Simple fetal heartbeat monitoring is still the best method for determining whether a baby is in distress during delivery and can reduce 30 per cent unnecessary caesareans, suggests a study.

Caesarean delivery is the most common surgical procedure worldwide, performed to expedite birth and avoid neonatal complications. However, the procedures carry risks like infection, excessive bleeding, damage to reproductive organs and blood clots. Listening to the fetal heart rate using a stethoscope intermittent auscultation has been used for years to assess the fetal state and whether the baby is experiencing distress that might require a caesarean delivery. Other monitoring techniques have become common in recent years, including echocardiograms and blood tests.

The study, published in the Canadian Medical Association Journal, showed that all methods had similar outcomes for babies, but only intermittent auscultation reduced the risk of caesarean deliveries up to 30 per cent without increasing the risk to babies' health. "Our analysis suggests that all additional methods introduced to improve the accuracy of electronic fetal heart monitoring have failed to reduce the risk of adverse neonatal or maternal outcomes beyond what intermittent auscultation achieved 50 years ago, and this may have contributed to the increased incidence of unnecessary emergency caesarean deliveries", said researchers including Bassel Al Wattar, Warwick Medical School, University of Warwick, Coventry in the UK.

For the study, the team reviewed 33 studies that included more than 118,000 women, mainly from high-income countries as well as India and Tanzania, to evaluate the effectiveness of different monitoring methods in improving outcomes for mothers and babies and reducing the number of caesarean deliveries. Rates of C-sections have risen in the developed world to more than 20 per cent of births, even though the World Health Organization recommends this surgery only for roughly 10 to 15 per cent of cases when the health of the mother or baby is in danger.

The researchers urged investments in developing novel techniques to monitor fetuses to make delivery safer for mothers and their babies.