(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.