• Why has routine continuous fetal monitoring persisted when decades of evidence show it doesn’t work?   Several motivations drive continued use of continuous fetal monitoring, none of which relate to improving maternal and child health.

Wolf, J. (2021). "They Said Her Heart Was in Distress". The Electronic Fetal Heart Monitor and the Experience of Birth in the U.S.A., 1960s to the Present.  Accessed https://www.jstor.org/stable/27120654

• After Joseph DeLee’s call in 1920 for obstetricians to perform routine medical interventions during birth, obstetricians in the United States began to adopt a series of standards, hoping to create the ideal conditions for “normal” labours. This predisposed obstetricians to embrace the electronic fetal monitor in 1969, years before researchers tested the machine for efficacy. 

2020

Arnold, J. and Gawrys, B. (2020).  Intrapartum Fetal Monitoring.  Accessed https://www.aafp.org/pubs/afp/issues/2020/0801/p158.html

• Continuous electronic fetal monitoring was developed to screen for signs of hypoxic-ischemic encephalopathy, cerebral palsy, and impending fetal death during labor. Because these events have a low prevalence, continuous electronic fetal monitoring has a false-positive rate of 99%. The widespread use of continuous electronic fetal monitoring has increased operative and cesarean delivery rates without improved neonatal outcomes, but its use is appropriate in high-risk labor.

Horsager-Boehrer. (2020). Is electronic fetal heart monitoring worthwhile?  Accessed https://utswmed.org/medblog/electronic-fetal-monitoring-high-risk-pregnancy/

• Research also shows that continuous EFM does not improve Apgar scores (a quick health assessment after birth) or rates of neonatal intensive care unit (NICU) admissions. However, studies have shown that use of continuous EFM can lead to higher rates of C-sections and operative vaginal deliveries.

2019

Cline, M. (2019, December 11). The risks of electronic fetal monitoring. Birth Injury Guide. Retrieved December 11, 2022, from https://www.birthinjuryguide.org/2014/05/risks-electronic-fetal-monitoring/#:~:text=EFM%20can%20cause%20stress%20that%20may%20lead%20to%3A,that%20the%20mother%20will%20need%20additional%20pain%20medication

Sartwell, C., Johnston, J. and Zebenegis, M. (2019). Cerebral Palsy, cesarean sections and electronic fetal heart monitoring: All the light we cannot see. Accessed https://journals.sagepub.com/doi/abs/10.1177/1477750919851055

• What went wrong with electronic fetal monitoring? The answer lies in a new analysis of the physiologic theories concerning fetal heart rate decelerations, demonstrating that the earlier electronic fetal monitoring theories were wrong. This revelation is only the latest evidence that electronic fetal monitoring use today is harming mothers and babies with useless C-sections. Yet electronic fetal monitoring use continues unabated. Why? This article explores the complex answers and bioethical concerns, through a review of the new evidence underlying fetal heart rate decelerations in labor.

2016

Paterno, M., McElroy, K. and Regan, M. (2016).  Electronic Fetal Hearth Monitoring; A Scoping Review. Accessed https://pubmed.ncbi.nlm.nih.gov/27565450/#:~:text=Background%3A%20In%20many%20United%20States,birth%20among%20low%2Drisk%20women.

• The largest study demonstrated an 81 percent increased risk of primary cesarean birth when EFM was used in labor, but did not differentiate between high- and low-risk pregnancies. Four randomized controlled trials examined the association of admission EFM with obstetric outcomes; only one considered cesarean birth as a primary outcome and found a 23 percent increase in operative birth when EFM lasted more than 1 hour. 

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Last updated June 2024