Reader,
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A new study published in the American Journal of Perinatology (Wiley et al., 2026) did something most FHR research doesn’t: it took blinded, specialist-level review of intrapartum tracings and tested it against actual neonatal outcomes, not just clinical impressions in the moment.
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The study looked at over 3,100 term singleton births, comparing FHR characteristics and ACOG categories between newborns with and without composite adverse outcomes (low Apgar scores, NICU-level interventions, HIE, and more).
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Here’s the part that should give every one of us pause: across the board, the standard framework, baseline changes, variability, accelerations, even the overall category I/II/III classification, did NOT show what we assumed it would. ​
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If you’ve ever felt that quiet uncertainty when you’re trying to fit what you’re hearing into “normal vs. abnormal,” this study is part of why. The categories we were trained on were never as airtight as they were presented to be, and now there’s data to back that up.
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We’re not going to walk through the full study in this email (that’s part of what we’ll dig into live), but here’s the question it raises for practice: if the textbook patterns don’t reliably predict outcomes, what should we be paying attention to? What does good clinical judgment look like when the framework itself has gaps?​
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That’s exactly the territory we’re covering in:
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​FHT Lab: Making Sense of Fetal Heart Tones​
Live Webinar | June 27, 2026 | 7:00–9:00 PM EST
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In this 90-minute interactive session, we’ll work through:
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​• What you’re actually hearing, and how to build a framework that holds up even when the textbook categories don’t
• Common patterns and what the fetal heart rate is (and isn’t) telling you, in light of where the evidence actually stands
• Clinical decision-making: when to observe, when to escalate, and how to reason through ambiguity
• Assessment frequency standards and the reasoning behind them
• Charting that accurately reflects your assessment and your clinical thinking​
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This is designed for experienced providers as much as students. If anything, the more tracings you’ve read, the more this conversation will resonate.
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​Last few days → $89 (Early Bird Pricing!)

Want to go deeper?

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If this conversation resonates with you, you might also consider the FHT Lab + 4-CEU Fetal Heart Tones Course Bundle. The live lab gives you the discussion and real-time decision-making practice; the self-paced course builds out the fuller framework — baselines, variability, all four deceleration types, defensive charting, and escalation — for 4 CEUs you can apply right away.

Regularly $275, the bundle is $199 when you register for the lab.

See you June 27,
Augustine