Electronic fetal monitoring?
Electronic Fetal Monitoring
Too much or too little? That question summarizes the dilemma across the board in obstetrics. Are we doing too much or too little to protect and support mom and baby? Electronic fetal monitoring (EFM) is one more topic in which we thought we were doing too little by only listening to a baby’s heartbeat intermittently and then we overshot by implementing continuous electronic monitoring (cEFM) for majority of U.S women delivering in hospitals. Learn more about cEFM and what it means for you in labor!
The advent of EFM:
Initially, the introduction of continuous EFM came about because intermittent monitoring picks up abnormal patterns preceding adverse outcomes for the baby. It was thought that we didn’t have enough information during labor to intervene appropriately to prevent adverse outcomes. Between 1973-1976 EFM was rolled out across intrapartum units as the standard of care. However, the only studies looking at the benefits and risks of continuous EFM was funded by the company who created the monitors.
What we know now:
Continuous EFM does not improve outcomes for the baby and increases the risk of c-section for mom.
Randomized controlled trials concluded that EFM was a failure. A 2006 Cochrane review that looked at 12 experiments made up of more than 37,000 women found that continuous EFM did not decrease adverse outcomes, like cerebral palsy, for infants. Additionally, low-risk mothers who received continuous monitoring were one-third more likely to have their baby admitted to an intensive care unit.
Abnormal heart rate patterns do not accurately predict the incidence of both early and permanent brain injury during birth.
Does continuous EFM change care during labor?
An analysis of birth videos revealed birth attendants were more likely to watch the monitor than the mother during times of distress. Centralized monitoring, when continuous EFM is projected onto a screen for nurses and providers to look at from afar, may provide a sense of confidence AND unwarranted mistrust leading to women feeling neglected during their labor. It's standard in the hospital setting to have a nurse manage more than one laboring patient because of continuous EFM. If using intermittent fetal monitoring the patient to nurse ratio has to change from 1:2 (or 1:3) to 1:1, which can be challenging.
What can you do to get the best care during labor?
-If you are low-risk and in labor, stay at home for as long as possible!
-Hire a doula!
-Ask about your hospital's electronic fetal monitoring policy. Do they have a policy for intermittent auscultation? Alternatively, does your hospital have telemetry unit for you to use so you can still be active during labor?
-What is your hospital's nurse to patient ratio? Moreover, what is the likelihood they have enough nurses to do intermittent fetal monitoring?
-If you have a high-risk medical condition or a high-risk pregnancy, it is best to use continuous EFM.