Tools or culture? Human factors, not technology, drive cesarean section rates for suspected fetal distress

Continuous CTG combined with structured team training was strongly associated with the lowest rates of CS performed for suspected fetal distress, without compromising neonatal safety. In contrast, universal continuous CTG without training led to higher intervention rates. Human factors, particularly training and organizational culture, appear to be more influential than monitoring technology alone in determining cesarean delivery rates for suspected fetal compromise.