Electronic Fetal Monitoring (EFM)

What it is:  There are two types,  external and internal.  External EFM is done by placing two straps around the laboring woman’s abdomen that measure fetal heart rate and uterine contractions.  Internal EFM is done after the membranes have ruptured (or been ruptured) by placing a small corkscrew shaped wire into the baby’s presenting part (head or buttocks) and a catheter placed into the cervix to measure uterine contractions.   

When they are used:  Once again it varies.  ACOG (American College of Obstetricians and Gynecologists) recommends EFM be used intermittently, for 15 minutes every hour.  Some hospitals and physicians use them perpetually from admittance into the hospital and some do not use them at all, using instead a stethoscope to monitor heart tones in the undelivered baby.   

Why they may be used as a matter of routine:  I can’t say for sure.  It is a billable expense, which you can bet figures into the hospitals agenda for policy use.  It is also less of a staff burden since nurses would have to monitor fetal heart tones with a stethoscope and that would require more time and patient interaction, an EFM can be read quickly, often from the nurses station.  Doctors may feel that perpetual use of EFM is really a benefit because of it’s ability to indicate fetal distress, but controlled randomized studies have shown that it’s reliability for indicating fetal distress is no better than intermittent use or the use of a stethoscope.   

Drawbacks to routine EFM:  This is one of those procedures that doesn’t at first seem like a bad idea, at least not the external monitoring.  The problem with it is that like an I.V., it tethers the laboring woman to the bed limiting her mobility and comfort.  It also replaces having a person monitor the baby, instead relying on a machine which beeps loudly and spits out ticker type tape and basically looks quite complex and overwhelming.  And to boot, it is no more reliable than a less confining form of fetal monitoring.

Internal EFM, because of it’s intrusion into the uterus and the infant's scalp,  runs the risk of introducing bacteria and infection to the infant and to the mother. An electrode screwed into a baby’s head cannot be a pleasant feeling.  I was told it would not hurt my baby, but now at 2 years old, she still has a scar in her scalp from it.  Somehow I doubt it didn’t’ hurt. Then there is the fact that the EFM utilizes ultrasound technology.  There are no long term studies proving that ultrasound is completely safe for the unborn baby.   Remember that X-rays were at one time used to peek into a pregnant woman’s uterus also and that proved to be a bad idea.