What Every Mom Needs to Know About Electronic Fetal Monitoring
Most women will give birth in the hospital and that means most women will have continuous electronic fetal monitoring. But this routine procedure is not as aligned with evidence as you would hope.
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If you’ve never been in the room with someone giving birth, it’s hard to imagine what it will be like when anticipating the birth of your first child.
One thing no woman would see in her imagination is two stretchy bands, attached to electronic monitors, wrapped around her pregnant belly.
But for most women, that is something she’ll experience.
Those bands and monitors are called electronic fetal monitoring.
What is Electronic Fetal Monitoring?
In the 1960s, a new machine was brought into the labor and delivery rooms of hospitals. Monitors were put on the mother’s belly and attached to a machine that gave a printout of the readings.
The machine showed two things:
- The frequency of the mother’s contractions (using a pressure gauge)
- The baby’s heart rate (using an ultrasound device)
The idea was that having a continuous reading of the baby’s heart rate could help notify doctors if the baby’s oxygen levels (and therefore heart rate) got too low.
The problem?
It was implemented with no evidence showing whether it actually accomplished what people said it could.
Kinds of Electronic Fetal Monitoring
While the kind of monitoring I described—two elastic bands around a mother’s belly—is the most common kind of fetal monitor, others do exist.
Some hospitals may provide a mobile option (one not attached to wires and a big machine). This mobile version is a little patch held on to your belly by sticky pads. You can even keep it on in the bath or shower if you want to get in the water during labor.
Another option is to use the double-band version but only intermittently. This may look like putting the bands on for 10-30 minutes every few hours. But hospitals have different definitions of “intermittent.”
Plus, evidence suggests that it doesn’t make much of a difference when compared to continuous monitoring.
Finally, some doctors may want to use an internal electronic monitor. This monitor is a small probe inserted into the vagina and twisted into your baby’s scalp. It can provide a better reading of the heart rate but can leave a scratch or bruise on your baby’s head. It may also increase the chance of infection.
What the Evidence Says
In short, evidence from multiple studies suggests that using electronic fetal monitoring—especially continuously—does more harm than good.
Let’s dig in a little deeper.
Benefits of Electronic Fetal Monitoring
To be fair, let’s start with a few advantages that electronic monitoring provides.
Reduces the Risk of Newborn Seizure
First, studies have suggested that continuous fetal monitoring reduces the risk of newborn seizures. And that is a good thing. However, the risk of newborn seizure is always very low. They occur in somewhere between 1 in 500 and 1 in 2500 babies.
Continuous monitoring can cut that number in half. But half of a 0.2% chance of something happening is a 0.1% chance of something happening. Both are miniscule numbers.
This all means that 667 women would have to have continuous monitoring in order to prevent one newborn seizure. Or, said another way, there would be at least 61 extra c-sections in order to prevent one newborn seizure. (And c-sections have real risks!)
Easier for Hospital Staff
Second, electronic monitoring is easier for hospital staff. The monitors are put on mom at the beginning of labor and then stay there. Getting the readings doesn’t require a single nurse or doctor to be in the room.
Rather than having to be “hands-on” and find the heart rate with a doppler or stethoscope, a nurse or doctor can come into the room, glance at the monitor, and know the baby’s heart rate.
Helpful During Medicated or Complicated Labors
Finally, electronic fetal monitoring can be useful during induced, medicated, or complicated labors. Inducing labor (especially through Pitocin) changes the normal physiology of labor.
Contractions are longer, stronger, and closer together and that puts unusual strain on both mom and baby. Because of that, monitoring becomes more important.
Being medicated (with an epidural or opioids) may also make monitoring a good idea, for similar reasons.
And if either mom or baby are experiencing complications (e.g. high blood pressure), doctors may be more adamant about monitoring for signs of distress.
Downsides of Electronic Fetal Monitoring
Unfortunately, electronic monitoring is one of those hospital routines that falls short when held to scrutiny. Though used for almost all women, it has more risks than benefits.
Doesn’t Improve Most Birth Outcomes
We’ll start with the big one here. Despite high hopes, continuous electronic fetal monitoring simply does not improve outcomes for baby and mom (except newborn seizures, as covered above).
Multiple studies have shown evidence that none of the following outcomes are changed by using continuous electronic fetal monitoring:
- APGAR scores (a measure of immediate newborn well-being)
- brain injury
- cerebral palsy
- developmental delay
- NICU admission
- newborn death
Leads to False Alarms
Electronic fetal monitoring, like all technology, is imperfect. It can show data that is incorrect.
