Continuous Electronic Fetal Monitoring in Labor: For Your Safety... But Is it Always Safe?

During labor and birth in a hospital, many women experience what is known as "continuous electronic fetal monitoring" (EFM). During this medical practice, two elastic belts are placed around the laboring woman's belly. One belt holds in place a monitor that measures the frequency and duration of mom's contractions, and the other belt contains a monitor that records baby's heart rate. During "continuous" EFM, these monitors remain in place throughout labor. This practice was developed in the 1960s as an added measure to monitor high-risk labors. In the 1970s, this practice became routine for all laboring women, high-risk or not. More recently (2006), 76% of mothers reported having continuous EFM during their labor.

So with all this continuous monitoring of babies' heart rate, surely we're seeing improved health outcomes, right? Wrong. In fact, studies have shown that for low-risk women, there is no significant differences in health outcomes when baby is continuously monitored in labor versus intermittent monitoring (the American Congress of Obstetricians and Gynecologists recommends monitoring every 30 minutes in active labor).

So if there's no added benefits to continuous EFM, there probably aren't any risks, right? Not exactly. Despite medical advances in technology, EFM isn't always accurate. False reading of baby's heart rate can signal danger -- and the need for a major medical intervention, like cesarean -- when there isn't a true need. Further, continuous EFM can significantly reduce mom's ability to move around in labor, which can increase pain and the use of narcotics and epidural, can slow labor, and can increase the need for other interventions, like Pitocin (a medication used to strengthen contractions).

Want to know more, including when EFM is needed and how it can be avoided? Check out this informative infographic (click to see larger) from Lamaze, which shares all you need to know about continuous EFM. For more background information, check out this resource from Lamaze.

Additional Resources

• Evidence Based Fetal Monitoring (Evidence Based Birth)
• Continuous EFM (Lamaze)
• Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (WHO)
• Pelvic Floor Health and EFM (Childbirth Connection)
• ACOG Fetal Heart Rate Guidelines (ACOG)

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