May 5, 2012 by Rebecca Dekker, PhD, RN, APRN
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**For an updated article on continuous electronoic fetal monitoring, please view this article instead, “Evidence-Based Fetal Monitoring”

Okay, so say you check into the hospital planning to have a natural birth (no epidural, no pitocin). In this case, you don’t need continuous monitoring– intermittent monitoring is  the preferred evidence-based practice (using a handheld doppler or fetoscope). But per hospital policy, you are still required to lay in bed for 20 minutes with the belts strapped around your waist to get a baseline fetal monitoring session.

Now that may not sound like a big deal to those of you who have never given birth yourselves. But for us moms who have been through labor, we know that it is not easy to lay in bed on your back for 20 minutes when you are in active labor. Those monitoring belts are tight and they hurt. If you are already trying to focus and get through each contraction, this monitoring only makes it harder. But it’s all worth it, right? As long as it’s necessary for the health of my baby! Right??

As I was doing my research for this blog, I started thinking– you know, this 20 minute monitoring thing– it’s really annoying. But… also, is it really necessary? What is the evidence behind this routine intervention?

Question: Is it necessary to do an initial 20-minute fetal monitoring period upon admission?

Answer: No. In low-risk women, intermittent auscultation with a handheld Doppler or fetoscope is safe and results in fewer C-sections than admission fetal monitoring.

Evidence: A brand new Cochrane review just came out this year (2012) to answer the very same question that I posed. The researchers examined results from 4 randomized, controlled trials with more than 13,000 women. After pooling all the results together, the researchers concluded that there are absolutely no benefits to doing a 20-minute fetal monitoring period on admission. In fact, women who were randomized to a 20-minute fetal monitoring period on admission were 20% more likely to have a C-section than women randomized to intermittent auscultation with a handheld Doppler or fetoscope. There were no differences between groups in the number of babies who died during or shortly after labor. The researchers concluded that patients should be informed that a fetal monitoring period upon admission has no benefits and is likely to increase the risk of C-section.

Did you have fetal monitoring when you or a family member went into the hospital to have a baby? Was it continuous? Intermittent? If you were able to negotiate for intermittent monitoring, did they make you do a 20-minute monitoring period when you first got there, just to “make sure everything was okay with baby”? Were you informed about the risks and benefits of this procedure?

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