Another frequently used medical intervention in the hospital setting involves the use of continuous electronic fetal monitoring. Our specific focus will be on continuous external monitoring.
Continuous external electronic fetal monitoring (EFM) has become the standard for many hospitals across the United States. EFM is not always an accurate tool & may lead to subsequent medical interventions.
What is EFM?
External Electronic Fetal Monitoring (EFM) consists of 2 bands across your belly, each has a sensor. Bands are connected to wired lines that lead to the EFM monitor. One sensor detects contractions of your uterus, the other sensor monitors your baby’s heart rate.
*History of EFM:
EFM use started experimentally in the 1970s
When introduced in the 1970s, birthgivers were not aware EFM was being used experimentally
No research was done to demonstrate its safety or efficacy during labor
Over the years, research has shown:
EFM may increase the chance of having a C-Section
When used during labor for low-risk pregnancies, it has not been shown to significantly affect adverse outcomes of neonates, such as perinatal death or cerebral palsy.
“In the U.S., ‘non-reassuring fetal heart tones’ (on EFM) is the second most common reason for first-time Cesareans (23%) after Failure to Progress (34%)”
-ACOG/SMFM 2015
Why EFM irks our soul
Attention moves from birthgiver to a machine
EFM sensor may not detect fetal heart rate in certain positions, may have limited positions to move into
EFM may hinder your ability to get out of bed
Increased perception of pain due to limited movement.
EFM may provide inaccurate findings leading to interventions (overtreatment)
EFM has loud alarms that many families find disturbing
Distractions during labor can move the mind from focus, increasing perception of pain
Can lead to stress, distraction, fear, stalling labor progress
What research, care providers, and guidelines recommend:
Hands-on, intermittent listening for those without known complications, low-risk pregnancies.
Issues with implementing hands-on listening in hospitals:
Training staff to use this device effectively (not enough time to do this)
Staffing issues (due to provider shortages or patient ratios)
When hands-on listening should not be used: pregnancy with multiples, breech, high body mass index (BMI), prior Cesarean, post-term pregnancy, pre-term labor, premature rupture of membranes, and the use of Pitocin (Bailey 2009), due to a lack of evidence of EFM vs hand on listening in these groups*.
*Evidence Based Birth (see previous links)
