EFM vs. Intermittent Listening: A Sometimes Senseless Debate

What type of monitoring should be used during labor and birth? Many will defend one type of monitoring over another. Here are the options:

  • Continuous External Fetal Monitoring (EFM)– The belts around the belly you so often see. One belt picks up the baby’s heart rate, one belt picks up contractions.
  • Intermittent EFM– The above method can be performed intermittently by simply disconnecting the belts periodically, assuming the baby is doing well.
  • Continuous Internal Monitoring– In this method, a tiny electrode is screwed in the baby’s scalp to read his heart rate. This method is much more accurate, but also somewhat more invasive since the amniotic sac has to be broken.
  • Intermittent Listening– Your care provider listens at intervals via a Doppler or fetoscope. Yes, mom has stop periodically to have someone listen to her baby, but its probably more comfortable than having belts tightened around the belly.

Today, I would like to look at only two of these options- continuous EFM vs. intermittent listening of any sort. (I will not address internal monitoring because it is generally considered to be more accurate, and is likely remain continuous throughout the duration of its use.) Some say that continuous EFM is more likely to catch a possible problem with the baby earlier than intermittent monitoring, and some say that EFM really only catches more reasons to perform a cesarean and avoid a potential lawsuit. Some insist that intermittent listening is just as safe as continuous EFM, some insist that a mother who desires intermittent listening is putting her baby at serious risk. I will not jump on the debate bandwagon today. Why? Because…

The method of monitoring chosen during labor and birth is only accurate to the extent that it is used correctly.

I cannot vouch for every single birth out there, but I will say that in my experience, it is extremely common for the baby to slip off the monitors. I cannot tell you how many times a nurse would come in, adjust the monitors, find the baby, walk out, and not five minutes later the baby would be off again (sometimes even from a mother simply shifting her weight, or from an active baby visiting the other side of the womb). Sometimes it would be thirty minutes to an hour until we would see the nurse return to adjust the monitors again. Suddenly, continuous EFM is no longer so continuous. Furthermore, in a busy hospital, nurses simply do not have the time to keep coming to adjust the belts or to listen themselves for a few minutes with a handheld Doppler. This is not a value judgement on nurses or hospitals- it’s simply the nature of the birth setting.

On the other hand, intermittent listening by an attentive care provider in any setting, if used correctly, may provide just as accurate information or even more accurate than the neglected EFM belts. Of course, it is extremely important that the care provider doing the listening is skilled at discerning differences in heart rates and knows well the trouble signs to look for. Plus, they have to listen frequently enough to detect signs of distress before they become an emergency. If these conditions are not met, then intermittent listening can of course fail.

My point is not to avoid choosing a specific type of monitoring over another, as certain types of births do call for more consistent monitoring than others. My point is that the issue simply cannot be debated when the methods of listening are so often used incorrectly. Once care providers make sure that continuous EFM really is continuous, and that the intermittent methods being used are done correctly and at appropriate frequency, then you can go ahead and debate all you want about the issues. 🙂

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2 responses to this post.

  1. This is an aspect of the debate that I had never before considered- and an excellent point! I’ll definitely keep it in mind for the future!


  2. […] more likely that a) the machines will not function properly and will  miss something (e.g. loose EFM, shifted blood pressure cuff, etc.), or b) the machines will “catch” something […]


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