Electronic Fetal Monitor (EFM)
Lets talk about the Electronic Fetal Monitor (EFM):
Basics- As shown in the picture above the EFM is the form of ultrasound used during labor. It usually consists of 2 bands strapped around moms belly during labor. One band measures the baby’s heart tones and the other measures the moms contractions.
In Colorado and many other states, hospitals are required (in order to keep their malpractice insurance) to monitor a mom with the EFM for 20 minutes of each hour during labor. There are many cons to the EFM. To give it some credit, there are times when the EFM has saved lives, but in general, it is an overused practice that at this point in time has more cons than pros.
Electronic Fetal Monitoring
Some believe that the increase in the use of electronic fetal monitoring is a likely reason for the increase in the cesarean birth rate. One of the biggest problems with fetal monitoring is exactly how to interpret the results. A claim made for the use of electronic fetal monitoring is that it identifies a baby who is having difficulty in labor (known as fetal distress or non-reassuring fetal heart rate.) However, several studies have shown that external electronic fetal monitoring is not any more accurate in diagnosing fetal distress than periodic manual checks of the baby’s heart rate (also called auscultation.)
One interesting perspective on the misuse of external monitoring comes from the inventor, Dr. Edward Hon. Dr. Hon, along with another physician, Dr. Orvan Hess, invented the electronic fetal monitor in 1957 to treat women with high-risk pregnancies. In the 1960′s, electronic fetal monitoring began in widespread use.
Thirty years later, Hon said at a conference on “Crisis in Obstetrics: The Management of Labor,” “If you mess around with a process that works well 98% of the time, there is much potential for harm….[most women in labor may be] much better off at home [than in the hospital with the electronic fetal monitor.]“ Is our misuse of electronic fetal monitoring in hospitals causing unintended problems?
Since the research on electronic fetal monitoring indicates that it has not improved outcomes, it is not surprising that there are critics of external fetal monitoring even among medical professionals. An editorial in the British Medical Journal (Goddard, 2001) stated that intermittent auscultation of the baby’s heart rate by a nurse or midwife during labor is ideal. Goddard states that, “There is good evidence that one to one care alone has a powerful effect on the labouring woman, reducing intervention.8 The cardiotocograph (fetal monitor) can become a surrogate for this best quality care and has a major impact on the caesarean section rate.”
(http://pregnancychildbirth.suite101.com/article.cfm/reason_for_cesarean_rate_increase)
There were a slue of studies done in the 80’s about the effects of ultrasound on an unborn baby. These studies were promising in showing how continuous ultrasound on the cells that make up a fetus cause those cells to react in a negative way. There were some tests that showed how ultrasound actually caused damage to those cells. An ultrasound machine uses a form of ultrasound called “pulsed” ultrasound. The picture you see on a traditional ultrasound machine is not a continuous picture, but instead, pulsed images put together at a rapid speed, giving the illusion of a continuous picture. The EFM is an actual continuous, non stopping ultrasound ray. There is speculation that this continuous ultrasound can cause a baby to go into distress while in the womb in labor.
Some more “conveniences” with the EFM is that while in labor a mother must be monitored for 20 continuous minutes. This is ONLY if a mother is NOT on any medication. If a mother is on medication she must be on the EFM for the entire pregnancy. Its a lose-lose in terms of the fact that a woman doing natural labor needs her freedom to move around, switch positions, & call the shots. 20 full minutes of each hour, a mother has to snap out of the groove that she is in, in order to be hooked up to the monitor. This can really throw a wrench into the process she is in. The lose to being on the EFM while having pain medication in labor is that you must be attached to it the entire time. With the studies that suggest that the EFM can cause distress to the baby while in labor coupled with the often misinterpreted readings of the EFM, can greatly increase a woman’s chance for complications in labor.
You can talk to your OB or midwife ahead of the birth and see what their policies are regarding the EFM. Some doctors who understand and respect the wishes of their patients will do the more painstaking work, of manually checking mom with a Fetoscope (a non ultrasounds device seen here.) or doppler and chart the baby’s heart tones throughout labor.
In homebirth scenarios for example, an EFM is not available, and not needed. There should be no difference between a mother not needing an EFM at home vrs in the hospital. The main reason an EFM is used, is not bc of the baby’s safety, but bc of malpractice insurance. If a mother was to have something go terribly wrong in labor and decided to come back and sue the hospital, the malpractice insurance requires that the hospital have had a perfect record of 20 minutes each hour of labor on the EFM, or they may refuse to insure that doctor or hospital.
