EFM – Good or Bad?

Electronic Fetal Monitoring is used to monitor contractions and the baby’s heartrate either continuously or intermittently. This provides a beat to beat view of the baby’s heart tones in relation to the contractions, so you can constantly see how the baby is handling labor.

This definitely has benefits for the high risk mother, but is it more risky for the low risk mother?

This method uses ultrasound, which leaves room for mechanical error, which causes incorrect interpretation and unnecessary intervention. For example, you lose your mobility, which may slow labor, which may switch the attention of the staff and your partner from you to the machine.

In the US, continuous monitoring is used more often than not and this is one of the reasons intervention and cesarean rates are so high.

You are constantly monitored to make sure your contractions are strong enough. As long as you are okay on your own, you won’t need pitocin. During a contraction, your baby’s heart tones are going to fall a little. This is not a reason to be alarmed. As long as they only go down 20 to 40 bpm, you are fine and no one will come rushing in to cut you open.

They will make you put on oxygen and lie on your left side if it start to drop more than that or if they are worried. After so long of nothing changing, they will section you if you aren’t dilated enough.

I read an article a bit ago titled “Routine Electronic Monitoring of Fetuses Is Challenged In Study” by Warren E. Leary.

I am just going to summarize the best points below.

-May lead to more cesareans, since every little thing is heard and can be interpreted differently by different people
-It is used continuously in 3 out of 4 labors.
-It is a good indication of stress in the fetus. Normal hearttones is if baby is getting enough oxygen. Decelerations indicate reduced oxygen which can lead to potential damage to the brain, central nervous system, and organs. This can sometimes result in death
-Two belts go around the woman’s waist. One monitors the baby’s heart tones and the other monitors the contractions.
-Many times this can erroniously indicate fetus is in trouble.
-Study published in the October issue of OBstetrics and Gynecology, found continuous monitoring does not diagnose problems better or faster than intermittent monitoring with a stethescope.
-If a problem is detected, they can reposition women to relieve pressure on the fetus, which most times can’t be done if you have continuous EFM
-EFM is recommended to be used only in high risk pregnancies.

***

Unless there is a problem in your pregnancy, you shouldn’t have to have EFM continuously through labor. You would be confined to your bed, and more often than not, a problem will arise which will raise your risk of interventions and cesareans.

Intermittent monitoring has been shown to have the same results as EFM but with fewer interventions and healthier babies. They can still diagnose things by listening to heart tones before during and after a contraction once an hour before pushing, and after every contraction while pushing.

Why have something you don’t need, especially if it is going to confine you to a bed where you can’t move around to lessen your pain?

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4 Responses

  1. I think EFM is unneccesary in most cases. Since studies have shown it doesn't improve birth outcomes, and yet most women still have it, it really is a tribute to how modern obstetrics doesn't follow current research. What do you think about it for VBAC clients? If I have a hospital birth they will tell me I have to have it. The hospital though does have telemetry that can go in the water, so at least I would be mobile.But I think frequent heart tones done by my care provider would be better, because that would insure that I have someone caring for me instead of a machine, and that will pretty much only happen in a home birth.

  2. I think the best thing for a VBAC mom is movement. Don't make her lie down, don't strap her to monitors. Intermittent monitoring does the same work with less interventions than EFM.And if you are a VBAC mom, you need all the support you can get, and if you have EFM, you won't get that.

  3. This is where I am torn. I don't know if my daughter would be here today if we didn't have the EFM. Her heart rate was way low. But on the other hand what IF it was monitoring wrong? They never once moved it around and only let me move for a few minutes during my labor (it was only a total of 1 hour spent in labor at the hospital so don't think TOO badly of my dr.) So what if it really was wrong and I could have had the oppertunity to finish pushing? Do you see what I mean?

  4. I definitely understand. The thing is, intermittent monitoring with a stethescope would have been the same, plus you could move around. I wish you hadn't had to have this happen. Wondering about your labor and if it was necessary is the worst. Especially when it ends in a cesarean.

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