Continuous Electronic Fetal Monitoring



What is electronic fetal monitoring (EFM)?

How can continuous EFM affect my pelvic floor?

What are other ways to monitor the baby's heart rate in labor?

When is continuous EFM generally recommended?




What is electronic fetal monitoring (EFM)?

The electronic monitor tracks and displays a baby's heart rate in parallel with the rise and fall of uterine contractions. Monitoring of the baby's heart rate can be external (picking up the heart rate through an ultrasound device held against the mother's belly with a belt or a mesh band) or internal (picking up the heart rate through a spiral electrode needle that is inserted through the vagina and cervix and catches under the baby's scalp). Contractions can also be monitored externally (using a pressure sensor held against the belly by a belt or a mesh band) or internally (with a thin tube inserted into the uterus).

How can continuous EFM affect my pelvic floor?

With continuous EFM, a woman is connected to a monitor throughout labor. This can indirectly harm the pelvic floor as it increases the likelihood of using vacuum extraction or forceps (assisted vaginal birth). This in turn, and especially when routinely carried out with midline episiotomy, increases chances of a serious tear into or through the anal muscle. Anal muscle tears can lead to leaking gas — and more rarely, feces — or a sense of urgency about elimination (bowel incontinence) and increase likelihood of pain during sexual intercourse.

What are other ways to monitor the baby's heart rate in labor?

The baby's heart rate can be monitored at regular intervals (intermittently) by using either the EFM machine, a hand-held device (Doppler), or a special stethoscope. This type of monitoring allows you much more freedom of movement to walk, use the toilet, use a shower or tub, seek positions of greatest comfort, etc. (The theory behind continuous EFM was that it would enable doctors to intervene sooner if a baby shows signs of trouble, but many studies have shown that babies are not born in better condition with continuous EFM in comparison with babies who are monitored intermittently.)

When is continuous EFM generally recommended?

Continuous EFM is standard practice with some interventions that increase the likelihood that a baby will have certain problems:
  • synthetic oxytocin (Pitocin or "Pit") may be given by intravenous (IV) drip to start or strengthen labor
  • epidural analgesia may be given for pain relief
  • vaginal birth after cesarean (VBAC) involves EFM because a sudden drop in the baby's heart rate is the most reliable sign of the rare occurrence that the scar from a previous cesarean has given way and is causing the baby problems. (See the complete Pregnancy Topic VBAC or Repeat C-Section for more.)

In addition to increasing risk for assisted vaginal birth, continuous EFM also increases risk for cesarean section. You may wish to speak with your doctor or midwife and nursing staff where you will be giving birth, in advance and again during labor, about monitoring the baby intermittently whenever possible.

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Most recent page update: 2/21/2006