Electronic Fetal Monitoring: The Risks

Electronic fetal monitoring (EFM) is a way for physicians to monitor an unborn infant’s heartbeat and to ensure that there are no medical complications. Although it’s beneficial for both you and your baby to have the peace of mind knowing that your physician is watching closely for any abnormalities, there are are certain instances in which an EFM may pose harmful risks, specifically when this type of monitoring is used continuously as opposed to intermittently.

Low-Risk Pregnancies: Is Continuous Fetal Monitoring Necessary?

Electronic fetal monitoring entails using an ultrasound before and during birth to record an infant’s heartbeat and to monitor maternal contractions. Although the procedure has been shown to be beneficial to mothers who are enduring a high-risk pregnancy, there has been debates as to whether it benefits those with low-risk pregnancies.  One of the main concerns is the utilization of continuous EFM as opposed to intermittent monitoring. For women with low-risk pregnancies, frequent monitoring is seen as unnecessary since there is relatively little risk to the infant except for the stress that the monitoring places on both mom and baby, including:

  • Increased chance of a cesarean surgery (C-section)
  • Increased chance of a vacuum extraction or forceps delivery
  • Labor may slow down
  • Maternal mobility may be reduced
  • Incorrect readings
  • Increased chance that the mother will need additional pain medication

Continuous Electronic Fetal Monitoring Statistics

According to the Cochrane database of systematic reviews and the WHO Reproductive Health Library (RHL), a total of 12 studies involving over 30,000 women were conducted in order to find the risks associated with continuous EFM.  Three of the studies involved low-risk pregnancies while an additional five studies involved high-risk pregnancies. The final four groups involved a combination of both high and low-risk pregnancies. Although the studies showed no difference in risks for those were given intermittent electronic fetal monitoring, those who underwent continuous EFM were at least 1.7 times more likely to undergo a C-section when compared with those in the intermittent EFM studies. There was also a slight increase in the risks of undergoing a vacuum and/or forceps delivery, which has been linked to several types of birth injuries when used improperly.

As a result of the studies, the U.S. Preventive Services Task Force issued a recommendation in 2009, stating that low-risk women should not be candidates for continuous EFM.  Currently, there is not enough research to determine if the risks of EMF outweigh the benefits of monitoring high-risk pregnancies. 

Make an Informed Choice

Be certain to weigh out of all the risks associated with continuous EFM before making a decision. Although your healthcare provider may urge women to undergo this type of monitoring, if you have any questions or concerns, don’t hesitate to express your thoughts.  In addition, there are other forms of fetal monitoring available, including the doppler method, a fetoscope, internal monitoring, and telemetry monitoring.