What is this machine that doctors attach to a baby when they are about to deliver? Let's learn everything about Electronic Fetal Monitoring (EFM)!

If you are expecting a baby, you must have seen it in a movie or on TV, where two straps are placed on the mother's belly in the labor room, and a line goes up and down on a nearby screen with a 'beep... beep...' sound. Many people think that this is to check the mother's heartbeat. But in fact, this is to check two things at the same time. One is the heartbeat of the little baby in the womb. The other is the contractions you are having. This is what we call Electronic Fetal Monitoring in medicine, or EFM for short as everyone knows. So, today we will talk about this very simply, in a way that you can understand.

Simply put, what is EFM?

Imagine, having a baby is a big journey for both the mother and the baby. This EFM is the best way for doctors and nurses to know if the baby is having any difficulties during this journey and if he is doing well.

Simply put, an EFM is a device that continuously monitors your baby's heartbeat and the nature of your contractions in real-time.

Now you might be thinking, "Why are you looking at these two together?" Here's why. When you're in labor, your uterus contracts very hard. At this time, the blood vessels that carry oxygen to your baby also tighten a little. It's like squeezing a water pipe. Most of the time, this isn't a problem for healthy babies, and they can handle this tightening pretty well. But sometimes, the amount of oxygen your baby gets can be a little less. If that happens, it can affect the baby's heart rate.

So what EFM does is continuously monitor how the baby's heartbeat changes when the contractions come and go. This allows the doctor to identify early on if the baby is in any fetal distress.

Does everyone need this EFM?

No. Not every pregnant woman needs continuous EFM monitoring. Someone who has had a healthy pregnancy without any complications may not need this. However, in some special cases, it is essential for the safety of the baby and the mother. Let's see what those cases are.

How does this EFM machine work?

There are two main methods for monitoring EFM. The first method is the most commonly used.

1. External EFM

This is what you see most often in movies. It's a very simple thing that happens.

• The first device: A nurse will apply some gel to your belly, find the best place to hear the baby's heartbeat, and place a small device there and tie it around your belly with an elastic band. This works using ultrasound technology, similar to a scan machine. This is what measures the baby's heartbeat.
• Second device:Another device is placed on your upper abdomen and is attached to another strap. This measures the number of times your uterus contracts and the strength of the contractions. This is called a tocodynamometer .

The information from these two devices is displayed as two graphs on a computer screen. It is also recorded on a long strip of paper. Doctors and nurses can look at this and get a good idea of ​​the baby's condition.

2. Internal EFM

This is not a very common procedure. It can only be done after your 'water bag' has broken . A doctor will resort to this method if an external EFM cannot provide a clear picture, or if they need very accurate information about the baby quickly.

• In this, the doctor inserts a very thin, small wire through the vagina and attaches a small electrode to the baby's scalp. While this may sound a little scary, it won't cause any major harm to the baby. This allows the baby's heartbeat to be measured very accurately.
• Also, if you need to accurately measure the pressure of the uterus, a thin tube (catheter) can be inserted into the uterus.

Are there advantages and disadvantages to EFM?

Like any medical device, EFM has its advantages and disadvantages, and it is important to be aware of these.

• False alarms: Sometimes, a miscalculation in the machine can cause an alarm to sound. For example, if you move around in bed, or if the sensor moves a little when the baby is moving inside the womb, the reading may change and an alarm may sound. Even if there is no real problem, these things can cause unnecessary fear and stress for parents and family members.
• Limited freedom of movement: When you are continuously connected to the EFM, your freedom to get out of bed, walk, and change positions is limited. In fact, walking and changing positions during labor can be helpful for labor.
• Leading to unnecessary medical interventions: Some studies have shown that continuous EFM monitoring, sometimes due to inaccurate recordings, slightly increases the likelihood of a decision to perform a Caesarean section , or to use forceps or a vacuum to deliver the baby, even when it is not really necessary.
• Risks of internal EFM:Although this is very rare, there is a very small risk of a small scratch on the baby's scalp or infection during the internal examination. It can also increase the risk of transmission of diseases, such as HIV, from a mother to her baby.

What do you do if the EFM shows that the baby is in distress?

First of all, a change in the EFM does not necessarily mean that the baby is in serious danger. It is a signal to the medical team that "OK, now we need to pay more attention to this." Don't panic at a time like this. Your doctor and nurse will know what to do.

Usually they try simple things like this:

• Changing your position: You can do things like turning yourself onto your left side and lying down. This can improve blood flow to the uterus and placenta, increasing the amount of oxygen your baby gets.
• You will be given oxygen: You can be given oxygen through a mask on your face. This will increase the oxygen level in your blood, which will also provide more oxygen to your baby.
• Saline (IV fluids) are given: A saline solution is put in your arm to give you fluids. This helps improve blood circulation.
• Changing medications: If you are taking a medication to induce labor (such as Pitocin®) , the dose may be reduced or stopped for a while.

Most of the time, these simple things will help the baby's heart rate return to normal. If that doesn't happen, and the doctor decides that it's too hard for the baby to stay in the womb, they will take steps to deliver the baby as soon as possible. This may be a vaginal delivery or a cesarean section. Remember, the most important thing here is the safety of the mother and baby.

Do you use EFM even before having a baby?

Yes, in some cases. There are times when EFM is used to determine the health of the baby even during pregnancy.

• For example, if you have an accident or fall in your womb after 20 weeks, you can stay connected to the EFM for a while to make sure the baby is not harmed.
• Also, sometimes EFM can help confirm whether you are experiencing true contractions or 'false contractions' (Braxton Hicks contractions) .

When you are nearing the end of your pregnancy, it is a good idea to discuss this EFM with your doctor. This way, you can gain a better understanding of it before delivery and discuss your preferences with your doctor.