Looking at the Evidence: The Benefits of Hands-On Fetal Monitoring

When planning a birth, it is important that the information you receive is evidence based. Reading the evidence can help you make unbiased decisions about your upcoming birth. So many women are pressured into procedures or other assertive birth techniques that either do nothing to help the baby or can actively cause harm. That's why I believe in evidence.

There are two kinds of fetal monitoring that are commonly used today: Electronic Fetal Monitoring (EFM) and Hands-On Listening. Both are meant to serve the same purpose, to monitor the baby’s heartbeat during the birthing process. In electronic monitoring, an ultrasound machine is used, while in hands-on listening, the care provider uses a fetal stethoscope or handheld ultrasound machine called a Doppler. Both EFM and hands-on listening show no substantial differences when it comes to Apgar scores, low-oxygen brain damage in infants, the necessity of admission to neonatal ICUs, stillborn, and newborn deaths. In the vast majority of in-hospital births (90%), electronic monitoring is the standard, but is this really the best method? Are their drawbacks to using electronic monitoring over hands-on listening? The evidence shows that, absolutely, yes, there are!

Studies, like this one from Evidence Based Birth®, have shown that those who use continuous EFM are much more likely to have a Cesarean, or use forceps and vacuum during labor. The use of most EFMs require the mother to be restricted to a bed, making them very uncomfortable, confined, and distracted from what should be their focus, actually giving birth. Worse, the nature of these devices mean that nurses may actually pay more attention to the monitor and less to the mother who really needs the support. There are a few positive aspects of EFM, including the automatic recording of the baby and mother’s heartbeats, which can be useful if there is a lawsuit. Additionally, EFM are associated with lower rates of newborn seizures by 0.15%. These seizures, however, tend to be very rare (only 0.2% of births).

When planning a birth, it is important that the information you receive is evidence based. Reading the unbiased evidence can help you make educated decisions about your up and coming birth.  So many women are pressured into procedures or other assertive birth techniques that either do nothing to help the baby or can actively cause harm. That’s why I believe in evidence. 

Unfortunately, hands-on listening is somewhat rare among birth caregivers (only 11% of births), and aren’t often used in hospitals due to staffing and equipment restrictions. However, the evidence clearly shows the advantages. Hopefully in the future, knowledge of hands-on listening will better understood by medical professionals, improving the quality of care that birthing mothers need. ​