Electronic fetal monitoring (EFM) is the use of an ultrasound device, usually attached to a belt placed around the woman’s belly, to record the baby’s heart rate and the mother’s contractions. The results are printed as a graph for the nurses or doctors to consult and to consider how the baby is reacting to the mother’s contractions.
How is Electronic Fetal Monitoring Used?
Electronic fetal monitoring was first introduced in the late 1960s (Warren E. Leary, “Routine Electronic Monitoring Of Fetuses Is Challenged in Study"). Today, most doctors and hospitals insist on using EFM for at least a portion of the woman’s labour; e.g., when she first arrives at the hospital, she will be hooked up to the monitor for 20 minutes. In high-risk pregnancies, the woman is expected to be monitored for her entire labour. Women who choose to receive an epidural during labour will also require continuous electronic fetal monitoring “to be sure the baby is handling the epidural well” (“Pain in Labour,” Mothering.com).
EFM indicates whether the baby is under stress during labour. Variations in the baby’s heart rate may show that that the baby is not getting enough oxygen. Doctors or nurses can then recommend a change in position, a dose of oxygen, a decrease in induction drugs, or, if these fail to improve the reading, a C-section.
Studies on Electronic Fetal Monitoring
Research studies are now questioning whether electronic fetal monitoring is really beneficial during labour. In her book Rediscovering Birth, Sheila Kitzinger notes, “Nine randomized trials have shown that electronic fetal monitoring . . . does not make birth safer for the baby, compared with intermittent monitoring using a hand-held Doppler or a Pinard’s stethoscope (the old midwife’s ‘trumpet’). Babies are not born in better condition after electronic monitoring, and its use does not reduce the number of babies who need special care” (Boston: Little, Brown, 2000, p. 94-95).
Unless the hospital is equipped with a portable EFM unit, a woman attached to an EFM must remain in bed, usually on her back, while being monitored. Many women find this uncomfortable and painful, and “science has shown laboring in bed has little proven benefit and may in fact, have negative effects on labor” (Brenda Lane, “Walking During Labor”). The EFM may thus contribute to slowing labour.
Leary notes that some women’s groups have challenged use of the EFM, saying that “it was accepted as standard practice before its effectiveness was proven and that it was an unnecessary interference in childbirth, particularly in low-risk pregnancies.” Of further concern to women is the fact that EFM has been shown to increase the rate of C-sections “because they can erroneously indicate that a fetus is in trouble” (Leary). Doctors may choose to do C-sections earlier because of poor EFM scores.
Women concerned about the risks of electronic fetal monitoring should consult with their doctors about other options, such as intermittent monitoring with a Doppler.
Bonnie Way - Bonnie Way is a freelance writer and editor who works from home while chasing her two daughters.
Join the Conversation