(dispensing preoccupation with actual ‘counting’ for 1 minute)
Notably, there isn’t detailed guidance on detecting the baseline FHR and
decelerations reliably on auscultation over 1 minute or more, which is
quite different from assessing it on CTG. This is demonstrated in very
simple schematic illustrations (Figures 1-3), although intuitive, need
to be presented for reflection. Guidelines 1,2 loosely
recommend “counting fetal heart-beats for 1 minute and documenting it
as a single figure as the baseline FHR.” Some authors have claimed that
midwives mistakenly write a very wide (or entire) range of FHR observed
as the baseline e.g. 130-146.10 But, this is not at
all the experience in UK and seems underestimation of midwives’ ability.
British midwives have been documenting a narrow range of FHR baseline
(e.g. 120 -125/min) with comments as accelerating to 140
/min.6 Paradoxically, replacing observation of
numerical display by an actual count over 1 minute (which may have no
relation to the baseline, see figures 2 and 3) is a flawed unwise
retrogressive step.1,2,9,10 Any challenge to this
retrogressive advice is further countered by an argument that there is
no evidence to recommend Doppler-device instead of Pinard stethoscope, a
mistaken simplistic interpretation in systematic reviews and
guidelines.1,2,7 It is far more reliable and accurate
to carefully observe the temporal FHR numerical readouts on the
Doppler-device and then select an approximate single figure representing
the average baseline.6,18 FHR baseline in reality is
not a single figure but could be written as such.