Electronic Fetal Monitoring in Labor: What the Research Really Says
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.
Many parents don’t realize that monitoring methods can also influence how freely you can move during labor. Movement and positioning are powerful tools for helping labor progress smoothly, which we talk more about in How to Actually Work With Labor—Not Against It.
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.
When Monitoring Is Actually Necessary
Electronic fetal monitoring was originally designed to detect babies who might not be getting enough oxygen during labor.
In very specific medical situations, closer monitoring can help providers keep a careful eye on how a baby is tolerating labor. These situations might include:
• certain high-risk pregnancies
• induction with medications like Pitocin
• known complications with the baby or placenta
However, decades of research show something important: using continuous monitoring for everyone does not improve outcomes for healthy pregnancies.
Large studies comparing continuous electronic monitoring with intermittent listening (using a handheld Doppler or fetoscope) consistently show:
• no reduction in cerebral palsy
• no reduction in newborn death
• no improvement in long-term outcomes
What does change is the intervention rate.
Continuous monitoring significantly increases the likelihood of:
• cesarean birth (63% higher rate of cesarean delivery)
• vacuum or forceps delivery
• additional interventions during labor
That’s why many midwifery models of care—especially in birth centers and home birth settings—rely on intermittent listening instead of continuous monitoring for low-risk labor.
This approach allows parents to:
• move freely
• use gravity and different positions
• stay focused on the labor process instead of the machine
In other words, technology can be helpful when it’s truly needed—but birth works best when it’s used thoughtfully, not automatically.
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.”If you're creating your birth preferences now, you might find Birth Plan Makeover helpful—it walks you through how to communicate your wishes clearly with hospital staff.
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.
Want to Feel More Confident Navigating Decisions During Birth?
Learning about things like fetal monitoring can feel overwhelming at first.
But when you understand how birth works—and how to communicate clearly with your care team—you stop feeling like things are happening to you and start feeling prepared to navigate them.
That’s exactly why I created a short training called:
10 Steps to a Calm and Confident Birth—Together
Inside this free class, I walk couples through the same framework we teach inside Our BirthRoom Academy so you can:
• understand what’s normal during labor
• learn how partners can support you like a Daddy Doula
• communicate confidently with doctors and nurses
• make decisions without fear or pressure
Because birth isn’t just something you go through.
It’s something you can own—together.
Confidence changes everything.
Continue Preparing for Your Birth
If this post was helpful, you might also enjoy:
• Train Your Partner to Be a Daddy Doula
• How to Actually Work With Labor—Not Against It
• Should You Induce Labor or Wait for Spontaneous Labor?
References
New York Times. (2025). The ‘Worst Test in Medicine’ Is Driving America’s High C-Section Rate. Retrieved fromnytimes.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.
