Some pregnancies are deemed too high a risk to rely on intermittent monitoring alone and ‘require’ Electronic Foetal Monitoring (EFM) instead. This requires two transducers to be attached to the mother’s stomach – one reads the intensity of her contractions and the other monitors the baby’s heart. These transducers are connected by wires to a monitor (in some hospitals they have waterproof wireless telemetry monitors) which then print out a cardiotocograph to be analysed. Whether a midwife is listening in, or reading the results from the printout, they are looking for any changes that are out of the ordinary. The problem with EFM is it’s not as accurate as you might expect. They have become very popular amongst the medical profession because in the over worked, minimal staff, environment of a lot of modern NHS hospitals, it is a lot easier to have several women hooked up to machines and be able to flit between them reading printouts, than it is to ensure babies are listened to on a regular basis. Also, as hospitals and maternity practices have become more and more risk adverse, it helps to have ‘evidence’ of reasons why procedures were performed in case something were to go wrong. The issue is EFM’s are notoriously inaccurate with a false positive rate exceeding 99% (Sartwelle and Johnston 2014). Bewley and Brailton (2018) in their article for the BMJ state:

“Cochrane, The International Federation of Gynaecology & Obstetrics, and the National Institute of Health and Care Excellence have all said no evidence shows human or computerised interpretation of cardiotocographs reduce the rates of intrapartum stillbirth and cerebral palsy, but it can cause maternal harm.” In other words, invasive procedures being performed on mothers and babies are not always necessary because if there is written ‘evidence’ on a cardiotocograph and the hospital were seen not to have acted on it, they would be liable if something did go wrong. In addition, they ‘require’ the mother to be lying on her back to get an accurate reading which leads to more painful contractions, which can lead to epidural requests, which can slow labour down, which requires syntocinon, which can lead to foetal distress and so on and so on. By the way – you really DON’T have to lie down if you’re being monitored. It is definitely easier for you to be doing so, as far as the caregivers are concerned as the transducers are less likely to come off. However, you’re giving birth so you don’t need to be obliging. If it is easier for you to stand up – stand up! If the monitor comes off, someone else can hold it in place.