Electronic fetal monitoring

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An electronic method of determining the baby's heart rate, the strength and length of contractions and the reaction of the baby to those contractions.

When is it necessary?

• When there are signs of fetal distress indicating that the baby may be experiencing difficulties during the labour.
• When an epidural has removed the mother's ability to interpret the strength and timing of her contractions.
• Commonly used when labour is being induced to determine the effects of the induction on the baby.

How is it done?

External monitoring uses two large elastic belts positioned around the abdomen. One holds a transducer (in a plastic disc) which emits an ultrasound beam to record the baby's heartbeat, the other belt records the strength and length of the contractions using a similar transducer. The belts are wired up to a machine that provides a printout of both readings. Internal monitoring provides the same information, but via an electrode attached to the baby's scalp (heart rate) and a fine tube inside the uterine cavity (contractions). Sometimes an external belt instead of an internal tube is used to measure the contractions. Rupture of the membranes is necessary to attach the scalp electrode.

Effects on the mother
Advantages:

	1.	Can be reassuring to have constant feedback about the condition of the baby.
	2.	Allows the mother to visually monitor the labour which she may be unable to feel if she has an epidural.

Disadvantages:

	1.	The mother is often restricted to bed and must remain still for the monitor to record well. This restricts her choices of positions for labour.
	2.	Transient variations in the baby's heartbeat may cause undue alarm and lead to further interventions which may later prove unjustified. Research shows that there is considerable disagreement on the interpretation of EFM printouts, even amongst experts viewing the same graph. This means there is likely to be both false positive and false negative results recorded.
	3.	Because internal monitoring is more accurate, early rupture of the membranes may be per- formed to allow a scalp electrode to be inserted. This procedure itself may cause fetal distress from increased direct pressure of the fetal head on the cervix with longer and stronger contractions.
	4.	The machine may become the focus of attention rather than the mother.
	5.	The effects of the exposure of mother and baby to long periods of ultrasound from the transducers are unknown.
	6.	Research has shown that electronic fetal monitoring is of no benefit in normal labours but significantly increases the chances of a caesarian section or forceps delivery. The baby's heartbeat can be noted just as effectively using a fetal stethoscope, with no side effects.

Effects on the baby
Advantages:

1.

May enable early detection of potential risks to the baby's health and well being during the labour.

Disadvantages:

	1.	Scalp electrode site may become infected.
	2.	Fetal distress may result from the application of the electrode or from the results of rupturing the membranes prematurely.