Electronic Fetal Monitoring in Labor: Pros and Cons (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.”
And nowhere is that more clear than with electronic fetal monitoring.
Recently, a New York Times article brought national attention to something many birth professionals have been discussing for years:
One of the most common tools used in labor may not be improving outcomes the way we once hoped.
If you’re planning a hospital birth, this is something worth understanding—because it can shape your entire experience.
What Is Electronic Fetal Monitoring?
Electronic fetal monitoring (EFM) is a tool used during labor to track:
your baby’s heart rate
your contractions
It’s typically done using belts placed around your abdomen and connected to a machine.
It was created with good intentions and to detect when a baby might be in distress.
And in certain situations, it can be incredibly helpful.
But here’s where things get more nuanced.
The Pros and Cons of Electronic Fetal Monitoring
Let’s look at both sides—because this isn’t about fear.
It’s about informed decisions.
When Continuous Monitoring Is Typically Recommended
Here’s an important distinction:
Saying continuous fetal monitoring is commonly recommended is not the same as saying it has been proven to prevent poor outcomes.
Continuous EFM is often recommended when there are factors that may increase concern about how baby is tolerating labor.
That can include situations such as:
oxytocin being used to induce or strengthen labor
preeclampsia or gestational hypertension
suspected fetal growth restriction
concerning changes heard during intermittent monitoring
certain other pregnancy or labor complications
In these situations, providers may want continuous information about your baby's heart rate so they can identify changes and respond quickly.
But here's where I think parents deserve more nuance:
More monitoring doesn't automatically mean better outcomes.
Even though continuous EFM has become standard in many higher-risk situations, the evidence that made us question its routine use—especially its inability to reduce outcomes like cerebral palsy or perinatal death—is important to understand.
So the question isn't simply:
“Is monitoring good or bad?”
A better question is:
“What information are we hoping to gain from this monitoring—and how will that information change our care?”
That’s informed decision-making.
What Does the Research Say About Continuous Electronic Fetal Monitoring?
This is where things get interesting.
Continuous electronic fetal monitoring was introduced with an important goal:
identify babies who may not be tolerating labor well enough to prevent serious injury or death.
That sounds incredibly reassuring.
But decades of research haven't shown the improvements many parents might assume.
Compared with intermittent listening, continuous EFM has not been shown to significantly reduce cerebral palsy or perinatal death.
It has been associated with:
more cesarean births
more forceps or vacuum-assisted births
fewer neonatal seizures
One major evidence review found continuous monitoring was associated with about a 63% relative increase in cesarean delivery compared with intermittent auscultation.
That's a meaningful trade-off.
And it's why I don't want parents walking into labor thinking:
More monitoring automatically means a safer birth.
The evidence is more complicated than that.
Does Continuous Fetal Monitoring Actually Make Birth Safer?
This is the question most parents really want answered.
And the answer isn't as simple as yes or no.
Continuous EFM gives providers more continuous information about your baby's heart rate.
But more information doesn't necessarily mean better outcomes.
For low-risk labor, intermittent auscultation is an evidence-supported alternative that allows baby's heart rate to be checked at regular intervals without being continuously connected to the monitor.
Research has found similar major neonatal outcomes while reducing cesarean and operative vaginal birth rates compared with continuous monitoring.
That's why knowing your options before labor matters.
Why Electronic Fetal Monitoring Can Change Your Birth Experience
This is the part most parents aren’t told.
When continuous monitoring is used routinely, it can:
Continuous Monitoring Can Make Movement Harder
Depending on the equipment your hospital uses, continuous monitoring may make it harder to:
walk
change positions freely
use the shower or tub
follow your body's instincts during contractions
And that's worth considering.
Movement and position changes are important tools for comfort during labor. If you want to understand why, read: How to Work With Contractions (Instead of Fighting Them).
If continuous monitoring is recommended, ask:
“Do you have wireless or waterproof monitoring so I can keep moving?”
Shift Focus Away From You
Instead of watching you—
Providers often watch the monitor.
And that can subtly change how decisions are made.
Monitoring Can Lead to More Intervention
Electronic fetal heart rate patterns aren't always easy to interpret.
A tracing that raises concern may lead the team to try things like:
changing your position
reducing or stopping oxytocin
giving IV fluids when appropriate
closer evaluation
assisted delivery or cesarean birth if concerns persist
Sometimes intervention is exactly what is needed.
But continuous monitoring also has a high false-positive rate, meaning an abnormal-looking tracing does not always mean a baby is experiencing dangerous oxygen deprivation.
