Why Continuous Fetal Monitoring Is Often Overused

When you walk into a hospital to give birth, one of the most common things you’ll see is a monitor being placed on your belly.

This is called electronic fetal monitoring (EFM), and for many families, it becomes a routine part of labor without much discussion.

But what most people don’t realize is that continuous fetal monitoring is not always necessary, and in many cases, it’s used far more often than evidence supports.

Understanding what it is, why it’s used, and what your options are can help you make more informed decisions during your birth.

What Is Continuous Fetal Monitoring?

Electronic fetal monitoring uses two sensors placed on your abdomen with belts.

One tracks your baby’s heart rate.
The other tracks your contractions.

This creates a continuous tracing that providers use to look for patterns, including how your baby’s heart rate responds during contractions.

The goal is to identify any signs that your baby may not be tolerating labor well.

What Is the Alternative?

The main alternative is intermittent auscultation (IA).

This means your provider or nurse listens to your baby’s heart rate at regular intervals using a handheld Doppler or fetoscope, instead of continuously monitoring.

Typically, this looks like:

• Listening for about one minute at a time

• Checking every 15 to 30 minutes in active labor

• Checking more frequently during pushing

With this approach, providers are still monitoring your baby’s well-being, just without keeping you continuously attached to a machine.

What the Evidence Shows

Continuous fetal monitoring became widely used in the 1970s, largely before strong evidence supported its routine use.

Since then, research has consistently found:

• Higher rates of Cesarean birth with continuous monitoring

• No improvement in major newborn outcomes, including:

  • Cerebral palsy

  • NICU admissions

  • Newborn death

  • Long-term brain outcomes

Intermittent auscultation, on the other hand, has been shown to:

• Lower the risk of Cesarean

• Maintain similar outcomes for babies in low-risk pregnancies

There is a slightly lower rate of very rare newborn seizures with continuous monitoring, but these events are uncommon, and it’s unclear how often they lead to long-term concerns.

Why Is Continuous Monitoring Still So Common?

If the evidence doesn’t strongly support routine continuous monitoring, why is it used so often?

There are a few reasons.

1. Habit and hospital routine
Continuous monitoring has become standard practice in many hospitals, even for low-risk births.

2. Liability concerns
Having a continuous tracing can feel like a form of documentation and protection for providers.

3. Interpretation of “safety”
Even though outcomes are similar, continuous data can create a sense of control or reassurance in clinical settings.

The Downsides of Continuous Monitoring

While it can be helpful in certain situations, continuous monitoring also comes with trade-offs.

• Limited movement
  Being connected to monitors can make it harder to walk, change positions, or use movement to help labor progress.

• Increased interventions
  False alarms on the monitor are common, which can lead to additional interventions, including Cesarean birth.

• Added stress
  Hearing changes in the monitor or seeing providers react to the tracing can increase anxiety, even when baby is actually okay.

• Barriers to comfort measures
  Using tools like the shower or tub may require special wireless monitors, which are not always available.

When Continuous Monitoring May Be Recommended

There are situations where continuous monitoring is appropriate and often recommended.

This can include:

• High-risk pregnancies

• Certain medical conditions

• Induction or augmentation with medications

• Epidural use (in many hospitals)

If you choose to use medications during labor, continuous monitoring is typically required. This is largely for safety and liability reasons, so providers can closely observe how your baby is responding to those medications and intervene if needed.

What Are Your Options?

If you are low risk, you may have more flexibility than you think.

You can:

• Ask if intermittent auscultation is an option

• Request breaks from continuous monitoring when appropriate

• Ask about wireless monitors to allow more movement

• Discuss your preferences with your provider ahead of time

This is not about refusing monitoring. It’s about choosing the type of monitoring that best supports your birth experience while still keeping you and your baby safe.

Using the BRAINS Framework

When decisions around monitoring come up, this is a perfect moment to use the BRAINS tool.

• What are the benefits of continuous monitoring in your situation?

• What are the risks?

• Are there alternatives, like intermittent monitoring?

• What does your intuition say?

• What happens if you do nothing or wait?

• Can you ask for space to think or discuss?

Slowing the conversation down can help you make a decision that feels aligned and informed.

How Doulas Support You in These Decisions

As doulas, we don’t make decisions for you. We help you understand your options.

We support you by:

• Helping you ask the right questions

• Explaining what’s happening in real time

• Supporting movement and positioning, even with monitoring

• Helping you and your partner feel confident speaking up

Our goal is to help you feel informed, supported, and in control of your experience.

The Bottom Line

Continuous fetal monitoring has a place in certain situations. But for many low-risk families, it is used more routinely than necessary.

Knowing your options allows you to balance safety with comfort, movement, and the kind of birth experience you want.