Continuous Electronic Fetal Monitoring (EFM) is a common intervention in labor, involving the ongoing assessment of your baby's heart rate to observe their well-being and response to contractions.
What it is
Continuous EFM typically involves two belts placed around your abdomen. One belt holds a transducer that detects your baby's heart rate, and the other measures uterine contractions. These sensors are connected to a monitor that displays and records the data, often printing it on a paper strip. This setup means that once EFM is initiated, your movement may be restricted, often requiring you to stay in bed or close to the monitoring machine. In the US, continuous EFM is a routine practice in nearly all hospital births, regardless of risk level.
What the evidence says
When we look at the evidence for low-risk pregnancies, a significant divergence appears between routine practice and what research suggests. A Cochrane review found that for low-risk births, continuous EFM did not improve cesarean rates or fetal outcomes when compared to intermittent auscultation. In fact, EFM has a high false-positive rate for identifying fetal distress, which can contribute to unnecessary cesarean births. Intermittent auscultation, which involves checking the baby's heart rate with a handheld Doppler every 15-30 minutes in active labor and every 5 minutes during pushing, is the standard approach in midwifery care and is supported by Cochrane for low-risk pregnancies. Understanding these distinctions can be a key part of your childbirth education.
When it's recommended
While routine for many, continuous EFM is specifically appropriate and often recommended in certain situations. These include high-risk pregnancies, after an epidural has been administered (due to potential blood pressure changes), when Pitocin is being used to augment or induce labor, or other specific medical indications. In these scenarios, the continuous data can provide valuable insights for your care team. It's always a good idea to discuss the specific reasons for any recommended intervention with your provider.
