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EFM: hinderance or help?

Tuesday, August 18th, 2009

Fetal monitoring comes in all shapes and sizes these days.  From a simple stethoscope and kick counts to the ultrasound, doptone and electronic fetal monitoring; each has it’s own pros and cons in checking in on your little one’s vitals.

Throughout your pregnancy, your medical professional probably uses a stethoscope or doptone to listen for your baby’s heartbeat.  You will also keep track of how active your baby is by noticing the kicks and movements inside your belly.  During labor, however, the trend has been towards a more technical method of monitoring.

If you have a hospital birth, odds are they will use an external fetal monitor (EFM) to track the baby.  The EFM is composed of an electronic transducer that is strapped to your belly by means of an elastic belt that send an electronic reading of the fetal heart rate (FHR) and mother’s contractions to a base station in your birthing room.  Anytime there are any dips or raises outside of the normal range (120-160 bpm), indicating stress, an alarm beep sounds.  This also goes off if the disks slide around while you are busy laboring or if it gets wet from your water breaking, etc. which usually causes nurses to rush in to see what is happening.

An obvious benefit to fetal monitoring is in diagnosing early fetal distress and being able to closely assess a high risk mother/pregnancy.

But the risk of the rate of high false-positives are an important one to weigh when allowing EFM.  Of course, no one has good data to back this up but it is noted that out of 1000 births, an extra 30 cesarean sections and an extra 38 forceps extractions occur in continuous EFM versus intermittent auscultation.  If a alarm situation does arise, changing positions, relaxing and giving mother oxygen can all help to relieve any stressors to baby.

There is no recommendation of EFM in low-risk mothers and it does not show an improvement in maternal or fetal outcomes.  So why is it such a common occurance (about 75% of births)?  It then becomes an issue of staffing as it is recommended that it be a 1:1 ratio of nurse to patient when using intermittent monitoring but obviously if a machine is doing the work for the nurse, then they can divide their time between more patients.

Besides the risk of unnecessary medical interventions, including cesarean section, continuous EFM can be cumbersome and an annoyance, especially if you wish to labor or deliver in a tub.  It can be discussed previous to birth to perhaps have intermittent monitoring.  I do however feel that if the labor is induced, it can be a great benefit to use continuous EFM as intermittent monitoring may not pick up on all the ups and downs that baby is experiencing due to the manufactured, chemical contractions from the pitocin.

As with any medical procedure, just be informed and aware of all the benefits and risks.  Ask why do I need this?  What can happen if I don’t have it done?  Are there any other alternatives?