Nine randomized controlled trials showed that Electronic Foetal Monitoring does not make births safer. Babies are just as safe when someone listens to the foetal heart just after contractions has finished and in the interim between contractions with a Pinard’s stethoscope or a handheld Doppler machine.
– Obstetrics and Gynecological Journal Nelson MD 1996.
Electronic Foetal Monitoring is a continuous monitoring of the foetus during labour.
This is done by either two straps around your stomach, one to monitor your contractions and the other the monitor your baby’s heart rate.
Or alternatively an electrode is screwed into your baby’s head, eliminating one of the belts around your belly, but causing great discomfort for your unborn child.
The biggest problem with the EFM is that it greatly increases your chance of further intervention.
- May enable early detection of potential risks to the baby’s health and well-being during the labour.
- It provides the hospital/care provider with a hard copy print out of your labour, very helpful in litigation.
- Can be reassuring to watch the babies heart rate
- Allows a care provider to visit the labouring women less often.
- Allows the mother to visually monitor the labour which she may be unable to feel if she has had an epidural
They told me that they just wanted to clip something to my baby so they could get a better reading, I later found out that they screwed an electrode into my unborn babies head. — (Debbie)
- Biggest disadvantage is that the EFM increases the caesarean rate.
- Doesn’t tell the future, it only tells what is going on now and is often misread.
- Considerably hampers the women’s ability to move
- It can be frightening to watch the baby’s heart rate
- Can lead to the labouring women being left alone for longer than she would be if a Doppler was being used
- Care providers can become obsessed with the EFM and stop focusing on the labouring women.
- If an internal monitor is used this will be screwed into the babies head. (see the photo of this screw)
- Internal monitor can leave a small abscess, even a permanent bald patch on the baby’s head.
- It is possible for the EFM not to work properly or for the information to be interpreted incorrectly resulting in unnecessary caesareans.
The technology now exists for obstetricians to monitor their patients remotely on their iphone.
I’m totally dependent on foetal monitors, cause they’re great! They free you to do a lot of other things. I couldn’t practice modern obstetrics without them. I couldn’t sit over there with a woman in labor with my hand on her belly, and be in here seeing 20-30 patients a day. You couldn’t see the volume of people, you couldn’t treat people. I’d say that in the 20 years that I’ve been in practice, what we do today is 90% different than what we did. We have laparascopes, we have ultrasound. We couldn’t stop labor in those days; we stop labor with tocolytic drugs today. At least 90% of the things that I do now weren’t part of my training. — (53-year old male obstetrician, From Robbie Davis- Floyd’s research)
Discuss the use of EFM with your care provider, if you do not what one used on you, say so.
The alternative is for a midwife to listen to your baby using a doppler or Pinard’s stethoscope.
This enables you to move around freely to manage your labour. You can also labour more freely in the shower and bath.
Using a doppler also prevents the use of the internal monitor being screwed into the baby’s head lessening foetal distress.
One of the greatest benefits from using the doppler over to EFM is that is creates a situation where your care provider needs to have one on one contact with you more often, look you in the eye and see how both you and your baby are doing.
What the literature indicates now is that when a stethoscope is used to listen to the “real” heartbeat through an echoscope (not the bounced back and recorded beat shown on a monitor read-out) the caesarean rate goes down by 50 percent with no adverse effects on fetal mortality rates. — Childbirth Educator, Sheila Kitzinger
Be mindful that even allowing an EFM to be strapped to you for even a short time (such as when first arriving at the hospital), may lead to pressure on you to keep it on for the rest of the labour if there is anything slightly out of the ordinary. This will then restrict your movement and maybe start the cascade of intervention.
In September 2009, a commonly used Foetal Monitor has been reported to produce faulty readings. The US Food and Drug Administration (FDA) has warned about inaccurate output readings, if not properly addressed, may lead to unnecessary interventions, failure to identify the need for interventions, and failure to identify foetal distress. They recommend the use of Doppler or Pinard Stethoscope. Question whether you need to expose your body or your baby to a machine that can lead to unecessary interventions based on faulty readings.
The most important thing in the room was the EFM, I was told not to move so it (EFM) could get a good reading, at one point a midwife walked in the room checked the EFM and then left, she didn’t even look at me! — (Kirsten)
First they where looking for the heart beat not going up and down to much, then they where concerned that it wasn’t going up and down enough, I felt like it didn’t matter what the printout was saying, they were always going to be concerned about it. — (Susie)
The expectant mother has been commonly treated as if she were seriously ill, even when she was quite healthy. All too often she has been forced to conform to a common pathway of care which stripped her of most of her individuality and much of her dignity….Too often the expectant mother has felt that her fate and the fate of her baby were dependent not so much on skilled personnel as upon an electrical black box that appeared to posses some great power that prevailed above all other. — (Pritchard and MacDonald, From Robbie Davis- Floyd’s research)
As soon as I got hooked up to the monitor, all everyone did was stare at it. The nurses didn’t even look at me any more when they came into the room – they went straight to the monitor. I got the weirdest feeling that it was having the baby, not me. — (From Robbie Davis- Floyd’s research)
The hospital policy was that I would need continuous monitoring, both of my contractions and the baby’s heart rate. The problem was that the cable to the machine wasn’t long enough so that I could stand under the shower, and there was no power source in the bathroom. My dear husband solved this problem by asking for an extension cord and then stretching every cord to the limit, keeping the door open so he could check the cords were all still connected and the belts hadn’t slipped off while I was under the shower. Read more.
Uncertain Value of Electronic Foetal Monitoring in Predicting Cerebral Palsy
This gives an overview of the history of foetal monitoring and it’s relationship to detecting intrapartum problems that could be possibly associated with cerebral palsy. Specific abnormal findings on electronic monitoring of the foetal heart rate were associated with an increased risk of cerebral palsy. However, the false positive rate was extremely high. Since cesarean section is often performed when such abnormalities are noted and is associated with risk to the mother, our findings arouse concern that, if these indications were widely used, many cesarean sections would be performed without benefit and with the potential for harm.
” …the only clinically significant benefit from the routine use of EFM was in the reduction of neonatal seizures. The rates of intrapartum and neonatal death, short-term morbidity and long-term morbidity including cerebral palsy were similar whether the foetal heart rate had been monitored continuously or intermittently.” (The New England Journal of Medicine, March 7, 1996 Volume 334; #10)
This gives rise to concluding that the foetal monitor has now been evaluated by 12 prospective, randomized, controlled trials involving more than 55,000 infants with the complete understanding now that there is no improvement in outcomes due to this technology.
Photo Credits: Black & White images