Fetal monitoring in labor is another area of modern obstetrics where evidence and practice don't meet. The rationale behind labor monitoring is to improve maternal and fetal outcomes by early detection of complications during labour. However, the research in this area shows higher levels of monitoring increases the risk of a c-section due to the high rate of false alarms from the technologies currently in use. There is no research to support the practice of routine continuous electronic fetal monitoring.
In reality, the baby's risk of having a problem in labor is less than 2.5%, unless pain medications are used. Only 5% of all mothers will have any complications. 75% of all complications in childbirth are due to maternal hemorrhage or a baby that does not breathe soon after birth. But, neither one of these complications can be detected by monitoring the baby during labor.
Other complications of types of labor monitoring include:
To truly understand monitoring during labor, you must be familiar with both the types and the tools used for each method:
This is monitoring for long periods of time. It is usually medically-indicated when medications are given during labor or under high-risk conditions, such as pre-eclampsia, diabetes, heart problems, or other potentially life-threatening complications.
This is monitoring on an intermittent schedule, such as every 15-30 minutes.
This usually only occurs in the rare instance of an unassisted homebirth (although many families will secure a fetoscope for monitoring at home) or in the case of a precipitous birth where the baby is born en route to the chosen destination.
A Fetoscope is similar to a stethoscope and carries a number of benefits as a tool during labor.
The Doptone is an ultrasound device that has the main benefit of being waterproof for use during waterbirth or if the mother uses the shower during labor.
The EFM is the most commonly used method in hospitals, despite the evidence that it is the least effective with the highest rates of false positives, adverse effects and its link to increasing the rate of c-sections without improving outcomes.
Telemetry is a form of EFM that allows for full mobility during labour. However, it is not widely available.
An internal fetal monitor is the most accurate way to determine fetal well-being. However, it is the most invasive method and can start a cascade of interventions if not used judiciously.
Ultimately, mothers choose the level of monitoring that best fits her circumstances. The more invasive options are medically indicated under certain circumstances but not for routine use. Some women need to hear the sound of the baby's heartbeat to relax while for others it causes undue stress and worry. It is standard procedure in most hospitals to require continuous EFM for the first 15-20 minutes to develop a baseline. After this the unit can be removed in favor of intermittent monitoring. Choices will be limited by the equipment available at the individual place of birth.
The more aware you are of your options, the more comfortable you'll feel making informed decisions about your care during labor. Make sure you ask your care provider about your options, including their routine practices.
If you are planning a hospital birth, you can also tour the hospital and ask for a copy of your doctor's standing orders to determine which interventions and procedures are his/her routine practice. This will help you determine which issues need to be addressed before labor, including fetal monitoring.
Page Last Modified by Catherine Beier, MS, CBE
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