Imagine a woman in labor at the hospital. How she is moving? Where is she in the room? What is she doing? Probably you see a woman lying down in the bed, wearing a hospital gown, hooked up to various monitors, straps and tubes.
In some high-risk situations these things may truly be helpful for moms and babies, or for mothers who choose epidural medications. But most healthy women do not need to be hooked up to anything in order to safely birth a baby. Imagine how different hospital birth would be if most women could move around at will without any sensors or straps attached to them. Imagine women moving instinctively in ways that made their bodies feel more engaged, relaxed, and productive.
How might the freedom to be mobile affect their sense of privacy and autonomy? How might nurses and doctors entering the room approach a woman who was walking around, rather than confined to the bed? When you are up and about and getting into your labor’s rhythm you are a lot less likely to passively accept the battery of routine procedures, vaginal checks and so on. I believe — I know — that women would have more self-confidence and a stronger connection to their primal birthing instincts if they could move how and where they pleased without being attached to fetal monitors — an incessant reminder that their bodies or babies could fail at any moment.
Electronic fetal monitoring (EFM) can help us to observe what the heart is doing, how well oxygenated the baby is, and whether the baby appears to be struggling or happily trucking along. EFM became routine in the 80’s under the assumption that it was going to save babies. It was believed that continuous monitoring would pick up the small number of babies who show signs of hypoxia or distress and save them by cesarean section. We now know that a baby’s heart rate in labor is not great indicator of how well the baby is going to do after s/he is born. Regrettably, the technology has been applied in such an extreme manner — virtually all women in the US are attached to a fetal monitor during most or all of their labor — without consideration of whether there could be too much of a good thing.
Studies on EFM were undertaken only after it became a routine part of hospital birth. We now have decades of evidence showing that continuous EFM has no effect on neonatal mortality or morbidity; it does not help babies be born any healthier. It does however increase the risk of cesarean birth by about three times. Physicians know this, and many will even admit it. Both the US Preventive Services Task Force and the Canadian Task Force on Preventive Health Care recommend against routine EFM for low-risk women, and cannot even recommend it for high-risk women in labor. Why then are healthy, low-risk, un-medicated women still being confined to fetal monitors when we know they don’t make birth any safer?
1) Electronic fetal monitoring produces a written record of the baby’s heart rate and it is believed that this record will help protect physicians against claims of malpractice or negligence should a patient decide to sue. As one labor and delivery nurse shared on the My OB Said What?!? site:
“We always do continuous fetal monitoring, not because we think it helps, but just for legal reasons.” — A labor & delivery nurse
2) It is easier for nurses to manage multiple patients when they are being monitored electronically. Nurses already perform the majority of care given to women in labor and they have heaps of charting to keep up with on top of patient care. A well-known physician and midwifery advocate confided to me that, as with many aspects of maternity care, EFM boils down to dollars and cents. Keeping women strapped in and hooked up affords hospitals a higher nurse-to-patient ratio.
There is another option: periodic monitoring with a hand-held doppler (or fetoscope if you are hoping to avoid ultrasound). This kind of monitoring is called “intermittent auscultation.” It is what midwives do at homebirths. ACOG even supports it, but it requires one-on-one nursing care, something hospital labor and delivery units do not provide. It also requires the unit keep a doppler readily available. I have attended countless hospital births where women are told they could be monitored with a doppler but there is no doppler to be found. ( I wanted to include a photo here of a hand-held doppler being used in the hospital. After about forty-five minutes of searching I gave up.)
Some women question their care providers prenatally about how long they will be hooked up to the monitor. They are frequently told they will only have to be on the monitor periodically each hour, but countless mothers will attest — it is a slippery slope. When you add in pitocin and pain medication, or a “concern” about the baby’s well-being, periodic monitoring turns into continuous monitoring (cEFM) rather quickly. When one intervention leads to numerous others we call it the cascade of intervention. EFM is a significant component of this cascade.
This is an area however where pregnant women can affect change. You can demand the freedom to be mobile in labor. You can demand to labor without electrodes and sensors on your belly. The science is on your side. Midwives are on your side. ACOG is even on your side (in writing). So yes, you CAN say no to the monitor, but you better bring your own doppler …and your own nurse.