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Will your doctor monitor your baby's health properly during labor?

Pregnant women put a lot of faith and trust in their doctors to keep them and their babies safe during pregnancy, labor and delivery. If something goes wrong, those doctors may need to be held accountable.

In some cases, doctors may not be monitoring a baby during labor properly. This often occurs because the doctor didn't use electronic fetal monitoring (EFM) strips.

What are electronic fetal monitoring strips?

EFM strips allow doctors to assess a baby's wellbeing during labor. It can be performed either externally using a handheld ultrasound probe or external transducer on the mother's abdomen, or internally via a device that attaches to the baby's scalp.

Continuous EFM is recommended for high-risk patients. Some of the criteria that would be applicable for EFM use include, but are not limited to:

  • Gestational diabetes
  • Hypertension
  • Asthma
  • Multiple babies
  • Past-due pregnancies
  • A previous cesarean section
  • Third-trimester bleeding
  • Preeclampsia

EFM can detect fetal hypoxia and metabolic acidosis early; these conditions are associated with an estimated 700 infant deaths per year.

EFM and cesarean births

Using EFM can make a big difference for patients who have planned or emergency cesarean (c-section) births. In Guildelines for Perinatal Care, the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend: "For women requiring cesarean [birth], fetal surveillance should be continued until abdominal sterile preparation has begun; if internal fetal monitoring is in use, it should be continued until the abdominal sterile preparation is complete."

EFM has direct implications for the baby's condition at birth and allows doctors to plan for several outcomes. In one example where a woman had an emergency c-section due to no cervical change in a prolonged birth, the baby was born limp, blue and with low Apgar scores. The baby was eventually transferred to the neonatal intensive care unit (NICU).

With EFM, the doctors could have made the decision to perform the c-section sooner. The baby may have been born healthy and without complications, sparring the baby from pain and the parents from the emotional rollercoaster of sending their baby to the NICU.

While many doctors don't like to use EFM because of the risk for false-positive results, the ability to track a baby's health during labor, especially if their mother is a high-risk patient, can make a big difference for patients.

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