The Truth About Baby Monitors in Labor: How EFM Impacts C-Sections and Your Birth Plan
At Our BirthRoom®, Stephen and I often remind expectant parents:
“It takes a long time for medicine to catch up to the science.”
That truth feels extra real after reading the recent New York Times article called “The ‘Worst Test in Medicine’ Is Driving America’s High C-Section Rate.”
What the Article Is About
The article talks about a tool called electronic fetal monitoring (EFM).
This is when a machine tracks a baby’s heartbeat and contractions during labor.
It was created with good intentions — to help keep babies safe.
But after decades of use, research shows it hasn’t actually made birth safer.
Instead, it’s one of the biggest reasons why so many women in the U.S. end up having unnecessary C-sections.
For us as childbirth educators, that’s both sad and hopeful.
Sad, because EFM can get in the way of the very things that help labor go smoothly — like moving freely, changing positions, using the shower, or having a calm and supportive birth space.
Hopeful, because people are finally starting to question it. When medicine starts listening to science, good change can happen.
What the Research Says
After decades of studying EFM, here’s what scientists have found:
It doesn’t make birth safer. Continuous EFM does not significantly reduce cerebral palsy, perinatal death, or poor Apgar scores compared to intermittent auscultation (periodic listening).
It leads to more surgery. Moms who have continuous monitoring have a 63% higher rate of cesarean delivery and higher rates of vacuum or forceps use.
It gives lots of false alarms. Most “distress” readings don’t mean the baby is really in trouble — up to 99% are false and do not indicate true oxygen deprivation or injury.
Hospitals keep doing it anyway. Many stick with it out of habit or fear of lawsuits.
What started as a safety tool often becomes a reason for unnecessary interventions. Despite the evidence, many hospitals still rely on continuous monitoring as a default — partly due to liability fears and long-standing habits in obstetric culture.
Why It Matters for You
When EFM is used on everyone — not just when it’s needed — it can change the whole birth experience:
You can’t move around as easily. The belts keep you near the bed, so it’s harder to walk, use gravity, or get in the shower.
Attention shifts away from you. Nurses and doctors focus on the monitor instead of your needs.
Cascade of interventions: Every “non-reassuring” tracing can trigger a series of escalating interventions — amniotomy, fluids, oxygen, position changes, or ultimately a C-section.
As one laboring mother described in a study:
“The monitor took the focus off of me and put it on the machine. Every time I rolled over, a nurse would rush in to readjust it, worried my baby could be in distress.”
Our View at Our BirthRoom®
At Our BirthRoom®, we believe technology should support birth — not control it.
If monitoring is truly needed, we’re thankful it exists. But for many healthy moms and babies, less is more. We honor the role of medical monitoring when medically indicated, but we also know that low-risk labors benefit most from movement, trust, and time.
That’s why we help couples learn the pros and cons of every tool.
We teach them to ask questions like:
“Do I really need continuous monitoring?”
“Can you check my baby’s heartbeat with a handheld device instead?”
“Can I stay up, walk, or shower while being monitored?”
Asking simple questions like these helps you stay in charge of your birth.
Birth works best when families and providers work together — not just follow protocol.
Why Change Takes Time
Stephen often says:
“Medicine moves in decades, not discoveries.”
Even when research is clear, change can be slow.
Hospitals worry about safety, rules, and lawsuits.
But as public awareness grows — through major media coverage and advocacy from families and birth professionals — we start to see change. Hospitals begin revisiting policies. Providers retrain in intermittent auscultation. Families come prepared with the knowledge and confidence to ask for options.
That’s how progress happens — one family, one conversation, one birth at a time.
How to Prepare and Protect Your Birth
Here are a few ways to plan ahead and protect your birth experience:
Ask early about monitoring. At your prenatal visits or hospital tour, ask:
“Do you monitor every patient continuously, or only when it’s needed?”
Knowing ahead of time helps you plan calmly.Know if you’re low-risk. If you’re healthy, full-term, carrying one baby in a head-down position, and have no complications, you may not need continuous monitoring. Occasional listening is often enough — and lets you move more freely.
Think about where you give birth. If you’re low-risk, consider an out-of-hospital birth, like a birth center or home birth with a qualified midwife. These settings usually use intermittent listening as the norm. You’ll have more freedom to move, personal attention, and a lower chance of unnecessary intervention.
Put it in your birth plan. You can write something simple like:
“We prefer intermittent listening and freedom to move unless continuous monitoring becomes necessary.”Stay active. If continuous monitoring is needed, ask if they have a wireless or waterproof option so you can still move, stand, or use the tub.
Team up with your partner. Help them learn how to ask good questions and speak up for you so you can stay focused on labor.
If you want simple scripts, practice questions, and step-by-step tools to make this easier, you can check out Birth Advocate Blueprint™.
It teaches you and your partner how to communicate clearly, stay calm, and speak up with confidence — even if the hospital feels busy or overwhelming.
Looking Ahead
Each time a major news story questions outdated medical habits, it helps push birth care in the right direction — toward being safer, calmer, and more respectful of the natural process.
We’re not against medicine. We’re for science.
And science tells us that most healthy labors go best with movement, peace, and emotional support — not with wires and alarms.
EFM was born from good intentions, but it’s time to match our practices with what the research now tells us. As educators, clinicians, and parents, we hope this national conversation helps move maternity care forward — one birth at a time.
Because as we often remind our students:
“It takes a long time for medicine to catch up to the science.”
But together, we can help it get there faster.
Cheers to safer births!
References
New York Times. (2025). The ‘Worst Test in Medicine’ Is Driving America’s High C-Section Rate. Retrieved from nytimes.com.
Alfirevic, Z., et al. (2017). Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews, Issue 2.
American Academy of Family Physicians. (2020). Intrapartum Fetal Monitoring. American Family Physician, 102(3):158-166.
Miller, S., et al. (2016). Beyond too little, too late and too much, too soon: A pathway to respectful maternity care worldwide. The Lancet, 388(10056):2176-2192.
Macones, G. A., et al. (2008). The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring. Obstetrics & Gynecology, 112(3):661-666.
Evidence Based Birth®. (2023). Fetal Monitoring: Evidence on Continuous Electronic Fetal Monitoring vs. Intermittent Auscultation. Retrieved from evidencebasedbirth.com/fetal-monitoring.
Tveit, H., et al. (2024). Using scientific evidence to guide medical practice: A qualitative study of barriers in obstetrics. Qualitative Health Research, 34(6):1049-1062.
Centers for Disease Control and Prevention. (2024). Cesarean Delivery Rate in the United States: National Vital Statistics Reports.
