:03:

The baby’s ready to come out.

Dr. Jennifer Lincoln – 00:45:04:

Yeah. You’re like, yay. So, you know, do you want to ignore it and just, you know, go to the cafeteria and go, oh, I’m sure it’s fine. Like you want to go verify. But a lot of times, yes, you’ll see that. And then we get all excited and we have a baby.

Dr. Rebecca Dekker – 00:45:15:

Interesting. So when parents are like confronted maybe with staff coming in the room saying something’s not right, like what questions should parents feel empowered to ask their care team?

Dr. Jennifer Lincoln – 00:45:30:

Yes. I think that it is, know that it’s your right to ask questions, right? You ask questions at the mechanic, you ask questions, you know, everywhere else that you go. So you absolutely have a right to ask questions when you’re doing one of the most intimate things that you probably will ever be doing and exciting, but potentially also stressful. So one thing that I think is a great way to phrase it is, can you tell me what you’re worried about? And then that forces the team to stop and be like, oh yeah, let me, let me break this down. As opposed to like the doctor and the nurse just huddling in the corner, like move here, which sometimes if things are really acute, we will, but then we should be explaining to you. But if it’s not an acute situation like that, so what exactly are you worried about? I understand. And I think it’s great to say, I know that test, you know, I read that article. I know that test isn’t always super accurate. So can you tell me what are some reassuring things or what are you going to do next to make sure my baby’s okay? Just to verbalize, because then you get the team to verbalize and they tell you their thought process. I’ve had situations where it is in that indeterminate category. And I’m having the patient move around. I don’t know which way it’s going to go. I don’t know if we’re going to settle out and it’s going to be great or it’s going to decompensate further. And so I just tell my patients, here’s what I’m seeing. That’s why I’m having you move around. I know it’s super annoying. You know, I’ll joke like we just numbed your legs and now we’re trying to get you to do aerobics in bed. It’s not fair. I’m not freaking out right now. Here’s the things that I’m looking for. If we get to this and this, then I’m gonna come in and have this conversation. But until that happens, I want you to know that I’m okay with where we’re at. And so I feel like that just helps patients feel like, okay, here’s what she’s thinking. Here’s her decision tree. And until she tells me to worry. So I think just asking those basic questions, it forces your team to go, oh wait, oh wait, they didn’t read the books. This isn’t there every day, which it is for us. Sometimes we get into that mindset, especially when we’re, you know, you might have four triage patients and a scheduled C-section and three patients in labor. And you’re just, you know, you’re not trying to be short, but you just forget. Oh yes, thank you for reminding me. I should explain this to you.

Dr. Rebecca Dekker – 00:47:28:

So ask for explanations and know that you have the right to ask questions. Yeah. What about if you’re in a situation where continuous fetal monitoring is recommended, such as with a VBAC or trial of labor after Cesarean? And you can see how it would be recommended for liability reasons. But thinking of people who maybe their first birth was a preventable Cesarean caused by the fetal monitoring and trying to have a vaginal birth when the last one turned into Cesarean. And here you are being told you must be monitored constantly. Like, how would you handle that?

Dr. Jennifer Lincoln – 00:48:03:

Yeah. Oh, that’s hard, right? Because you’re like, I want to have a vaginal birth. And they’re telling me that. This is our policy and you must. And maybe it’s more with the years of practice I have. Like I’m going to have a conversation and I always, I tell my patients, I’m not going to strap you to the bed and I’m not going to hold you hostage. Like at the end of the day, this is your body and I respect that. And if you are, you know, you came in in labor and you are trying, you know, having a vaginal birth. Well, just because you refuse or decline continuous monitoring doesn’t mean I’m going to strap you to the gurney and we’re going to go do a C-section. Like I’m just going to document that we had this conversation. Here’s the reason I recommend it. Since I don’t have this monitoring now, here is the things that I definitely want you to tell me about, you know, pain or whatever. And know that if I start to, you know, if when we do check in, I see things that are concerning, can we revisit this? Can we, you know, I hear that you don’t want it at baseline, but if the situation changes and my spidey senses go up, can we have another conversation? And I can’t tell you how many times, and it’s not just related to monitoring, whether it’s an IV or whatever. Once people see that they don’t have to like, I hear you, can you trust me if we get to a different spot? Then people are like, yeah, thank you. Thank you for not just seeing me as a number or an ACOG recommendation. And maybe it’s just with more years of experience. I feel fine because yes, in the back of my head, am I thinking if this goes south, you know, and I end up, you know, on a stand somewhere. Well, I’ve got my documentation to say I did this and I respected her autonomy, which is, you know, just like I can’t force her to have a C-section. I can’t force somebody to do this. And I trust in that. I’m sure there’s a colleague who’s listening who’s been burned by that, but we have to think long term and overall here that we first have to do no harm. And I think that’s really important.

Dr. Rebecca Dekker – 00:49:39:

Yeah. It’s like you have to decide as a physician, like where your line is. And for you, it’s bodily autonomy is really important and clear communication. It sounds like. And building trust too, right?

