Worried about your baby's heartbeat? Let's talk about Electronic Fetal Monitoring (EFM)!

If you are about to give birth, or if someone in your family is about to become a mother, this story will be very important to you. Today we are going to talk about a method of monitoring the health of the baby, especially the heartbeat, while the mother is in the womb and during labor. This is what we call `Electronic Fetal Monitoring` or `(EFM)`. Simply put, it continuously monitors the baby's heartbeat.

Why is this `EFM` being done? What is its importance?

Think about it, when a mother is in labor, meaning when the baby is trying to come out, her uterus contracts. These contractions can cause some of the blood vessels that supply oxygen to the baby to become constricted. Usually, this isn't a big problem for the baby , as they get the oxygen they need. However, sometimes the oxygen levels can drop. If that happens, you may notice a change in the baby's heart rate.

So, what this `EFM` does is to continuously monitor the baby's heartbeat, identify any problems early, and take the necessary steps to protect the baby. Rarely, the baby may experience some discomfort (fetal distress) due to lack of oxygen. Then this `EFM` can catch it quickly.

Is this `EFM` really something everyone needs?

Now you might be thinking, 'So it's good for everyone to do this.' But think about it. Some studies have found that regular EFM for low-risk pregnant women has increased the number of unnecessary cesarean sections and deliveries using vacuum devices or forceps.

Also, no significant relationship has been found between EFM and whether newborn babies have better Apgar scores (a score that measures the health of a baby after birth), or whether conditions such as cerebral palsy, developmental delays, neurologic injuries, or whether babies are admitted to neonatal intensive care units (NICUs) are reduced.

Many obstetricians and gynecologists believe that EFM is not necessary for pregnant women who are at low risk of complications . The doctor can periodically check the baby's heartbeat with a stethoscope or ultrasound. This is called intermittent auscultation.

So when is EFM recommended?

Okay, so there are some cases where EFM is specifically recommended. According to the American College of Obstetricians and Gynecologists, if you have been given medication to induce labor or an epidural to reduce pain, you should use EFM.

Also, if a high-risk pregnancy is identified, the `EFM` is used. For example:

• Health conditions of the mother: `(preeclampsia)` (this is a condition of high blood pressure that occurs during pregnancy), `(diabetes)`, if she has had a previous cesarean section, if she has had bleeding during pregnancy.
• If your baby passes meconium stool during labor, this can sometimes indicate fetal distress. This is called meconium, the baby's first stool.
• If the baby is small (small fetal size) or has any congenital abnormalities.

Despite these recommendations, many obstetricians and gynecologists still routinely use EFM. So it's a good idea to talk to your doctor about this.

Have you ever used `EFM` for entertainment?

Yes, sometimes the baby's health is monitored with an EFM before labor even begins. Especially if there has been any trauma to the mother's belly , such as after 20 weeks of pregnancy, the doctor may recommend monitoring the baby with an EFM for 4 to 24 hours.

Also, EFM can help determine whether labor is true or false . Sometimes mothers feel pain, but it is not true labor. Symptoms of false labor include:

• The pain is intermittent, not continuous, and the gaps between the pains are not decreasing.
• The pain stops when you walk, rest, or change position.

What types of `EFM` are there?

There are two main types of `EFM`. Let's see what they are.

1. External EFM

This is the most common method. You may have seen it before. Your doctor uses two elastic bands and attaches two devices to your abdomen.

• One is an ultrasound-like device. It is placed over the area where the baby is thought to be present and measures the baby's heartbeat.
• The other is a pressure gauge. It is placed on the upper abdomen and measures how often and how long uterine contractions are occurring. However, this method cannot accurately measure the intensity of the contractions, that is, how often they occur.

2. Internal EFM

This is a slightly more complicated procedure than the external one, as it involves inserting equipment inside, and it is not done for everyone. However, this is used when it is difficult to accurately measure the heart rate with the external `EFM` when the mother is moving around.