That's part of the challenge.
The monitor gives information.
The information still has to be interpreted.
Fetal Assessment Doesn’t Automatically Mean Continuous Monitoring
Here’s something I wish more first-time parents understood:
Monitoring your baby’s well-being and continuously electronically monitoring your baby are not the same thing.
The alternative to continuous EFM isn’t simply not checking the baby.
With intermittent auscultation, a trained provider periodically listens to your baby’s heart rate using a handheld Doppler or fetoscope.
This approach is common in midwifery care and allows your baby to be assessed without you being continuously connected to a machine.
And this is personal for me.
I had one birth-center birth and three home births.
I wasn’t continuously attached to an electronic fetal monitor during any of them.
But that didn’t mean my babies weren’t being assessed.
My midwives periodically listened to their heart rates while I was still able to:
move freely
change positions
get into the water
rest where I felt comfortable
follow what my body was telling me to do
That experience shaped the way I think about fetal monitoring today.
Because somewhere along the way, many of us absorbed this idea:
More monitoring = more safety.
But the research doesn’t make that equation so simple.
For healthy, low-risk labor, continuous EFM has not been shown to reduce cerebral palsy or perinatal death compared with intermittent listening, while it is associated with higher rates of cesarean and assisted vaginal birth.
So I think we need to ask a different question.
Not:
“Should my baby be monitored?”
But:
“What level of monitoring makes sense for my pregnancy and labor?”
That’s a very different conversation.
Our Approach: Start Conservatively and Reassess
At Our BirthRoom®, we believe interventions should have a reason.
For a healthy, low-risk labor, that may mean beginning with the least intervention necessary and allowing physiology to do its job.
If circumstances change?
Reassess.
If something about your baby’s heart rate becomes concerning?
Have the conversation.
If your clinical situation changes and additional monitoring is recommended?
Ask why, understand what information it may provide, and make the decision from there.
Choosing a low-intervention approach doesn’t mean ignoring safety.
It means not automatically escalating care before there’s a reason to.
We’re not against medicine.
We’re for using it thoughtfully.
And as both medical professionals and childbirth educators, that distinction matters deeply to us.
Know Your Options Before Labor
If you’re planning a hospital birth and hoping for a low-intervention experience, don’t wait until contractions are three minutes apart to find out what your options are.
Ask during pregnancy:
“For a healthy, low-risk labor, is intermittent auscultation an option here?”
“Is continuous EFM routine hospital policy, or is it based on individual risk?”
“What would cause you to recommend moving from intermittent listening to continuous monitoring?”
You don’t have to walk into that conversation ready for a fight.
You’re simply gathering information.
Because you don’t need a medical degree to advocate for yourself.
You need to understand your options before you're being asked to make decisions.
Prepare Your Partner for This Conversation, Too
You shouldn’t have to carry all of this information by yourself.
Talk through your preferences with your partner before labor so they understand why they matter to you.
If you’ve chosen intermittent listening for a healthy, low-risk labor, your partner can help communicate that preference when you arrive.
And if something changes?
They can help slow the conversation down long enough to ask:
“What has changed?”
“What are you concerned about?”
“What are our options?”
Your partner isn’t there to argue with your care team.
They’re there to help you stay informed, supported, and involved—especially when you’re busy doing the work of labor.
The Part Most Parents Aren’t Prepared For
Knowing what something is isn’t the same as knowing how to navigate it in real time.
Because in the moment, you may feel:
overwhelmed
rushed
unsure what to say
Want to Advocate for Yourself With Confidence?
This is exactly why we created something a little different.
Because birth prep isn’t just about labor.
It’s about communication.
It’s aboutdecision-making.
It’s about knowing how to speak up calmly.
Birth Advocate Blueprint™
Inside, you’ll learn:
✨ What to say in real conversations with your provider
✨ How to ask questions without feeling pushy
✨ How to stay calm under pressure
✨ Simple scripts that actually work
So instead of feeling like things are happening to you—
you feel confident navigating them.
Electronic fetal monitoring started with good intentions.
And in the right situations, it still has an important role.
But for many healthy pregnancies—routine use may create more intervention than benefit.
The goal isn’t to reject medical tools.
It’s to use them wisely.
Continue Preparing for Your Birth
If this helped you understand your options more clearly, here’s where to go next:
• Thinking About Induction? Read This First
• How to Work With Contractions (Instead of Fighting Them)
• Train Your Partner to Be a Daddy Doula
