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Continuous Electronic Fetal MonitoringWhat is electronic fetal monitoring (EFM)? How can continuous EFM affect my pelvic floor? What are other ways to monitor the baby's heart rate in labor? When is continuous EFM generally recommended? What is electronic fetal monitoring (EFM)?The electronic monitor tracks and displays a baby's heart rate in parallel with the rise and fall of uterine contractions. Monitoring of the baby's heart rate can be external (picking up the heart rate through an ultrasound device held against the mother's belly with a belt or a mesh band) or internal (picking up the heart rate through a spiral electrode needle that is inserted through the vagina and cervix and catches under the baby's scalp). Contractions can also be monitored externally (using a pressure sensor held against the belly by a belt or a mesh band) or internally (with a thin tube inserted into the uterus).How can continuous EFM affect my pelvic floor?With continuous EFM, a woman is connected to a monitor throughout labor. This can indirectly harm the pelvic floor as it increases the likelihood of using vacuum extraction or forceps (assisted vaginal birth). This in turn, and especially when routinely carried out with midline episiotomy, increases chances of a serious tear into or through the anal muscle. Anal muscle tears can lead to leaking gas — and more rarely, feces — or a sense of urgency about elimination (bowel incontinence) and increase likelihood of pain during sexual intercourse.What are other ways to monitor the baby's heart rate in labor?The baby's heart rate can be monitored at regular intervals (intermittently) by using either the EFM machine, a hand-held device (Doppler), or a special stethoscope. This type of monitoring allows you much more freedom of movement to walk, use the toilet, use a shower or tub, seek positions of greatest comfort, etc. (The theory behind continuous EFM was that it would enable doctors to intervene sooner if a baby shows signs of trouble, but many studies have shown that babies are not born in better condition with continuous EFM in comparison with babies who are monitored intermittently.)When is continuous EFM generally recommended?Continuous EFM is standard practice with some interventions that increase the likelihood that a baby will have certain problems:
In addition to increasing risk for assisted vaginal birth, continuous EFM also increases risk for cesarean section. You may wish to speak with your doctor or midwife and nursing staff where you will be giving birth, in advance and again during labor, about monitoring the baby intermittently whenever possible. Most recent page update: 2/21/2006
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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality and value of maternity care through consumer engagement and health system transformation. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families. |
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Listening to MothersSM III: New Mothers Speak Out (June 2013) reports on new national surveys about issues women face in the postpartum period and their views about maternity care.
Access the full report and supplementary materials  Listening to MothersSM III (May 2013) is the third national survey exploring women's experiences in pregnancy and childbirth. Commissioned by Childbirth Connection, conducted by Harris Interactive, and funded by the W.K. Kellogg Foundation, the survey polled 2,400 women who gave birth in U.S. hospitals from 2011 to 2012. Results show that medically intensive experiences are typical, and evidence-based practices are underutilized. Childbearing women need better support and knowledge to navigate their maternity care. Access the full report and supplementary materials New Report: Maternity Care and Liability Go to report and supporting materials New Report: The Cost of Having a Baby in the United States Go to report and supporting materials New Cesarean Resources: Go to Best Evidence Report Go to web pages and booklet for women 
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