Why Continuous Fetal Monitoring Isn’t the Safety Net They Claim — And Why Your Freedom to Move Matters More
- Annelisa McCavera
- Nov 14
- 4 min read
One of the most beautiful things about physiological birth is how much your body knows what to do when it’s allowed to move freely. Swaying, lunging, sitting backwards on a chair, leaning into your partner, dropping into hands-and-knees — these aren’t just “comfort measures.” They are biomechanics.
They help baby rotate, help your pelvis open, help contractions work more efficiently, and help you stay grounded in your instinctive rhythm.
But in most hospital settings, the very first thing they try to do is take that freedom away.
They put on the belts, strap you to the bed, and roll a machine next to you — all under the umbrella of “safety” and “monitoring baby.” And many mothers don’t even realize that the risks often used to pressure them into continuous monitoring… aren’t actually supported by evidence.
For decades, hospitals have told women that constant electronic fetal monitoring is necessary to keep babies safe and that without it, a baby could suddenly deteriorate. But the large randomized trials, systematic reviews, and international guidelines all say something very different:
The outcomes with continuous monitoring are not better. The outcomes with intermittent, hands-on listening are actually more accurate and even safer for both mother and baby.
And yes… With intermittent, you can move, squat, rock, dance, get in and out of the shower, and labor in your full, embodied power while baby is still checked regularly.
So why does the fear-based messaging persist? And why are women still told that declining continuous monitoring is “dangerous” when the statistics prove the opposite?
Let’s walk through the actual science behind this — and why your ability to move freely in labor is not only safe, but deeply protective.
What the evidence actually shows:
The big Cochrane-level evidence
Decades of randomized trials have compared continuous electronic fetal monitoring (EFM/CTG) with intermittent auscultation (Doppler or fetoscope) in low-risk births.
Here’s what they found:
A 2020 review in American Family Physician summarized the data clearly: continuous EFM has a false-positive rate of around 99% for predicting cerebral palsy.
This means the monitor frequently suggests a problem when baby is actually fine — triggering cascades of interventions.
Source:
That same review reported that, for healthy low-risk mothers:
• Intermittent auscultation statistically lowers the cesarean rate
• Lowers the rate of instrumental births (vacuum/forceps)
•Does not increase fetal death
•Does not increase cerebral palsy
In other words: the hands-on, human-centered monitoring is safe for babies and much safer for mothers.
The 2017 systematic review
A major systematic review (“Intermittent Auscultation versus Continuous Fetal Monitoring”) found:
• Continuous monitoring increased C-sections
• Increased instrumental deliveries
• Did not reduce perinatal death
• Did not reduce cerebral palsy
Sources:
The 2024 scoping review
A recent 2024 review found that routine continuous EFM in low-risk pregnancies was associated with an 81% higher chance of primary cesarean section — without improving newborn outcomes.
Source:
Neonatal seizures — the one nuance
Some studies show continuous EFM reduces short-term neonatal seizures, but:
• Seizures are extremely rare
• The reduction does not translate to lower cerebral palsy rates
• It offers no long-term neurodevelopmental benefit.
So this “benefit” is statistically real, but clinically limited — and still must be weighed against dramatically higher maternal intervention rates.
Fetal scalp electrodes (“the scalp screw”)
Hospitals may escalate to a fetal scalp electrode when EFM doesn’t trace well — often blamed on mom’s movement or baby position.
But the evidence here is important:
A U.S. cohort of 171,698 births found fetal scalp electrode use increased:
• Scalp injury
• Cephalohematoma
ALL without improving major neonatal outcomes.
Link:
This reinforces the same theme: the escalation pathway of continuous monitoring tends to increase interventions without improving safety.
Why does the U.S. still do continuous EFM on almost everyone?
Not because it’s better.
But because:
• It allows fewer nurses per patient
• It fits hospital liability culture
• It’s easier to watch from a computer than at the bedside
• It standardizes documentation for lawsuits
• It’s built into hospital workflow, not built on evidence
Even the AAFP acknowledges that structured intermittent auscultation isn’t standard here because it requires more staff presence — not because it’s less safe.
Source:
What major guidelines actually recommend
NICE (UK)
NICE guidelines tell clinicians to inform low-risk women that:
• Continuous monitoring increases interventions
• These risks “may outweigh the benefits” for low-risk pregnancies
• Intermittent auscultation should be the default
Additionally- according to: FIGO, AWHONN, ACNM, AAFP
They all agree intermittent auscultation is appropriate and safe for low-risk births.
It’s literally global consensus.
Why this matters for your birth?
When movement is restricted:
• Labor becomes longer
• Pain perception increases
• Baby has a harder time rotating
• Epidural rates rise
• Interventions snowball
• Risk of tearing increases
• Cesarean risk increases
When movement is protected, and monitoring is hands-on rather than machine-led, mothers stay in their power and babies are still safely and consistently monitored.
Want intermittent monitoring but not sure how? Here’s how to talk to your provider:
Here’s a script you can use:
“Because I’m low-risk, I’d prefer intermittent auscultation instead of routine continuous monitoring, unless a genuine concern arises. Can we agree on how often baby will be checked and under what circumstances continuous monitoring would be needed, and that my consent is attained after assessing all risks vs benefits?”
Ask:
• What criteria move me from low-risk to continuous monitoring?
• Will I still be able to move freely?
• What would trigger escalation to a fetal scalp electrode?
• How can we protect my mobility unless there’s a true emergency?
The heart of it all — the Meraki Mothers way
At Meraki Mothers, we believe deeply in informed, embodied, autonomous birth.
Your body was designed to move.
Your baby relies on your ability to move.
And the science overwhelmingly shows that routine continuous monitoring — the thing that restricts your movement the most — does not protect babies the way parents have been led to believe.
Movement protects you.
Presence protects you.
Hands-on care protects you.
Not machines.
Let this knowledge empower your birth, your choices, your sovereignty — and the way you show up as a mother from the very first moment.
Sincerely, a Meraki Mother.
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