Your doctor or midwife monitors the fetal heart rate of your baby to assess their well-being and how well they are tolerating labor. They primarily use electronic fetal monitoring (EFM), which is the most common obstetric procedure during labor. Your care provider uses EFM to recognize signs of low oxygen and respond quickly if your baby needs an intervention. While electronic fetal monitoring can identify emergencies, research shows that continuous monitoring does not necessarily improve outcomes and is linked to higher rates of cesarean and assisted births.

Most low-risk pregnancies can safely use intermittent monitoring. Hospital policies, provider training, and individual risk factors all influence the type of monitoring your provider recommends. By learning about your options and discussing them ahead of time, you and your care provider can create a plan that keeps your baby safe while supporting the birth experience you want.

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What is Electronic Fetal Monitoring?

From your care provider’s standpoint, monitoring your baby’s heart rate is the best way to track your baby’s well-being during labor and alert your doctor or midwife if there is a problem. Electronic fetal monitoring (EFM) is a method to continuously record your baby’s heartbeat and your contractions during labor. It uses sensors placed on your abdomen (or sometimes a small electrode placed on your baby’s scalp) to measure and record both the fetal heart rate and the timing and strength of contractions. The information appears as a graph on a screen or a paper printout that shows how your baby’s heart rate responds to contractions over time. This helps your care provider assess how your baby is tolerating labor and alerts them to any signs of distress.

According to ACOG, electronic fetal monitoring is the most common obstetric procedure in the United States. Nearly 90% of pregnant patients undergo EFM during labor. This procedure has a significant effect on decision-making, and 27.3% of primary cesarean deliveries are due to a nonreassuring fetal status as detected by EFM.

The problem with the practice of continuous electronic fetal monitoring is that there are still questions about whether this practice is evidence-based, even though it has become the standard of care in the United States.

Normal Heart Rate

Your baby’s normal heart rate baseline is typically between 110 and 160 beats per minute. Tachycardia heart rate higher than 160 beats per minute. Bradycardia is a rate lower than 110 beats per minute.

Your baby’s heart rate naturally fluctuates, and this normal variation is called variability or beat-to-beat variation. A healthy range of variability is usually 5 to 25 beats per minute. It’s also normal for your baby’s heart rate to speed up temporarily, known as an acceleration. These accelerations can happen when your baby moves, when your doctor or midwife presses on your belly to check their position, or if your provider touches your baby’s head during a vaginal exam. These short-term changes in heart rate are completely normal and a sign that your baby is doing well.

How Your Baby’s Heart Rate Changes During Labor

Labor and birth are the most physically demanding events of your baby’s life. Each time you have a contraction, blood flow to the placenta temporarily decreases, which briefly reduces your baby’s oxygen supply. While this might sound concerning, it is completely normal and part of how the body is designed to function during labor. The oxygen reduction is short, and your baby’s oxygen levels return to normal as soon as the contraction ends. When the oxygen supply to the placenta dips during a contraction, your baby’s heart rate naturally slows down. Once the contraction passes, their heart rate returns to its usual range. This pattern is normal, and your baby is well equipped to handle it.

Identifying Concerns and Understanding Fetal Distress

A doctor or midwife identifies fetal distress by looking for significant changes in a baby’s heart rate. Remember, your care provider monitors heart rate as a measure of your baby’s well-being. Before birth, babies rely on the umbilical cord and placenta to deliver oxygen. If a baby is not receiving enough oxygen in the womb, their heart rate may decrease. The goal of electronic fetal monitoring is to identify babies who are low on oxygen and determine the underlying cause to correct it.

The Risks of Low Oxygen

Metabolic acidemia occurs when a baby is deprived of adequate oxygen for over 60 minutes. This can increase the risk of complications after birth, including cerebral palsy. This condition is caused by abnormal brain development or damage to the developing brain that affects a child’s ability to control their muscles. About 85–90% of cases of cerebral palsy are congenital, meaning they occur before or during birth. Of all congenital cases, only about <a href="https://journals.lww.com/co-pediatrics/Abstract/1999/12000/Causes_of_cerebral_palsy.2.aspx" rel="noreferrer n