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Used to monitor the baby's heart rate and strength of contractions throughout labor, Electronic Fetal Monitoring (EFM) is an intervention swept in with technological advances and the era of actively managing childbirth. Many obstetricians, nurses, and health care consumers mistakenly believe constant monitoring will help save babies from distress or death. Here's how is works.

With External EFM, two transducers are held in place by belts around mom's abdomen. One transducer monitors the frequency, length, and strength of contractions. The other uses ultrasound to hear and record the baby's heartbeat. Both belts are attached by a wire to a machine where the values of these transmissions are displayed on a screen, as well as printed out as they are recorded.

Internal EFM is similar in the way that contractions and the baby's heartbeat are both monitored. The difference is that the baby's heartbeat is monitored with an electrode inserted through the vagina and into the baby's scalp. Contractions are monitored internally with a thin tube placed inside the uterus. Mom's membranes (bag of waters) must be ruptured to use Internal EFM, which means if they have not ruptured spontaneously, they will have to be artificially broken.

What are the advantages of Electronic Fetal Monitoring?

• It may be reassuring to either parent or caregiver(s) to have constant feedback on baby's condition.
• Medicated mothers may be able to use the monitors to help the visualize their labor pattern.
• Baby's well-being may be able to be detected if it is being compromised.

What are the disadvantages of Electronic Fetal Monitoring?

• Freedom of movement is extremely limited, even restricted to bed, limiting position changes.
• Normal fetal heart tone variations and decelerations may be misinterpreted as a sign of fetal distress.
• Mother often feels like a bystander at her birth as the focus tends to shift toward the monitors instead of her.
• In the case of internal monitoring, the site where the scalp electrode is inserted may become infected.
• Insertion of the electrode or premature rupture of membranes in order to insert the electrode may cause fetal distress.

What are the alternatives to continuous EFM?

The ideal alternative to continuous EFM is what's called Intermittent Auscultation. This means the baby's heartbeat is monitored periodically throughout labor with a specialized stethoscope, called a fetoscope, or a hand-held Doppler device. This is usually done immediately following a contraction, to make sure it is healthy and listen for normal variability. This approach to monitoring allows mothers to be able to move freely since they are rarely required to stay in one position for a long amount of time.

Since this method of monitoring is rarely employed among labor and delivery wards, another alternative you may consider is Intermittent EFM. Using this method, you are usually required to have a monitoring strip recorded for a short time period upon initial arrival at the hospital, and periodically throughout the rest of labor until the baby is born. The intervals at which labor should be monitored vary greatly between care providers, but most tend to follow the guidelines outlined by the American College of Obstetrics and Gynecology (ACOG).

ACOG standards state intermittent fetal heart rate monitoring throughout labor performed by observing and recording heart tones every 30 minutes in the first stage of labor. The 1982 standards say that in the second stage of labor, heart tones should be monitored every 15 minutes while preparing for delivery and every ten minutes during delivery. ACOG states that EFM shows NO significant benefits over intermittent auscultation on neonatal outcome. ACOG also states the significant increase in the risk of Cesarean or surgical delivery posed by EFM.

Another possible alternative if continuous monitoring is insisted upon is using a Telemetry unit. This is a device that straps around mom's belly and provides readouts on contractions and heart tones but is not strapped to a machine, which allows mom freedom of movement. Some hospitals do not have this device available, so if you may be in need of it, do the legwork ahead of time to secure the option!