Dr. Jennifer Lincoln – 00:49:51:

Yeah, right. Exactly. Because sometimes there are those moments where you’re like, oh boy, we have gone off the rails. And, but it’s because of that trust that I can look you in the eye and be like, remember that time I said this, well, we’re there now. So can I please, can we do that IV? Cause I’m really worried. And then, you know, like, yes, get it. And that’s wonderful because they’re not feeling like, who is this person who’s not even trying to listen to me? I think it’s important. I also think too, that this really highlights, I do not want you to be talking with your team about continuous monitoring for the first time when you come in, in active labor. This is a phenomenal conversation to have ahead of time. I include checklists in my book of things, you know, kind of when you’re, when you’re shopping around for your OB or your midwife, that this is one of the questions, like, what do you think about intermittent monitoring? Is that offered at your hospital? And if from the get-go, they’re like, oh yeah, sure. If you want, you know, blah, blah, blah, blah, blah. That gives you a data point to go, hmm, like how much is this the right person for me versus, you know, awesome. Now I don’t have to worry about that. That’s their default or, or whatever. So, um, so many of these conversations kind of ahead of time can avoid stress when you’re actually coming in to have your baby, which is what I want for everybody. Cause it’s just not the time to be having all these conversations. If you can plan.

Dr. Rebecca Dekker – 00:51:01:

Out of all the patients you see as a hospitalist, what percentage of the ones who come in in labor for an induction do you think have thought about fetal monitoring or like made a plan or talked with their OB or midwife in advance?

Dr. Jennifer Lincoln – 00:51:15:

Yeah. I’d say very few. And the reason is, so as a hospitalist, the patients that I get are like high risk transfers from other places. I joke that when I get to do like a nice… Straightforward vaginal birth. Like I get to come out and I was like, guys, I got to be a midwife today. And the nurses are like, we love that for you. Yes. And it wasn’t a 32 weeker, you know, like it was a term. So I would say very few. I think part of it is people don’t think about it. The other part of it is people just assume, cause you just assume either prior births or, you know, again, technology, this also just the hierarchy of medicine. Well, of course you’re taking my blood pressure. You’re doing this. There’s no questioning that like you just do it. It’s just part of what you do. So I think a lot of people haven’t thought about it, but that may change with things like the New York Times article, because definitely I was starting to hear people chat about it, which I loved. So in addition to people chatting about this beforehand is ways that you can advocate for yourself, whether it’s related to fetal monitoring or other things in labor is to have somebody else who’s like whole job is to think about that stuff, whether it’s your partner or your doula or a family member, and to know that leading with a place of curiosity and kindness can go so far. And I get, you know, you might walk into the hospital, especially if you didn’t want to be there, if you’re a transfer from home or a birth center to come in and just be like, well, I know all you want to do is a C-section and da, da, da, da, da. And there’s probably a lot of, you know, there are some people like that, but to lead with, you know, I heard this thing about continuous monitoring and I’m worried about this. Can you tell me what we can do to minimize this? And just to have it come, you know, people just want to be talked to in a, in a collaborative way. And I think that’s just really important, but I understand certain groups of people might be really worried about speaking up, especially if they’re Black or Brown, or if they have other issues that might make people judge them, younger patients. And that’s where I think it’s really important. If you can talk about these things ahead of time. Or know that I understand why you don’t necessarily, you feel like you shouldn’t have to do these things. And I feel for people in those situations. And I also want you to get the birth that you want and deserve. So just knowing ways to mitigate these things or to talk about them ahead of time. So you don’t have to worry about it when you come in. It can be a wild ride. And I just want as many people to be prepared as possible, which sometimes is hard. It feels like in this country with so much good information, not so good information. So, you know, just preparing yourself as much as you can. So when you come in, you really can just focus on your labor and meeting your baby.

Dr. Rebecca Dekker – 00:53:39:

Well, thank you so much, Dr. Lincoln, for all the work you do in educating millions of people, helping them get more prepared with good information. So we’re excited for your book to come out on March 24th.

Dr. Jennifer Lincoln – 00:53:49:

Thank you. Thanks for having me.

Dr. Rebecca Dekker – 00:53:52:

This podcast episode was brought to you by the Evidence Based Birth® Childbirth Class. This is Rebecca speaking. When I walked into the hospital to have my first baby, I had no idea what I was getting myself into. Since then, I’ve met countless parents who felt that they too were unprepared for the birth process and navigating the healthcare system. The next time I had a baby, I learned that in order to have the most empowering birth possible, I needed to learn the evidence on childbirth practices. We are now offering the Evidence Based Birth® Childbirth Class totally online. In your class, you will work with an instructor who will skillfully mentor you and your partner in Evidence Based Care, comfort measures, and advocacy. So that you can both embrace your birth and parenting experiences with courage and confidence. Get empowered with an interactive online childbirth class you and your partner will love. Visit evidencebasedbirth.com/childbirthclass to find your class now.