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?
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).
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.
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.)
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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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
Most recent page update: 2/21/2006