The Risks of Electronic Fetal Monitoring
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 is beneficial to have the peace of mind in knowing that your physician is watching closely for any abnormalities, there are are certain instances in which an EFM may pose harmful risks. More specifically, there are risks to continuous monitoring as opposed to intermittent monitoring.
Is Continuous Fetal Monitoring Necessary?
EFM entails using an ultrasound before and during birth to record an infant’s heartbeat and to monitor maternal contractions. Although the procedure is beneficial to mothers with a high-risk pregnancy, there is debate 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 may seem unnecessary. There is relatively little risk to the infant except for the stress that the monitoring places on both mom and baby. EFM can cause stress that may lead to:
- 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
The Cochrane database of systematic reviews and the WHO Reproductive Health Library (RHL) reports a total of 12 studies involving over 30,000 women. The purpose of the studies was 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.
The studies showed no difference in risk for women using intermittent EFM. However, those who underwent continuous EFM were at least 1.7 times more likely to undergo a C-section compared to those in the intermittent EFM studies. There was also a slight increase in the risk of requiring use of a vacuum or forceps during delivery. Vacuum extraction and use of forceps have 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 EFM outweigh the benefits of monitoring high-risk pregnancies.
Make an Informed Choice about Electronic Fetal Monitoring
As an expectant parent, it is important to weigh all of the risks associated with continuous EFM before making a decision. Although your healthcare provider may urge you to undergo this type of monitoring, don’t hesitate to express your thoughts. If you have questions or concerns, speak up.
There are other forms of fetal monitoring available, including the Doppler method, a fetoscope, internal monitoring, and telemetry monitoring. The choice of fetal monitoring should be made only after a careful assessment of your health, your baby’s health and what is best for both of you.