• In this, the heartbeat is measured by inserting a thin wire (electrode) through the vagina and attaching it to the baby's scalp (rarely elsewhere).
• Also, to measure the intensity of uterine contractions, a thin tube, called a catheter, can be inserted into the uterus.

Importantly, internal EFM can only be performed if the water has broken and the cervix is ​​slightly dilated. This method is often used when the data from external EFM is unclear, or when more precise observation is needed.

How does this `EFM` work? What does it look like?

Both of these devices (external or internal) are connected to an external monitor. This is where all of these activities are recorded electronically or on paper (readout). You may have seen it in movies, where two lines are recorded going up and down.

Your doctor will first take your baby's baseline heart rate and check this chart periodically. Some changes in your baby's heart rate during contractions are normal. However, changes that may indicate a problem include:

• Having a heart rate that is higher than normal (tachycardia) or a heart rate that is lower than normal (bradycardia) for a long period of time.
• Showing abnormal patterns of heart rate slowing during contractions.

Some EFM devices may even have alarms set to alert the medical team if there is a dangerous change in the baby's heart rate.

Is it difficult to move around while wearing this?

Yes, there may be some discomfort. When you have an external EFM, you often have to stay in bed or a chair. However, some hospitals have wireless telemetry monitoring facilities for external EFM. Then you can move around a little more freely. With an internal EFM, you definitely have to stay in bed.

What are the risks of `EFM`?

Although `EFM` is a very useful thing, like everything else, it can also have some small risks.

Common `EFM` (especially external) can cause:

• False alarms can cause unnecessary anxiety and lead to unnecessary tests.
• The ability to move around is limited. In fact, moving and changing positions during labor can help reduce pain and make labor easier.
• Mistakenly believing that the baby is in fetal distress, a decision may be made to deliver the baby using a cesarean section, a vacuum device, or forceps, which may not be necessary.

There are additional specific risks in internal `EFM`:

• The electrode (wire) used for internal EFM may cause a small wound or scratch on the baby's scalp .
• The mother may develop a maternal infection (rarely).
• There is a very small chance of transmitting diseases like HIV or genital herpes from mother to baby (for mothers who have these).

Things that can happen with a catheter (to measure contractions) placed in the uterus (these are very rare):

• The umbilical cord can become entangled.
• The uterus may be perforated.
• The placenta can tear.

While it's important to be aware of these risks, it's also important to remember that these things don't happen all the time. Doctors only use them when absolutely necessary.

How long does it take to get the results? What if the baby is in fetal distress?

Your doctor and nursing staff will continue to look at this EFM chart throughout the day and will also tell you how your baby is doing. This is real-time information.

An abnormal EFM reading does not necessarily mean that the baby is in danger. The doctor may tell you to change your position (e.g., turn to your left). Doing so may improve the baby's blood flow and resolve the problem. The mother may also be given extra oxygen or saline.

However, if some of the heart rate patterns continue to be abnormal, meaning that the baby is in real distress, the doctor will decide whether to perform an immediate cesarean section or deliver the baby vaginally using a vacuum device or forceps.

Finally, what to remember

So, you probably understand what EFM is and what it does. In some cases, EFM can help us to be sure that the baby is doing well and to identify any problems that require immediate delivery. However, for many women who are having a healthy, low-risk pregnancy and are not taking medication for labor (unmedicated labor), Electronic Fetal Monitoring is not necessary.

When you're planning to have your baby, talk to your doctor about their general practices regarding EFM. Don't be afraid to ask questions like, "Doctor, will I need EFM? What are the pros and cons of it given my situation?" By discussing your wishes in advance, you can be prepared to make the best decisions for you and your baby.

Remember, every pregnancy and every delivery is different. It's important to talk openly with your doctor about your concerns and what's on your mind. Then you can face this important time with peace of mind.

` Baby's heartbeat, electronic fetal monitoring, EFM, childbirth, pregnancy, labor, baby's health