I am so happy to be able to keep my patients off the monitor! For over 20 years, the dangers of continuous electronic fetal monitoring (EFM) have been documented, yet 85% of women laboring in the U.S. are still being strapped into beds, with their nurses struggling to keep unbroken tracings of both babies’ heart rates and moms’ contractions. In a Cochrane Review of over 37,000 cases in 13 studies, published in 2013, the danger and uselessness of EFM is confirmed yet again. EFM was shown to significantly increase a woman’s risk of an instrumental delivery (i.e., forceps or vacuum extraction) or Cesarean section without improving her baby’s chance of survival. In other words, being continuously monitored increases her risk of an unnecessary C-section.
In my practice, with a low-risk laboring woman, I monitor her baby every 30 minutes, and then, while she is pushing, every 15 minutes. This means listening with doppler during and between 2 contractions. If heart rate is normal, listening stops, and everyone can again focus on helping her cope with labor. It changes the center of attention. Instead of all eyes on the baby, who is a passive passenger, we pay mind to the woman actively working hard to bring that baby out. She needs this. If we can invest more energy and resources in helping her, she and her beloved baby have a better chance of a drug-free delivery.
I had a wonderful experience a few weeks ago with a young couple having their first baby. Between long, warm showers, she sat on the edge of her bed, feet on the floor, almost still, quietly entranced, serene in her fatigue, time suspended in the quiet night. During contractions loving hands held hers, and she struggled through them, but between them, she was peaceful and calm in the dimly-lit sanctuary. I knelt beside her every 30 minutes and listened to her baby with my doppler, then put it aside. We could have been anywhere. They could even forget that it was a hospital. And after the sun rose, her healthy baby was born, without intervention or medication. This would not have been the experience it was with her strapped to a beeping monitor, lying in bed.