Every time someone comes into Labor and Delivery with a natural birth plan, I cannot help but find myself hoping they are not assigned to me. It’s not for the reason you might think. I actually like taking care of naturally laboring women. I feel like I can be a much greater help to them than somebody who is just going to come in and get an epi. The reason it is so hard is because it is impossible to monitor them. Either I am running in there every fifteen minutes getting a heart rate, in the middle of everything else I have to do, or I am trying to figure out a way to keep the stupid bands in place while they are moving all over the place. I never actually get a good strip and then I have to sit there and chart that. Depending on who the doctor is, it can also be difficult. A lot of them still want the patients continuously monitored, which is nearly impossible. I had one doctor tell me they didn’t give a damn if I had to sit on the floor and hold the monitor in place the entire labor. I wish my job was so easy that I could take the time to do that. I wish there was a better way to let women labor the way they want and still make sure the baby is okay. I also have to say, even though I have read the research that says it’s okay for moms to be off the monitor, every time they are I still hold my breath whenever I go to put that monitor back on. It gives me angina. I guess I am just too anxious.
—S. R., Labor and Delivery Nurse
The first challenge in regards to fetal monitoring in healthy natural labors is gaining acceptance among hospitals and obstetricians that there are alternatives to continuous electronic fetal heart rate monitoring (EFM). As discussed in Chapter 5, despite the lack of evidence in support of EFM in low-risk mothers, the practice is widespread and deeply entrenched in standard obstetrics practice. Nurses, doctors, and hospital administrators need to reacquaint themselves with the evidence concerning effective fetal monitoring in order to become more open minded about options such as intermittent auscultation. However, it is unlikely that this will change anytime soon and most naturally laboring women will find their hospital and/or provider will recommend electronic monitoring for at least some portion of their labor.
Thus, practically speaking, the real challenge for women, their nurses, and their providers is to find ways to monitor that do not inhibit ambulation, positioning, and access to hydrotherapy. Mothers undergoing EFM have traditionally been restricted to the bed because monitoring was conducted via abdominal transducers, which were attached with approximately 3-feet long wires to large, bulky machines. The majority of maternity units still utilize these ...