There are two kinds of monitors: external and internal. The external monitors are attached to a heavy elastic band that is strapped across the mother's abdomen. She must lie quietly so the monitors do not slip. The baby's heart beat is recorded on a machine that documents the moment to moment heart rate on graph paper along with the mother's contractions. The internal monitor does the same things, but it is attached directly into the baby's head by a metal screw. The uterine contractions are monitored by a probe that is inserted into the uterus. Some feel that this is a more accurate reading. During most labors and deliveries, no other method of monitoring the baby's heart rate will be used. However, EFM does not reduce infant deaths, improve outcomes or give information that permits potentially bad situations to be corrected or avoided. The strips are frequently mis-read. One study found that 71-95 % of babies diagnosed by EFM as distressed were not. Additionally, studies have shown that most causes of brain damage are not related to actual distress during the birth process but rather due to distress prior to labor. In spite of near universal use of EFM, little evidence exists that any change has taken place in the numbers of brain damaged babies being born.

Auscultation with a fetascope, stethoscope, pinard horn and other low-tech devices for listening to the baby have been found to be as effective for monitoring most laboring women.

The risks of using EFM are well known: higher intervention rate of all kinds due to misinterpretation of strips leading to a misdiagnosis of fetal distress. The use of EFM may increase the risk of cerebral palsy by increasing the risk of infection. More babies have abnormal fetal heart rate patterns when monitored by EFM than by auscultation, and it may be that this finding is caused by EFM rather than simply being detected by it. Mothers may report not remembering parts of their labors due to anxiety that was created by using the monitors.

One of the greatest risks to the baby who receives an internal monitorying electrode is that of infection at the insertion site. The woman with a history of herpes may be wise to forego internal monitoring our of concern of passing this disease on to her baby via the scalp electrode.

191. Cohen & Estner, Silent Knife, page 168.
2. Korte & Scaer, A Good Birth, A Safe Birth, pages 108-109.
3. Korte & Scaer, pages 119-124.
4. Birth Gazette, "On Epidurals: Pros and Cons", Vol. 9, No. 1, Winter 1992, pages 19, 21.
5. Davis-Floyd, Robbie, Birth as an American Rite of Passage, 1992, pages 113-116.
6. Hillard, Paula Adams, "As they Grow Pregnancy and Birth, Forceps Delivery," Parents magazine, July 1990, pages 94, 97.
7. Gross & Ito, "All about Anesthesia," Parents, Vol. 65, April 1990, pages 213, 218, 221.
8. Cohen & Estner, page 162.
9. Korte & Scaer, page 108.
10. Korte & Scaer, pages 127-128.
11. Korte & Scaer, page 129.
12. Sultan, A.H., "Third degree obstetric and sphincter tears: risk factors and outcome of primary repair," as abstracted in the Journal of the AMA, May 25, 1994, Vol. 217, page 15520.
13. Korte & Scaer, pages 105-106.
14. Goer, Henci, Obstetric Myths versus Research Realities, page 179-202.
15. Cohen & Estner, pages 162-168.
16. Korte & Scaer, pages 106-107.
17. Goer, page 109.
18. Cohen & Estner, pages 158-159.
19. Goer, pages 131-153.
20. Korte & Scaer, pages 1, 38-39, 64, 77, 83, 90, 109-113, 134, 150, 156, 164, 187, 199-200.