Electronic fetal monitoring (EFM

Electronic fetal
monitoring (EFM) is a method for examining the condition of a
baby in the uterus by noting any unusual changes in its heart
rate. Electronic fetal monitoring is performed late in pregnancy
or continuously during labor to ensure normal delivery of a
healthy baby. EFM can be utilized either externally or
internally in the womb.

Purpose

The heart rate of a fetus undergoes constant adjustment

as it responds to its environment and other stimuli. The fetal
monitor records an unborn baby's heart rate and graphs it on a
piece of paper. Electronic fetal monitoring is usually advised
for high-risk pregnancies, when the baby is in danger of
distress. Specific reasons for EFM include: babies in a breech
position, premature labor, and induced labor, among others.

REFERENCE:http://naturalchildbirthedu.com/2010/01/11/electro
nic-fetal-monitor-efm/

When electronic fetal monitoring was originally

introduced in the 1960s and 1970s, the hope was that it would
help physicians diagnose fetal hypoxia, or lack of oxygen, in
time to prevent damage to the baby. This lack of oxygen, also
known as perinatal asphyxia or birth asphyxia, is an important
cause of stillbirth and newborn deaths. It occurs when there
are less than normal amounts of oxygen delivered to the body
or an organ and there is build-up of carbon dioxide in the body
or tissue. A lack of blood flow to an organ can cause asphyxia.
Perinatal asphyxia can occur a long time before birth, shortly
before birth, during delivery, or after birth. If the interruption
to the supply of oxygen is short, the baby may recover without
any damage. If the time is longer, there may be some injury
that is reversible. If the time period without oxygen is very
long, there may be permanent injury to one or more organs of
the body. It is important to detect any signs of asphyxia as
soon as possible. One of the signs is an abnormal heart rate
and rhythm in the unborn baby, which can be detected by
electronic fetal monitoring.
The fetal monitor is a more intricate version of the
machine that a health care provider uses to listen to a baby's
heartbeat. The monitor that is used during prenatal visits just
picks up the sound of the baby's heart beating. The fetal
monitor also keeps a continuous paper record of the heart
rate. In addition, the fetal monitor can record uterine
contractions on the lower part of the paper strip. This helps
the doctor or midwife determine how a baby is handling the
stress of contractions. The normal pattern is for the baby's
heartbeat to drop slightly during a contraction and then go
back to normal after the contraction is over. EFM looks for any
changes from this normal pattern, particularly if there is a
drastic drop in the baby's heart beat or if the heart rate does
not recover immediately after a contraction.
Because it is an indirect test, it is not perfect. When an adult
complains to a provider about not feeling well, checking the
heart rate is only one of many things that the doctor will do.
With an unborn baby, however, checking the heart rate is
basically the only thing that a doctor or midwife can do.
Fetal monitoring can be helpful in a variety of different
situations. During pregnancy, fetal monitoring can be used as
a part of antepartum testing. If the practitioner feels that a
baby may be at increased risk of problems toward the end of
pregnancy, a baby can be checked every week or every other
week with a non-stress test. In this test, changes in the baby's
heart rate are measured along with the fetus' own movements.
The heart rate of a healthy baby should go up whenever she or
he moves.
Fetal monitoring is used on and off during early labor. As labor
progresses, more monitoring is often needed. Usually, as the
time for delivery nears, the monitor is left on continuously
since the end of labor tends to be the most stressful time for
the baby.
A baby who is having trouble in labor will show characteristic
changes in heart rate after a contraction

Electronic fetal monitoring (EFM) is performed late in

pregnancy or continuously during labor to ensure normal
delivery of a healthy baby. EFM can be utilized either
externally or internally in the womb. The illustration above
shows the internal procedure, in which an electrode is
attached directly to the baby's scalp to monitor the heart rate.
Uterine contractions are recorded using an intrauterine
pressure catheter which is inserted through the cervix into the
uterus.
(Illustration by the Electronic Illustrators Group.)
(late decelerations). If a baby is not receiving enough oxygen
to withstand the stress of labor and delivery is many hours
away, a cesarean section (C-section) may be necessary.

Description

Using the external fetal monitor is simple and painless. Two

elastic belts are placed around the mother's abdomen. One
belt holds a listening device in place while the other belt holds
the contraction monitor. The nurse or midwife adjusts the belts
to get the best readings from each device.
Sometimes, it is difficult to hear the baby's heartbeat with the
external monitoring device. Other times, the monitor may
show subtle signs of a developing problem. In either case, the
doctor or midwife may recommend that the external belt be
replaced with an internal monitor.
The internal monitor is an electronic wire that rests directly on
the baby's head. The provider can place it on the baby's head
during an internal exam. The internal monitor can only be used
when the cervix is already open. This device provides a more
accurate record of the baby's heart rate.

Preparation

There are no special preparations needed for fetal monitoring.