The Problem with Electronic Fetal Monitoring

Fetal Heart MonitorDid you know that, during the year that electronic fetal monitoring was introduced, the cesarean section rate in our country jumped from 5% to 23%. According to the World Health Organization, the optimal rate that provides the best outcomes for mothers and babies is between 5% and 10%; additionally, rates above 15% are more harmful than helpful. When the c-section rate was first measured in the United States back in 1965, the rate was only 4.5%. The current rate is about 34%; in other words, one out of three laboring women end up giving birth via cesarean section in our country.

The percentage of cesarean sections performed in the United States is outrageously high. One of the reasons for the increase is the use of electronic fetal monitoring (EFM) during labor. EFM allows the doctor or midwife to keep track of the baby’s heart beat. With external monitoring, a fetoscope (a special stethoscope for listening to a fetus’ heartbeat) or a Doppler is used to listen to the baby through the abdomen. With internal monitoring, a sensor is attached to the baby through the cervix. EFM may be performed continuously (all the time) or intermittently (every so often).

Electronic fetal monitoring is problematic for a number of reasons. First, doctors and nurses often rely too much on EFM without actually paying attention to the mother or the baby.  Second and directly related to the first, EFM often prevents the mother from moving around. In many cases, having the mother change her position can fix the problem with the baby picked up by the monitor. For example, because the medical staff is not paying attention to the mother, no one notices that she is laying in a position such as flat on her back that is causing stress on the baby.

Finally and most importantly, doctors feel the need to do something with the results of electronic fetal monitoring. If the monitor picks up a chance in the baby’s heartbeat, to avoid potential litigation, doctors will start performing interventions such as cesarean sections. Although many of the babiess who are born via c-section could have safely been born vaginally, all too many obstetricians play the hero and immediately turn to a surgical birth. When the baby is born safe and healthy, the doctor plays up the heroic rescue via cesarean section. The parents rarely question the need for the surgery but are instead grateful to be holding their healthy and safe newborn.

Before I even conceived my daughter, I knew that I did not want to be tied down to a bed with continuous electronic fetal monitoring. I am very much against all of the unnecessary interventions that most hospitals try to impose upon laboring women, which is one of the main reasons that I chose a homebirth. During my labor, my midwife did use EFM but only intermittently. She was so quick and stealthy that I do not remember how many times she check on my daughter’s heartbeat. I know that she checked a few times in between contractions and that my daughter’s heartbeat was in the normal, healthy range every time. However, my midwife never disturbed me in an effort to use EFM.

Electronic fetal monitoring is not in itself an evil tool. When my midwife first checked my daughter’s heart rate, I felt an incredible sense of relief at hearing her little heartbeat. I knew too that my midwife would be able to tell if my daughter were having any serious problems through the intermittent use of EFM. However, I would never have been able to give birth in the way that I wanted had I been tied down to a bed with a continuous monitor. Electronic fetal monitoring during labor is a useful tool but only when used properly.

Was your baby’s heartbeat monitored during your labor? Continuously or intermittently?


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Why does the national U.S. cesarean section rate keep going up?:

Image Credits

Fetal Heart Monitor:

Heather Johnson

Heather Johnson is a mother, wife, writer, librarian, and linguist. She earned a BA in English studies with a minor in creative writing from Illinois State University in May 2007, an MS in library and information science from the University of Illinois at Urbana-Champaign in May 2009, and an MS in English studies with an emphasis in linguistics at Illinois State University in December 2011.

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