How electronic fetal monitoring (EFM) impacts your birth

When you hire a care provider to support you during your birth, they will want to monitor you and your baby during labor to ensure everyone is tolerating the process well. Most care providers use some sort of electronic fetal monitoring (EFM) to monitor your baby’s heart rate during labor.

There are two types of monitoring that tend to be used to monitor a baby’s heart rate during labor: continuous monitoring and intermittent monitoring. During continuous monitoring, your baby’s heart rate is monitored constantly, usually by wearing the monitors throughout labor. During intermittent monitoring, the care provider monitors your baby’s heart rate for a few seconds or minutes at a time at various points throughout labor. The baby’s heart rate is not monitored constantly during intermittent monitoring the way it is during continuous monitoring.

It may seem like continuous monitoring may be the safer of the two choices, but research shows that both ways are equally safe. Continuous monitoring increases the risk of the baby being born via Cesarean birth without actually improving birth outcomes.

There are different monitoring tools available, depending on birth location. Each of these tools can impact the way someone can labor.


Nearly all out-of-hospital midwives and a small handful of hospital-based care providers serving in the Houston area use a  handheld doppler to monitor a baby throughout labor. This can be done comfortably in just about any position and usually does not disrupt someone’s labor rhythm very much, if at all. Most midwives are accustomed to being in crazy positions and can usually listen to heart tones without the client even knowing. Heart tones using a doppler can be taken in or out of the water.*

* Knowing whether or not an electronic fetal monitor is waterproof is important when deciding on what type of birth you would like to have.

Standard EFM

When most people think of electronic fetal monitoring, they usually picture the electrodes and belts often used in hospitals. These types of monitors have the benefit of being able to be worn throughout labor and work very well if someone is planning on not moving very much during labor.

For those clients who plan to move throughout labor, these monitors might pose a few problems that need to be taken into consideration.

These monitors may need to be readjusted… a lot. Each time you change positions, the nurse may need to come in to readjust your monitor. This could be as frequently as after every contraction. Some positions work better than others with these monitors, so you will need to experiment with which positions are more monitor-friendly. Any position that you can sustain without moving very much will usually work well with these monitors. That is, until you change positions again.

If you decide that this is the best type of monitoring for your birth, try to keep up with your rhythm and let the nurse worry about the monitors. If you can keep doing your thing without being too distracted by readjustments, you will be all set.

If your chosen birth location uses this type of monitoring, it is helpful to find out whether or not their monitors are wireless. Some Houston hospitals have wireless monitors that enable you to walk everywhere without being tethered to the bed. If your hospital does not provide wireless monitoring, you will be limited to positions that are on or around the hospital bed.

You will also want to find out if these monitors are waterproof. If you are hoping to labor in the tub or shower, you will want to choose a hospital that has waterproof monitoring. In my experience, if a hospital provides waterproof monitors, they are more likely to support someone laboring in the tub or shower. The hospitals that do not offer waterproof monitoring tend to be less likely to support the use of the tub or shower in labor because, in those cases, someone would need to remove the monitors while they labored in the tub or shower. Those hospitals tend to be skittish about removing monitors and practicing intermittent monitoring as well.

In other words, if waterproof monitors are unavailable, it is highly unlikely that you will be able to use the tub or shower during labor at that particular birth location.


One of the newest monitors I have seen in a few Houston hospitals is the Monica Novii Wireless Patch System. These monitors seem to be a step on the right direction, but they do have some drawbacks. These monitors are wireless and waterproof, so if they are working as they should, you ought to be able to use them in the tub or shower. However, more often than not, these monitors have not worked as they should during the births I have attended with them. The bluetooth technology they operate on often makes them finicky, but when they work properly, they are a dream. When they don’t work properly, they are pretty much useless. I’ve seen some clients choose an epidural when they were prevented from being able to use the shower (nature’s epidural) after the Novii just refused to work properly.

As you can see, something as simple as how you monitor your baby during labor has a tremendous impact on how you are able to labor. It can determine which positions you can use and what comfort measures are available to you to use during labor. It can determine your general freedom of movement throughout the birth process. In order to have the type of birth you want, it is a good idea to choose a birth location that has the type of monitoring available that supports your ideal birth. Not all monitoring is created equally!

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