Electronic Fetal Monitoring

Did you have those two straps put on your belly when you were in labor? One monitoring contractions and the other monitoring fetal tone? Or, maybe you had an NST (Non Stress Test) done to make sure everything was okay? Maybe they told you that internal monitoring was necessary? Then screwed something into your baby's head, internally? These are forms of electronic fetal monitoring.

Did you know that these constant monitoring systems are not necessary? Were you aware that they are actually showing to be harmful in low risk pregnancies?

Let's talk about it!

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What is Electronic Fetal Monitoring?

Electronic Fetal Monitoring is an ultrasonic machine monitoring baby's heart rate while a pressure sensor is monitoring mom's contractions. The fetal monitoring creates a baseline and records how it changes with a contraction. The maternal monitoring tracks the duration and frequency of mom's contractions.

There are many variations of EFM (Electronic Fetal Monitoring). External and internal. It became a 'thing' in hospitals in the 1970s, without ever really being proven safe. It has been used ever since, in about 90% of births held in facilities! They have even gone as far as creating monitors that are wireless and waterproof so you can wear them in the shower. Let's also note that these new, updated, monitors have very little research completed on them. A technological breakthrough or a disservice to a physiological function?

Studies completed show the slew of complications associated with constant EFM. Increased chances of cesarean, vacuum, and/or forceps delivery are a few of the interventions connected with continuous EFM use. And unfortunately, all these interventions carry a risk of serious birth injuries.

When it comes to the impact of EFM, statistics show us that cesarean rates in the US went from 5% to 32% from 1970 (when EFM began)-2016. And, coincidentally, non-reassuring fetal heart tones are the second most common reason for first-time cesareans in the U.S. - you don't say?! (https://journals.lww.com/…/Practice_Bulletin_No__184___Vagi…)

Internal monitors (fetal scalp electrodes [FSE]) are also proven harmful. Many times, they force this on over weight/larger women because it is easier to get a read than with the bands on their belly. FSE are screwed into the neonates head while they are still inside of mom, after waters are released (naturally or manually). YES, screwed into their scalp. A literal screw. The study below concludes the following:

1. Women with internal monitors were more likely to develop a fever than women without internal monitors.

2. The risk of CD (cesarean birth) was higher in women with internal monitors.

They claim that it is not as harmful as intrauterine pressure catheters [IUPC, another internal monitoring option], but let's get real - NONE OF IT IS NEEDED. Where is that doppler, though??
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760973/)

NST testing is also a form of constant EFM. They are called Non-Stress Tests because it doesn't inflict stress on the fetus, even though this claim has not been proven. There is not a scenario where an NST would be the best option, in my opinion. If there were concerns of decreased fetal movement or fetal distress, an ultrasound would give a more accurate conclusion than that of an NST, especially if the possible issue would be related to oxygen/placenta/cord complication. Of course, that is merely my opinion. More on NST another day!

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What are the Complications of EFM?

In 2009 the U.S. Preventive Services Task Force released a suggestion stating that Low-risk women should not be candidates for continuous EFM. It does not improve long-term outcomes, and it increases operative deliveries.

Again, this began in the 1970s with zero research or studies completed. Women were not informed that they were literal guinea pigs, trying something with zero safety studies. To this day, evidence on our updated technologies are not proven safe for the baby during labor. (https://journals.lww.com/…/Electronic_Fetal_Monitoring_As_A…)

Why are we going this route? Especially when we have options of intermittent monitoring, such as fetal doppler and fetal stethoscope use!? There has only been one study completed thus far, as far as I am aware, comparing EFM use during labor to intermittent monitoring using a doppler or fetal stethoscope. The outcome was insane! The EFM group of constant monitoring detected 54% more abnormal fetal tones than either of the other methods. As a result, 28% more of those in the EFM group were subjected to a cesarean than in the intermittent monitoring group. The system is over active and creates more fear and concern than is necessary. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542781/)

Also, when evaluating an article from The Journal of Perinatal Education, I found The indiscriminate use of EFM in the labor room is not improving outcomes, and is actually causing harm to healthy women with uncomplicated pregnancies. Employing a low-tech, high-touch approach needs to be the main philosophy while providing nursing care to most laboring women.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010242/)

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So, why is EFM Pushed So Hard?

Why is EFM used in facilities without being proven safe? Here are 7 reasons why:
*Liability
*Lack of resources
*Time
*Marketing
*Training
*Nurses views on monitoring
*Lack of leadership from professional organizations
These are elaborated in great detail through the Evidence Based Birth link below.
(https://evidencebasedbirth.com/fetal-monitoring/)

What is quite eye opening in my opinion, is that in other countries such as Canada or the UK (where health insurance is not a thing), they do not suggest constant electronic fetal monitoring for low risk women. This leads me to believe that revenue may be a factor in the equation.

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Final Thoughts

How does constant fetal monitoring make you feel? Do you feel safe using these tools during labor? Does the idea of being strapped with bands on your contracting abdomen during labor sound like a brilliant idea to you? Especially when it has never been proven to improve the outcome, but likely worsen outcome in many cases. I don't know about you, but I don't want anyone touching me in labor. I do not even want any clothes touching me, let alone tight bands strapped around my belly that is contracting every few minutes.

Please research this topic in depth before consenting to its use, be sure your choice is fully informed. If you would like to learn more, I would suggest checking out the links below. The link to Evidence Based Birth sharing on EFM covers the topic in great detail, I'd start there. The last link is loaded with many studies on EFM as well. Make your own educated choice! There are a couple of other really good articles linked below.

Electronic Fetal Monitoring: The Risks; Birth Injury Guide - https://www.birthinjuryguide.org/…/risks-electronic-fetal-…/

Fetal Monitoring: Creating a Culture of Safety with Informed Choice - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010242/