New York Labor and Delivery Nurse on the Helpful Aspects of Electronic Fetal Monitoring

Posted on: November 18, 2014

Why Electronic Fetal Monitoring is a Woman’s Friend

by Enid Nwosisi

What is Electronic Fetal Monitoring?
As a labor and delivery nurse, I find that the majority of expectant moms need electronic fetal monitoring (EFM) at least once during their pregnancy. In addition, during labor, all women need EFM, either intermittently or continuously.

By providing critical information about the medical status of fetus and mother during pregnancy and labor, EFM plays an essential role in helping to ensure a successful pregnancy and delivery. The test results either reassure the care provider and family that the pregnancy and delivery can continue safely, or indicate the need for intervention.

The test itself consists of two types of monitors placed on the pregnant woman’s abdomen – one to monitor the fetal heart rate, the other to monitor uterine contractions of the mother. Comfortable and painless, both are forms of an “ultrasonic” procedure with which many women are already familiar. A cool gel is used on the fetal monitoring portion in order to hear the baby’s heartbeat, while the mom’s test is done “dry.” However, instead of providing images, EFM offers auditory (sound) feedback, as well as a “tracing,” a printed and an electronic record of data. This way, providers always have the information at hand, and can use it to guide their decisions.

The myth that, during labor, EFM testing requires that you lie immobilized in bed, is just that – a myth. Many women will be happily surprised to learn that during labor, you can undergo EFM while pacing, standing, sitting in a rocking chair, or even using the ball, as long as the monitoring information could be attained accurately on the tracing and the maternal/fetal status remains stable.  At NWH, we use abdominal belts or bellybands to hold the monitors in place, giving you the substantial freedom of movement. That is why I urge women to relax about EFM, and to view it as a friend, not a foe.

What information does EFM provide your care provider?
EFM provides the following vital information about the medical status of both fetus and mother during pregnancy and labor: It shows the baseline fetal heart rate, defined as the most consistent number of beats per minute, as well as the degree of variation from this rate. EFM also indicates if the baby is well-oxygenated – receiving adequate oxygen, and whether there is good central nervous system activity. EFM also shows the presence and pattern (though not the intensity) of labor contractions. Once contractions are seen, EFM shows how often the contractions are occurring, how long the contractions are lasting and how the baby is tolerating the contractions. The relationships of these factors are important to each other and skill is needed for interpretation. Thus, the licensed care providers and registered nurses are well-trained to interpret tracings and provide the necessary interventional care for the optimal outcome for the mother and the baby.

How does EFM help in determining fetal well-being?
During pregnancy, there may be signs that are cause for concern. A common situation is that the mother does not feel the baby moving as much as it should be. At times revealed during the routine visit, a manual (palpation) exam by your obstetrician or certified nurse midwife, discovers that the woman is having contractions, sometimes without the mom-to-be even knowing it. This scenario is more common among women in their first pregnancy, who simply do not know what a contraction feels like, especially if they are used to having intense menstrual cramps, in the past. There have been instances, where women tolerate such “cramps” for hours or even days, not thinking anything of it. These women could be happy and chatting with their husband during the office visit, when in reality, they are going into labor. The concern is that contractions may cause the cervix to dilate, which could start the downward passage of the fetus. If this occurs many weeks early and is allowed to proceed, the baby will be premature, which puts the newborn at risk. In this scenario, EFM is important.

When the palpating care provider detects signs of early labor, EFM can be used to determine if contractions are occurring. If so, care providers could intervene, when necessary. EFM is also essential if a pregnant woman is in an accident or a fall that creates friction or pressure on the abdomen. EFM is then used to determine if the fetus is still well-oxygenated and has an intact central nervous system, has an acceptable heart rate with moderate variability from the baseline and if the placenta is still healthy and able to support the pregnancy. Accelerations which are abrupt increases that return to the acceptable range are healthy signs, as well. However, the absence of accelerations is not an unhealthy sign.

How should you prepare for EFM during pregnancy?
Expectant moms going in for fetal monitoring are best off wearing two-piece comfortable clothing so the abdomen is easily accessible. Mothers need to drink plenty of water beforehand to keep well-hydrated and should not miss a meal (unless directed to do so by their provider), both of which help in obtaining necessary information on the baby’s movements and maternal status.

Why is EFM so important during labor?
At NWH, all women in labor get, at minimum, a 20-minute EFM tracing that produces key data on mom and baby.  With respect to the mother, the test shows whether contractions are occurring, and if they are regular, irregular, or too frequent. In order to be considered in the best condition, the baby must meet certain criteria, including a baseline fetal heart rate within the acceptable range of 110-160 beats per minute, and moderate variability from that baseline. A woman who has chosen to have an epidural will receive continuous EFM, because the epidural blocks the sensations of pain from contractions, thus reducing or eliminating the feedback that providers get from the patient’s perceived level of pain. In addition, the medications involved can cause the mom to have hypotension (low blood pressure). Mothers can usually tolerate hypotension, but the baby may not be able to and continuous EFM provides a means of evaluating the baby after an epidural. If labor is being induced or augmented, monitoring will also be continuous. Mothers who choose medication-free “natural” childbirth, are monitored intermittently.

A true Thanksgiving story …and a family’s heartfelt thanks for EFM.
I have personally witnessed the significance of EFM many times. I would like to share a quick story about one of those instances. It was around 2 a.m. on the morning after Thanksgiving Day. My patient was pregnant with her fourth child, and she had not felt the baby move since Wednesday morning – the day before Thanksgiving. She had been so busy cooking, then cleaning up, that she had been distracted. Now she was alarmed. She called her provider, saying, “I do not feel my baby moving. I drank juice and laid down and I have not felt any kicks to count.” The doctor told her to go to the hospital, immediately. Upon arriving, she told us that she had felt nothing in the car ride over, not even one kick. She was terribly worried. We put her on the EFM monitor. She was at term – 39 weeks; if she had gone into labor, it would have been allowed to proceed. EFM let us immediately hear the fetal heart. The mother was so relieved, with happy tears. We listened for a full 20 minutes to be sure that the baby was well. The monitoring helped us to confirm that everything was fine, and the patient and her husband went home reassured and happy. This is just one of countless cases that I have personally witnessed that demonstrates how EFM is a boon to women. So please, do not be wary of EFM.  See it as a caring friend!

Editor’s Note: Enid Nwosisi, MSN, RNCV, C-OB; C-EFM; C-OBU, AWHONN Instructor Administrator is a nurse in the Labor & Delivery Department at Northern Westchester Hospital.