Your body knows how to labor, messing with it in any form has the greater potential to cause more harm than good. We are not the fetus in utero listening to what kind of pitch or sounds an EFM might be emitting. We do not understand how having to sit leaning on our back for 20 minutes each hour, hour after hour, can cause natural labor to be disrupted. The best things to do in any labor is to let nature take its course and listen in on occasion by Doppler or Fetoscope to make sure baby sounds healthy and strong…and then leave mom ‘be’, to have her baby naturally.
Here are a couple more links to some sites that talk about the Electronic Fetal Monitor:
-http://www.childbirth.org/articles/efm1.html
-http://www.childbirth.org/articles/efmref.html
-http://www.squidoo.com/birthrisks
-http://jrsm.rsmjournals.com/cgi/reprint/94/1/14.pdf
-http://www.childbirthconnection.org/article.asp?ck=10201
-http://www.babycenter.com/0_fetal-monitoring_1451559.bc
-http://www.lamaze.org/OnlineCommunity/AskanExpert/tabid/363/aff/14/aft/31322/afv/topic/Default.aspx
Thank you again for being patient with me over the holidays! I do greatly enjoy posting about Pregnancy! Please feel free to leave me a comment about this topic or any topic!! Thanks for taking the time to read & check out my website.
- Julie 
| Print article | This entry was posted by Julie Wannamaker on January 11, 2010 at 12:00 am, and is filed under Labor/Delivery. Follow any responses to this post through RSS 2.0. You can leave a response or trackback from your own site. |
about 3 years ago
>> If a mother was to have something go terribly wrong in labor and decided to come back and sue the hospital, the malpractice insurance requires that the hospital have had a perfect record of 20 minutes each hour of labor on the EFM, or they may refuse to insure that doctor or hospital.
That’s absoluately true.
>> Your body knows how to labor, messing with it in any form has the greater potential to cause more harm than good.
Can’t agree here. There are times when we intervene too much, but clearly there are times that intervention is required to protect baby and mother. Though EFM as a whole may not be beneficial, there are clearly individual cases where it is lifesaving. Saying that every labor will go well without intervention is to throw us back to the dark ages. Though most labors will go well and most babies will do well, it is the natural course for some babies and mothers to die in childbirth, like in every other species on our planet. Humans are not protected from this just because we can create some holistic theory of childbirth. Some babies won’t come out alive, and some will damage mother a great deal in doing so. Just look at any part of this world that has no access to obstetrical care – lots of dead babies and vesicovaginal fistulas in rural Africa.
Nicholas Fogelson, MD
about 3 years ago
Thank you for posting your opinion on my site! I appreciate the expertise and opinion.
I agree, it would be wrong for me to state that in EVERY case EFM is wrong. In no way is ANYTHING an “always” in my book. Thank you for clarifying if my blog post came across as if I was saying that the EFM was in no shape or form a good thing for some cases. I bet there are numerous occasions where something has been detected by the EFM that might have gone unnoticed and helped save lives.
One thought that is brought to my mind though is that the EFM is not used in homebirths, only a doppler, and the doppler is used occasionally at no set interval time frame. This gives mom the ability to roam around and have more freedom in her birth, where as in the hospital on the EFM, that freedom is limited. I know that having to sit, in what could possibly be an uncomfortable position, for 20 full minutes could be just what it takes to send a woman who was coping well up to that point in her labor to a place where she feels like she can not cope any longer, increasing her risk of getting Medication (if she was trying for a natural birth).
I know that hospitals and doctors have to do the 20 minutes for the insurance. I feel it is unfortunate though that some of the woman’s freedom is taken away because of the insurance companies policies.
Thank you for your posts! I value the comments.
about 3 years ago
“Saying that every labor will go well without intervention is to throw us back to the dark ages…..Just look at any part of this world that has no access to obstetrical care – lots of dead babies and vesicovaginal fistulas in rural Africa.”
I would like to point out that there are far more variables to infant/maternal deaths in Africa than not having obstetrical care or the lack of use of EFM’s:
In tropical Africa, the main causes of infant and child deaths are more or less the same in most countries. These have been identified as infections, protein-calorie malnutrition, and birth trauma (Page and Coale, 1972; Newman, 1979; Newland, 1982).The infections include neonatal tetanus, diarrhea, respiratory infections, measles, and malaria (Page and Coale, 1972; Chen, 1983).
As for your esicovaginal fistulas, according to wikipedia:
“Vaginal fistulas can also result from violent rape. This injury has become common in some war zones, where rape is used as a weapon against civilian populations.”
It seems more of a cultural end economical issue than an obstetrical one. Of course, not saying that medical care would not be beneficial to those people, but if they were not malnutritioned, diseased, and subjugated, the birth process would be far less dangerous in it’s normal state. These same issues were apparent during the medieval ages and it is not that birth itself needs managing but women’s overall health.