Electronic Fetal Monitoring: Everything You Need to Know

Electronic Fetal Monitoring is a form of listening to your unborn baby's heartbeat and to measure the strength of your contractions. Two straps are wrapped around your belly that have doppler-like instruments attached. These instruments send measurements to a machine, which then records the information received on strips of paper, which are kept with your chart after the birth. The use of EFM became widely popular among hospitals in the 1970s, without proper testing and research on its use. EFM quickly replaced intermittent monitoring by nurses with hand-held dopplers or fetoscopes.

There are two very big reasons why EFM became so popular, although I'm sure there are many more. One is that a "strip" from the machine is hard proof of the progress of your labor; with it, physicians can defend themselves in court should a patient decide that the caregiver made a mistake while caring for her. Judges will more likely rely on this information rather than a handwritten chart provided by the nursing staff. Two, a hospital that routinely uses EFM requires less staff, since one nurse can monitor many patients at the nurse's station. Less staff requires less cost to the organization, which leads to a more stable income for the head emplyees of the hospital.

Generally, when a woman questions the purpose of the monitor, she will be told that it is to protect her and her baby, and that they are less likely to suffer injury or death with "proper monitoring". The hospital managers do not tell them about the physician's fear of malpractice suits or the concern over budget. Women and their families are also given a lack of information concerning research and statistics like the ones provided below. Here are what a few medical professionals have to say about EFM:

"In most hospitals, doctors use fetal monitors routinely, although one study of 70,000 pregnancies found no difference in outcome between monitored and unmonitored patients, and other studies have shown that monitoring results in an increase in infant mortality among patients monitored." (How to Raise a Healthy Child ... In Spite of Your Doctor, Robert Mendelsohn, MD. 1984)

"The 985 edition of Williams Obstetrics (the most widely used textbook in the U.S.) says, "an equally satisfactory outcome for the fetus can be achieved without continous electronic fetal monitoring of the fetal heart rate, continuous intrauterine pressure recording and fetal scale measurement, if the mother and fetus are closely attended by appropriately trained labor room personnel." (A Wise Birth, Penny Armstrong, CNM and Sheryl Feldman, 1990)

Using an EFM system also leaves room for disagreement over the treatment of a particular case. Sheila Kitzinger describes a study where four obstetricians were asked to examine the same fetal traces and to determine if it was necessary to deliver immediately. Surprisingly enough, they only agreed in one out of five cases¹.

"EFM has increased the cesarean rate with no increase in fetal wellbeing." (ACOG, 1996)

The CBE Reporter indicated that broad studies had been done, "showing no difference in fetal outcomes using either IA [Intermittent Auscultation] or EFM". (CBE Reporter, 2000)

"This ubiquitous machine has not been associated with any noticeable lowering of infant mortality. Research done since then shows that intermittent listening with a fetascope [or doppler] is every bit as good at detecting a baby who is in trouble from lack of oxygen. From the mother's standpoint, intermittent listening is far better - less painful and less likely to lead to ineffective labor and cesarean section." (Ina May's Guide to Childbirth, Ina May Gaskin, 2003)

Another issue related to EFM that is often downplayed or ignored altogether, is its effect on the type and amount of support that women receive while in labor. I have witnessed myself how easy it is for the doctor or midwife, nurse and even the husband and labor coach to be drawn the EFM screen. Instead of asking the mother how she is feeling or if the contraction has ended, they stare at the screen and don't bother talking to the mother. Not only does EFM leave the mother feeling alone and unnecessary in her endeavor, but it also prevents her from adopting optimal postions for moving the baby into and through her pelvis.

Therefore, in most instances, it would be wise for a woman to request a fetascope or handheld doppler during her labor. She will be more comfortable out of bed, and she will inevitably receive more humane care, rather than from a machine.

Every woman has the right to use EFM, either continuously or intermittently. On the same hand, every woman has the right to information concerning the benefits and risks to each. If you have concerns about its use, use the information provided here to discuss with your caregiver its necessity for your particular pregnancy, labor and birth.

And of course, I highly recommend you to do your own research on procedures that are likely to be used on you or your baby. This will reasure you that you are getting the correct information, and that which is necessary to provide true informed consent to those procedures.