First, let’s be clear. We are absolutely not anti-monitoring. Every responsible labor attendant should monitor the baby’s heart rate, but that doesn’t have to mean constant, electronic monitoring. In this post, we briefly touched on types of monitoring available. So if we agree that monitoring is a necessity, why is it a concern?
Being on a monitor may increase your chance of more interventions, such as forceps or vacuum delivery and cesarean section, while not decreasing positive outcomes. This article from Evidence Based Birth lists several studies showing that while laboring women wearing the external fetal monitors had higher rates of these interventions, they didn’t have significantly lower rates of health problems with their babies. Mothers on continuous monitoring request more pain medication. Even ACOG recognizes that other options for monitoring are appropriate and safe.
Intermittent monitoring interrupts what is working. Intermittent monitoring with the external, wearable monitors is probably the most laboring-mother-friendly option in hospitals, though it is not without its downside. While birth center and homebirth midwives use a handheld monitor on a regular schedule (depending on the phase of labor, etc.) intermittent monitoring in a hospital usually requires the mother to have the external monitors put back on for 15-20 minutes every hour. A common scenario for intermittent monitoring goes like this: a mother is laboring in the shower, standing, leaning forward, = and dealing very well with contractions. The nurse comes in to inform her that it has been 45 minutes and she need to get 15 minutes of “a good strip” on the monitor. The mother must now get out of the shower, dry off (or walk around dripping), come into another room, have the monitors placed – almost always while lying on her back, and then try to deal with contractions in a manner that “keeps the baby on the monitor”. The monitors don’t work as well in the upright, leaning forward position, so if the nurse can’t or won’t stay in the room and hold the monitor in place, the mother has to find another position, even though leaning forward feels best. The mother ends up lying in bed on her side (which can slow progress), not able to use the water that was helping her or the position she chooses. By the time the 15 minutes (which turns into 30 with the time getting out of the shower, getting it set up, finding a position, and waiting for the nurse to return) is up, the mother is in so much discomfort that she doesn’t want to go to the effort of getting back out of bed, undressed (if she got redressed) and back to the shower, because even if she does, it’s only going to be for another 45 minutes. Frustrated and now in more pain, the mother requests an epidural. This is just one of several common scenarios we see play out regularly. Women who are doing fine, feeling strong, confident, and capable of dealing with labor end up at the beginning of the intervention avalanche because they have to change what they are doing, or cannot do what they want to, because of the monitors.
Monitoring increases fear, and may decrease personal support. Listening to the monitor can increase anxiety in some laboring mothers (and often in their partners!) when they hear normal decelerations or when the monitor has simply failed to pick up the heart rate. That fear tenses muscles, making contractions more uncomfortable and less productive, and it also makes the entire experience more frightening. Our brains tell us that if we must be monitored, there must be some danger, and it makes it more difficult for us to relax and focus on what needs to be done. Additionally, some birth partners become almost obsessed with watching the monitor, assessing the “size” of the contraction or paying more attention to the monitor than the birthing mom. Nurses who are caring for multiple patients find it easier to check the monitor strip than to assess the mother manually, meaning less hands-on care.
Monitoring is without a doubt the most common procedure in hospital births, but one that often carries little-to-no discussion of options and risks. Many women are simply told they have no choice but to be on the monitors, some hospitals may not have handheld Dopplers or fetoscopes or the trained personnel to use them. Women educating themselves about the concerns and choices and requesting them from their healthcare providers are the only way to improve this part of birth