Options in Fetal Monitoring | Erie PA Doulas | Meadville Doulas | Northwest PA Doulas

What exactly is Fetal Monitoring?

So, you’re thinking about your options regarding your upcoming birth so you’ll know what to expect. Knowledge is power. Fetal monitoring is one of the details you might want to consider.

What is electronic fetal monitoring (EFM)?

This is usually done externally. Sensors are secured to your abdomen using elastic belts. These sensors are used to continuously record two things during labor: the heartbeat of the baby (using a Doppler ultrasound machine) and the contractions of the birthing parent’s uterus (using a pressure sensor). The sensors are linked to a machine that shows the baby’s heart rate and also the contractions.

fetal monitoring

You are able to get out of bed, but since you must stay close to the monitor, it’s difficult to walk around freely. You can sit on a birth ball, a chair, or stand near the monitor. In America, EFM is the standard of care during labor, especially with a high-risk pregnancy or when the laboring person chooses an epidural. The benefit is that it can be reassuring if everything is going well and it can display a problem right away if one suddenly occurs.

Internal monitoring is rarely needed except in special situations. A thin wire extending from the sensor is inserted into the vagina, into your uterus, and attached to the baby’s scalp.

Remember, if there are changes in the baby's heartbeat during labor, it doesn't always mean there is a serious problem. Monitoring may be linked to an increase in cesarean births and the use of other interventions. Your care provider will interpret the results of any fetal monitoring you have, and suggest interventions as he or she sees necessary.

That being said, there are THREE ALTERNATIVES
to the standard Electronic Fetal Monitoring (EFM) method:


1.     Intermittent EFM. The birthing parent wears the same sensors as in continuous EFM but only for 20-30 minutes of every hour. This method is not popular (according to one 2007 study, it’s used in 4% of births). Depending on hospital policy, your risk factors, and how your labor is progressing, you can request intermittent monitoring. While you are not being monitored, you are free to move around. You may choose to include this in your birth plan but keep in mind that if a problem arises, you will need to be continuously monitored.

2.     Intermittent auscultation. Intermittent auscultation (what a mouthful!) is a method of periodically listening to the baby’s heartbeat. According to the same 2007 study, this method is used even less often in the United States, during merely 3% of births. Your care provider will use a fetal stethoscope or hand-held Doppler to listen to baby’s heart rate for approximately 60 seconds. Simultaneously, the care provider palpates the contractions using his or her hand on the laboring person’s abdomen. This is done every 15-30 minutes while the cervix is dilated 5-10 centimeters and every 5-15 minutes during the pushing phase.

In 2009, ACOG stated that this method is an “appropriate and safe alternative” to EFM. Just like in intermittent EFM, you are free to move around in between monitoring. Since there is a lack of evidence proving that continuous monitoring is necessary, some families request this type instead.

3.     Wireless Telemetry. This type of EFM uses wireless monitors to keep an eye on your baby. Sensors are attached to your belly on a belt and you are given a fabric band to keep them in place. Though this is not available at all birth locations, your doula will inform you of which local hospitals offer this type of monitoring.

4.     No monitoring. In certain birthing locations, this is an option if you are considered “low-risk.”

So why is fetal monitoring important? The goal is to be able to identify complications so that interventions can be made in order to prevent serious conditions including (but not limited to) newborn seizures and brain damage. Talk to your care provider to find out what type of fetal monitoring he or she typically uses. Whatever type of monitoring you have during your labor, your doula will tailor her support to assist you in the best way possible.