When a person goes into the hospital in labour, one of the first things that the staff of the hospital will do is strap two little disks on the persons tummy. This is what we call Electronic Fetal Monitoring, or EFM. These little disks are meant to detect the baby’s heart rate and when the uterus is contracting, and it prints this information on a little graph we call a Strip. As an Edmonton doula, I get to see strips a lot as you can imagine, but technically speaking doulas in Edmonton are not officially trained to read and interpret strips. That being said, some of you may know that I am the daughter of a retired labour and delivery nurse, and my wonderful mother who knew how much of a birth nerd I am gifted me with something really special: her old nursing textbooks! One of the books she passed along is called Fundamentals of Fetal Health Surveillance (produced by the Canadian Perinatal Programs Coalition and on it’s 4th edition published in 2009), and I’ve got to say as an Edmonton doula who loves ALL things birth, this is probably the most interesting one! EFM is such a huge part of birth in our current culture and as I sift through it, I’m realizing that all doulas in Edmonton should have an opportunity to learn more about this standard procedure.
Before reading this text I really never thought there could be any cons to monitoring the baby in labour. I mean, more information is always good right? Well, to be honest this statement isn’t entirely true, especially when you’re looking at a labouring person. The issue lies in the fact that not all of this information is completely error-proof, and even if it were we can’t always know why the strip is showing what is shows (more importantly if the issue requires intervention or not). First off, as wonderful as this technology is those damn disks are tricky to get placed right! And if you’re like most birthing people you want to be able to move around and cope with contractions however feels right – and you can’t fully do that with the disks on. So if say the person birthing is laying on their back in bed and strapped to the monitor and decides to roll onto their side, the disk measuring the heart can slide out of place and all of the sudden the baby has no pulse! (Except they do, it just wasn’t being detected). Now it’s common for this to happen often when being continuously monitored, so imagine how someone who needs to move around’s strip is going to look? Scary!
Second, when a birthing person is monitored, the idea is that the heart rate of the baby is constantly being watched and any deceleration or acceleration will be noted and recorded. So if there tends to be a lot of decels or accels or both, the care provider can take steps to remedy what is causing these fluctuations. The problem is… how do we know what that is? Most skilled nurses and doctors and midwives (and probably some Edmonton doulas) can take a really good educated guess as to what’s causing them, but at the end of the day it will only ever be a guess. I can’t tell you how many clients I’ve supported as a doula in Edmonton, that we’re told one thing because of their baby’s strip, and then when it comes time to deliver we find out it’s something completely different. At the end of the day we all need to remember that EFM is a source for information, not a solution or remedy to anything adverse that is happening.
Im sure many of you are saying “well, there’s no risk in knowing more information”… except there actually is. According to my moms wonderful textbook, for every 58 births 1 additional cesarean will replace a vaginal birth because of EFM. The reason why (in my opinion) is that the strip may have told the care providing team that issues were going on with the baby that needed intervention, and we know that medical interventions tend to take on a domino effect (once one thing is added, then things keep being added until the result is a cesarean birth). Another issue is that with continuous EFM, those darn disks make it pretty hard to move, and anyone who has given birth can attest that staying still during labour is IMPOSSIBLE unless you’ve got an epidural on board. So a scenario that as an Edmonton doula I’ve seen time and time again is: birth person goes into the hospital, the strip doesn’t look perfect so continuous monitoring is recommended, person can’t move and cope with labour pains how they need to, person gets an epidural. And here my friends, is where Edmonton’s 90-95% epidural rate comes from!
Now I definitely don’t want to disregard EFM as a useless medical intervention either – as a doula in Edmonton I’ve seen the information gathered from EFM be used to save mom’s and baby’s lives. I’m definitely a supporter of its use when necessary, but there are ways that it can be used more responsibly. First, many hospitals will offer what we call Intermittent Auscultation, or IA, which is the monitoring of the baby in intervals for shorter periods of time. This provides a sort of “check in” to make sure baby is still tolerating labour. If your strip does look abnormal and it warrants being monitored continuously, take breaks! In this textbook it does state that SOGC (Society of Obstetricians and Gynaecologists if Canada) recommends when a normal heart rate is identified , taking 30 minute breaks (as long as baby’s heart rate is stable) is appropriate. That being said, many hospitals and care providers in them don’t practice this way and want you to stay on the monitor always. If you find yourself trying to compromise in this situation, just remember that the monitor in itself is not a cure for anything – it will only give you information. And if it comes down to either getting off the monitor to use the shower for 30 minutes so you can make it all the way to pushing, or staying in bed on your back and baby can’t make it through the pelvis and now a cesarean is required, I would like to think that most of you would insist on a small break. Breaks can also clear any mental and emotional distress that may have arisen from hearing fluctuations in baby’s heart rate.
Sorry, this post is a long one – but it has totally got me pumped up this Monday morning! We’re you continuously monitored in labour? What was your personal experience with EFM?