In South African private hospitals it is almost universal to strap belts and sensors around your abdomen, leave you in bed, and watch the monitor to see your contractions.
Many women say that they feel like everyone forgets them. Nurses and even labor partners are too busy watching the screen and printouts.
Continuous electronic fetal monitoring has a high false positive rate – meaning that it often says that a baby is in danger when the baby is doing just fine.
Often if a baby’s heart rate drops a simple change in position will bring it right back up. Unfortunately the fetal monitor leaves you stranded on your back in bed.
There have been studies showing that continuous monitoring does not significantly improve birth outcomes for women and babies.
Because of the high false positive rates continuous fetal monitoring puts you at greater risk for caesarean section.
There is also a possibility of your labor being slowed or ineffective because you’re unable to move. You may feel more pain because you are unable to work with your body.
The inability to change position may cause your baby to get less oxygen than he or she should. If you are hooked up to an internal monitor, infection could be introduced to your birth canal and uterus. Your water will have to be broken. And your baby will have a monitor hooked into his or her scalp.
Nine randomized controlled trials showed that Electronic Foetal Monitoring does not make births safer. Babies are just as safe when someone listens to the foetal heart just after contractions has finished and in the interim between contractions with a Pinard’s stethoscope or a handheld Doppler machine.
– Obstetrics and Gynecological Journal Nelson MD 1996.
Positives
- May enable early detection of potential risks to the baby’s health and well-being during the labour.
- It provides the hospital/care provider with a hard copy print out of your labour, very helpful in litigation.
- Can be reassuring to watch the babies heart rate
- Allows a care provider to visit the labouring women less often.
- Allows the mother to visually monitor the labour which she may be unable to feel if she has had an epidural
Negatives
- Biggest disadvantage is that the EFM increases the caesarean rate.
- Doesn’t tell the future, it only tells what is going on now and is often misread.
- Considerably hampers the women’s ability to move
- It can be frightening to watch the baby’s heart rate
- Can lead to the labouring women being left alone for longer than she would be if a Doppler was being used
- Care providers can become obsessed with the EFM and stop focusing on the labouring women.
- If an internal monitor is used this will be screwed into the babies head.
- Internal monitor can leave a small abscess, even a permanent bald patch on the baby’s head.
- It is possible for the EFM not to work properly or for the information to be interpreted incorrectly resulting in unnecessary caesareans.
Alternatives
- Discuss the use of EFM with your care provider, if you do not what one used on you, say so.
- The alternative is for a midwife to listen to your baby using a doppler or Pinard’s stethoscope.
- This enables you to move around freely to manage your labour. You can also labour more freely in the shower and bath.
- Using a doppler also prevents the use of the internal monitor being screwed into the baby’s head lessening foetal distress.
- One of the greatest benefits from using the doppler over to EFM is that is creates a situation where your care provider needs to have one on one contact with you more often, look you in the eye and see how both you and your baby are doing.
