I would like to thank Drs Vintzileos and Smulian for their recent insightful editorial “Decelerations, tachycardia, and decreased variability: have we overlooked the significance of longitudinal fetal heart rate changes for detecting intrapartum fetal hypoxia?” My contention is that this phenomenon “longitudinal change” has been overlooked secondary to technological advance. The present generation of computerized fetal monitors projects a screen of the tracing only spanning a 7 ½-minute period. In addition, the time frame does not expand when scrolling in reverse. If one minimizes the screen, the time frame spans to 25 minutes. However, the tracing becomes exceedingly more difficult to interpret secondary to the size restraint of the tracing.

In a return to a paper record, one has the ability to examine the fetal tracing in a similar fashion to a tailor measuring out fabric–at arm’s length a yard at a time. Secondarily one can take the commencement of the paper record; elevate it, walk to the opposite wall of the delivery suite and visualize the entire record. As if viewing the horizon from atop a skyscraper. This enables the observer to see longitudinal change as well as patterns of repetition in the fetal heart rate. I would venture to postulate that we, “the obstetricians,” were previously performing such a procedure.

In addition, in April of 2008 the Society for Maternal-Fetal Medicine proposed a “new” 3-tier classification system for interpretations of fetal heart rate patterns. This proposal coincided with the stopping of the manufacturing of fetal scalp sampling sets. Since that time there has been a myriad of articles and algorithms to manage category II tracings. These ambiguities and proposals could be easily eliminated by performing fetal scalp sampling, a procedure that was made technically easier by introduction at birthing beds and the wide utilization of epidurals. This test yielded fetal blood gas and base excess data that would eliminate these discrepancies in interpreting category II tracings.

New-model automobiles with heightened technological advances take the highways every year, only to be recalled for faulty designs and construction. New medications are placed into circulation only to be withdrawn from the marketplace because side effects have appeared in the population that were not present in premarket trials.

Finally in 2005, at our institution, Winthrop-University Hospital, we were investigating fetal pulse oximetry–its performance and management, again, yielding data enhancing the ability to evaluate fetal status. Did this go the way of the Ford Edsel?

Perhaps what we need to do is take 2 steps backward to proceed 1 step forward.