continuous fetal monitoring: routine, but not recommended
Fetal monitoring record
Let’s connect the dots—why is continuous fetal monitoring (CFM) commonplace in hospital birth if it’s not actually recommended for low-risk pregnancies? ACOG’s guidelines recommend intermittent monitoring for low-risk births, yet continuous fetal monitoring remains the standard in many hospitals. So, how did we get here?
a brief history: how did continuous fetal monitoring become the norm?
CFM became widely adopted in the 1970s and 80s, originally intended for high-risk pregnancies. The idea was that constant monitoring would allow providers to quickly detect fetal distress and improve outcomes. But over time, hospitals began using it for all births—not just high-risk ones—despite growing evidence that it doesn’t improve outcomes for low-risk births.
Instead, continuous fetal monitoring led to higher rates of interventions like cesareans and instrumental deliveries, often due to false alarms from normal fluctuations in the baby’s heart rate. Yet, the practice stuck—largely due to hospital policies, liability concerns, and the standardization of obstetric care.
how continuous monitoring works
Continuous monitoring usually involves two monitors held in place by bands around your belly:
Fetal heart rate monitor (tracks baby’s heartbeat).
Tocodynamometer (“toco”) (measures contractions).
Even if you opt for intermittent fetal monitoring, the toco monitor can still be left on continuously.
Fetal heart rate monitor and toco.
why is continuous fetal monitoring still the norm?
Even though research shows no better outcomes with continuous compared to intermittent fetal monitoring, it remains routine in many hospitals. Some possible reasons:
Liability Protection – Hospitals use CFM as a “CYA” measure to have a recorded strip of fetal heart rate data for legal documentation—even if it doesn’t actually improve birth outcomes.
Obstetrical Model of Care – The standard hospital approach is designed around managing high-risk births. Even though most pregnancies are low-risk, hospitals tend to default to continuous fetal monitoring because the obstetrical model tends to prioritize monitoring and proactive management (intervention) over a hands-off approach.
Perceived Safety – Having continuous data feels reassuring, but evidence shows continuous fetal monitoring doesn’t improve safety for low-risk births. What it does do, however, is increase the likelihood of interventions due to false positives.
why consider intermittent monitoring instead
Intermittent fetal monitoring using a fetal doppler.
Less Anxiety Over Normal Variations – Babies’ heart rates naturally fluctuate, and with CFM, those normal changes can trigger unnecessary concern or intervention. With intermittent monitoring, providers listen at intervals, reducing the likelihood of overreacting to harmless changes.
More Mobility – CFM can be restrictive, even with wireless monitors. With intermittent monitoring, you can move freely without worrying about sensors slipping or needing constant readjustments.
A Less Medicalized Birth Experience – Fewer beeping machines and fewer distractions can help you feel more at home and less like a patient.
No Difference in Outcomes – Research shows no difference in baby’s health between continuous and intermittent monitoring, but continuous fetal monitoring is linked to higher cesarean and instrumental delivery rates.
so, what’s best for you?
There’s no one-size-fits-all answer, but it helps to ask yourself:: Will continuous fetal monitoring help me feel more at ease, or will it add unnecessary stress during my labor?
If you’re in a hospital setting, you can ask about your options and advocate for what feels right for you. Birth isn’t one-size-fits-all.
questions to ask your provider
If you’re unsure about intermittent vs. continuous monitoring, you might ask your provider:
How do you feel about intermittent fetal monitoring?
Who is a good candidate for intermittent fetal monitoring?
Can you help me understand the evidence on intermittent fetal monitoring?
When do you recommend continuous fetal monitoring over intermittent fetal monitoring?
(Note: CFM is often necessary if additional interventions like an epidural or Pitocin are introduced.)
Further Reading
📖 American College of Obstetricians and Gynecologists (ACOG) – Practice Bulletin on Fetal Monitoring
📖 Cochrane Review – Intermittent vs. Continuous Fetal Monitoring
📖 Evidence-Based Birth – The Evidence on Fetal Monitoring
📖 Journal of Midwifery & Women's Health – Safety of Intermittent Auscultation