For example, the false positive rate for detecting cerebral palsy in an unborn baby is greater than 99%. In simple terms, that means that only 1 or 2 out of 1000 babies who are predicted to have cerebral palsy because of what electronic fetal monitoring shows (and are thus treated accordingly) will actually have the condition.
Aside from imperfections in the monitoring, researchers have suggested that the accepted range of “normal” fetal heart rate during labor may be too narrow. In reality, babies adapt remarkably well to the rigors of normal labor. And it’s normal for their oxygen levels and heart rate to fluctuate and then return to a healthy level.
But interpreting the output of the monitors requires professional judgment. And doctors are human, just like the rest of us. If a doctor sees something worrying, they are trained to intervene and do something to circumvent the supposed problem.
Unfortunately, the preferred solution is to do a c-section.
Increases C-section Rates
One thing is widely accepted in the research about electronic fetal monitoring: it significantly increases a mother’s chances of having a c-section. The increase may be as much as 63%. (And the increase can be exaggerated in hospitals with already-high c-section rates.)
According to a study published in the American Journal of Obstetrics and Gynecology, “non-reassuring fetal heart tones”—usually indicated by electronic fetal monitoring—is one of the most common reasons given for first-time c-sections (second only to “failure to progress,” or labor dystocia).
RELATED >> C-sections: Why and How to Avoid Having One
Increases Instrumental Birth Rates
Similar to the effect on c-section rates, electronic monitoring increases the chances of a baby being born with the help of forceps or a suction device. Women who have continuous fetal monitoring have a 15% increased chance of experiencing an instrumental birth.
(And instrumental birth is one of the top risk factors for severe perineal injury.)
Restricts Movement
The more wires and machines a mother is attached to during labor, the harder it’s going to be for her to move freely. Though continuous monitoring doesn’t necessarily mean a woman is stuck in bed, nurses and doctors are more likely to encourage her to stay still so as not to disturb the monitors.
Unless you have access to the mobile water-resistant monitors, you also won’t be able to get in the water as a way to relieve some discomfort during labor.
Can Be Distracting for Mom
Relaxation is key to a productive, comfortable labor. But sounds and displays of running machines can easily mess with a woman’s relaxation. While noises and lights can be muted by putting a towel over the machine, it will likely still be harder to fully relax and surrender to labor.
In fact, researchers have found that when a woman is distracted, she experiences more pain.
Redirects Attention From Mom to a Machine
Many women report a poor experience with electronic fetal monitoring because doctors and nurses pay more attention to the readings on the machine than her. Checking on mom, in these cases, consists more of looking at the numbers than seeing how mom is really doing.
Unsurprisingly, this leads to an overall worse experience with birth.
In a fascinating study, researchers found evidence that a woman’s experience of pain and her feeling of satisfaction with her birth experience has far more to do with the attitudes and behaviors of her care providers than it does with the actual physical sensations or methods of pain management she experienced.
You Don’t Need Continuous Electronic Fetal Monitoring
With a few exceptions, most women do not need—and, in fact, should not have—continuous fetal monitoring. The hospital staff may tell you that you have to have some form of electronic monitoring, but rest assured, you can still say no.
Most of the time, intermittent monitoring using a doppler machine or a stethoscope will be sufficient.
Even professional recommendations support this.
Alternative: Intermittent “Hands-On” Monitoring
If you still want monitoring but don’t want to take on the risks of continuous electronic fetal monitoring, your care provider should be able to do intermittent auscultation—a fancy way of saying they use a doppler or a stethoscope instead.
Some people call this “hands-on” monitoring.
Using either a doppler or a stethoscope requires your care provider to be close to you and take a more involved approach to your care.
Other benefits of intermittent “hands-on” monitoring include…
- Less discomfort for the mother (no bands always around her belly)
- Everyone in the room can hear the baby’s heartbeat when it’s checked
- Can be used in many different laboring positions
- Doesn’t restrict mom to bed
- Can be used underwater
- Seems to be the best option for detecting true abnormalities in heart rate
Conclusion: Truly Informed
Every mother wants the best for her baby. But in order to really achieve that, we moms need all the information. Now you have the information about electronic fetal monitoring you need to make the best choice for your situation.
To summarize…
- Most pregnancies and births have no complications requiring extra monitoring.
- When things aren’t complicated, electronic monitoring increases risk without providing much benefit to mom or baby.
- If you get induced, choose to use medication during birth, or have high blood pressure or other health conditions, you may want to use continuous fetal monitoring.
Whatever the case, now you can make a truly informed choice. And that’s always my goal for you.
Until next time,
Allison
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