Routine, Required, or Risky? Reorienting the Idea of Safety about Fetal Monitoring in Birth

For decades, continuous electronic fetal monitoring (EFM) has been presented to families as a cornerstone of “safe” hospital birth.

Two belts strapped to the belly.
A screen tracking heart rate and contractions.
Reassurance through technology.

But when you look closely at the evidence, a very different story emerges. One that families deserve to know.

The Promise vs. the Reality

Continuous fetal monitoring was introduced in the 1970s with the promise that it would:

• prevent stillbirth

• prevent brain injury

• improve newborn outcomes

At the same time, cesarean rates in the United States began to rise sharply and have remained above public health targets ever since.

Today, cesarean surgery is most often justified in healthy pregnancies by a diagnosis of “fetal distress” — a diagnosis that is almost always based on fetal heart rate monitor readings, according to studies analyzing tens of millions of births.

So the question becomes:

Does continuous monitoring actually deliver the safety it promises?

What the Evidence Actually Shows

The answer, repeatedly, has been no.

• In 1996, the U.S. Preventive Services Task Force reviewed the evidence and gave continuous fetal monitoring its lowest possible grade: D, actively recommending against its routine use in healthy pregnancies.

• A rigorous 2017 systematic review comparing continuous monitoring with intermittent auscultation (listening with a handheld device) found that continuous monitoring:

  • did not reduce stillbirth

  • did not reduce cerebral palsy

  • slightly reduced rare neonatal seizures, without improving long-term neurological outcomes

• What it did increase was the likelihood of cesarean birth — by 63 percent.

This pattern has been confirmed repeatedly over decades.

So Why Is It Still Routine?

This is where the conversation becomes uncomfortable.

Obstetrics is the most frequently sued medical specialty. In court, fetal monitor strips often become central pieces of evidence, with expert witnesses on both sides offering competing interpretations.

Continuous monitoring persists not because it improves outcomes, but because it creates a paper trail that can be used for legal defense.

As one obstetrician quoted in a New York Times investigation put it, the specialty has continued performing major abdominal surgery “without a shred of evidence of benefit.”

This is not about individual providers acting in bad faith.
It is about a system shaped by liability, fear, and institutional protection.

The Canadian Context Matters

Here’s the part Canadian families especially need to hear:

Canada does not recommend routine continuous fetal monitoring for healthy pregnancies.

Neither does the United Kingdom.

Canadian obstetric guidelines align with the evidence, supporting intermittent auscultation as the standard of care for low-risk labour.

And yet, because U.S. medical culture exerts enormous influence, many Canadian families are still told that continuous monitoring is “required,” “policy,” or “non-negotiable.”

That simply isn’t true.

What This Means for Families

If you are healthy and low-risk, you have options.

You are allowed to ask:

• why continuous monitoring is being recommended

• whether intermittent monitoring is appropriate

• how mobility, position changes, and upright labour can be supported

• what alternatives exist that protect physiology while still ensuring safety

This isn’t about rejecting medicine.
It’s about informed consent.

Families cannot consent to what they are never told.

Every workplace develops a culture of practice. Sometimes that culture is evidence-based. Sometimes it persists simply because it has gone unquestioned. When practices are never examined, they continue unchecked.

It is your right to gather as much information as possible for your birth.

Why This Matters for Birth Experience and Outcomes

Continuous monitoring often results in:

• restricted movement

• labouring in bed

• increased pain

• more interventions

• a higher likelihood of cesarean surgery

Intermittent monitoring allows for:

• mobility

• body-led positioning

• improved pain coping

• support for physiological labour

• lower intervention rates

These differences are not minor. They directly affect whether a birther feels a sense of agency, safety, engagement, and trust in their body.

A 2019 study published in the National Library of Medicine,
Quality of Childbirth Care in Women Undergoing Labour: Satisfaction with Care Received and How It Changes over Time, concludes:

“We must focus on involving women in their own care. If women feel safe, supported and sufficiently informed, they will have the chance to play an active role in their childbirth process by making decisions.”

And yet, despite this evidence, routine practice tells a different story.

According to the Canadian Maternity Experiences Survey (2021), among women who had or attempted a vaginal birth:

• 90.8% reported electronic fetal monitoring at some point during labour

• 62.9% reported continuous use of EFM
  (Public Health Agency of Canada)

A New York Times investigation, widely shared under the headline
“The ‘Worst Test in Medicine’ Is Driving America’s High C-Section Rate”, further documents how continuous fetal monitoring remains routine despite evidence showing it does not reliably improve outcomes and is closely linked to increased surgical birth.

A Call for Transparency

Families deserve care rooted in evidence.
Safety should be defined by outcomes, not routines.
And trust must be built through honesty.

Sharing this information is not about creating anxiety.
It is about restoring choice.

When families are fully informed, they make grounded, confident decisions — in hospitals, at home, and everywhere in between.

That is what respectful maternity care looks like.

How Families Can Reorient to Safety Together

Reorienting away from the idea that safety lives only in monitors or machines is not a mental exercise. It’s a relational and somatic one. Because birth happens in community, this reorientation works best when the whole support system participates.

Here are gentle ways families can begin:

1. Name the difference between monitoring and safety
Monitoring is a tool for gathering information. Safety is an experience in the body. Saying this out loud helps everyone remember that data does not equal danger, and quiet does not equal risk.

2. Practice safety cues before labour begins
During pregnancy, take time to notice what helps the body settle. This might include touch, breath, movement, eye contact, voice, or familiar routines. When labour begins, these cues help the nervous system recognize safety without needing external reassurance.

3. Stay connected to the body, not just the screen
If monitoring is used, invite support people to stay oriented to the birther. Hands on the back. Steady voice. Eye contact. Simple reminders like, “Your body knows what it’s doing,” help keep attention grounded in lived sensation rather than numbers.

4. Support movement whenever possible
Movement is one of the body’s primary ways of regulating stress and pain. Walking, swaying, changing positions, or using upright postures helps restore trust in bodily cues and supports physiological labour.

5. Share responsibility for asking questions
Partners and support people can help hold the cognitive load by asking what monitoring is showing, what alternatives exist, and whether changes are urgent or precautionary. This allows the birther to stay embodied rather than pulled into decision-making under stress.

6. Normalize flexibility, not perfection
Reorienting doesn’t mean never using monitoring. It means staying connected to choice. Families can move between tools and body awareness as needed, without framing either as failure or risk.

7. Remember that calm is data too
A regulated nervous system, steady breath, and responsive support are meaningful indicators of wellbeing. They deserve as much attention as any machine.

When families reorient together, safety becomes something felt, not outsourced. This shift supports clearer communication, more grounded decision-making, and a birth experience that honours both evidence and embodiment.

If this information raises questions, brings clarity, or leaves you wanting support as you navigate your own birth decisions, and somatic safety for your birth, you don’t have to do that alone.

I offer somatic, trauma-informed coaching for pregnant and postpartum families, as well as birth workers, to help make sense of complex information, build embodied confidence, and prepare for conversations with care providers.

You’re welcome to book a free consultation as a gentle first step.
This conversation is about clarity and connection, not pressure or persuasion.