We would like to thank Dr Levine for his comments regarding our recent editorial. Dr Levine makes 3 points.

First, Dr Levine suggests that the “longitudinal change” in fetal heart rate (FHR) patterns may be easier to evaluate by viewing the length of the unfolded paper FHR tracing instead of the present generation of computerized electronic FHR monitoring systems. As we stated in our editorial, most current electronic FHR storage systems allow for retrospective evaluation of longitudinal FHR changes from the beginning of the labor very quickly and that this task should not take more than a few minutes. We believe that retrospective electronic review of FHR tracings for longitudinal changes is easier and more practical as compared to looking at the entire FHR tracing paper record.

The second issue raised by Dr Levine was against the discontinuation of manufacturing fetal scalp sampling sets that, however, occurred prior to the 2008 publication of the 3-tier FHR classification system. We agree with Dr Levine that fetal scalp pH may be helpful in decreasing false positives, but according to some investigators, its use has its own problems and there is no evidence that it improves outcome.

The third point has to do with failure of fetal pulse oximetry to enter our practice and the possibility that technological advances may fail to catch on as was the case with the Ford Edsel. This is a valid perspective. We agree with the analogy of an automobile recall, which is appropriate if something is defective, but this doesn’t work in the health care world where there is little money to fix needed changes in design or recover from mistakes. Unfortunately, we muddle through with worn brakes, broken turn signals, low fuel mileage, loose steering, and try to get through our required inspections, while preserving a quality driving and safe passenger experience.