positive pregnancy and birthElectronic Fetal Monitoring Is Not Evidence Based. I remember when electronic fetal monitoring was introduced into routine obstetric care for all laboring women.  It was in the 1970s and I was a midwife student on a busy labor and delivery unit.  Electronic fetal monitoring, EFM was the focus of attention and basis of care.  The assumption was that outcomes would be improved by observing the fetal heart beat continuously.  Women complained that it was uncomfortable to wear the monitoring belts and that it restricted their movement.  At the same time epidural anesthesia was being introduced and the epidural made EFM more tolerable.

In 1970 the concept of Bioethics—the linking of scientific advances to human values and Patient Autonomy—replaced the Hippocratic tenet that instructed physicians to make choices for the patient. [1] Patients became active participants in choosing their medical care. Ironically the obstetric specialty did not follow this new philosophy that requires care to be evidence based and that information be provided so patients can make their own choices. Never tested or evaluated prior to its introduction into routine labor care for all women, EFM is implicated in the current epidemic of cesarean section and the increase in maternal mortality that comes with unnecessary cesareans.

Other medical specialties voluntarily adopted the new paradigm of evidence based care and patient autonomy to choose their care but Obstetrics did not. EFM was introduced without any testing for safety or effectiveness and even as 50 years of evidence suggested it is associated with increased maternal and fetal morbidity and mortality its routine use continues. https://mhnpjournal.biomedcentral.com/articles/10.1186/s40748-017-0060-2 There is no data to support the use of  EFM to improve birth outcomes. Midwives understand and respect the physiology of birth. Outcomes are better when normal birth physiology is not altered or interfered with. http://beststartbirthcenter.com/about/our-statistics/ Evidence shows that eating and drinking and having freedom of mobility supports childbirth physiology.  Electronic Fetal Monitoring Is Not Evidence Based. Having family, partner, spouse, friend(s) present as per the wishes of the women are helpful. Human labor is a common life event—a normal physiological process.

By- Roberta Frank, CNM