EFM(External Fetal Monitoring) is it too common and does it really benefit mothers and babies?

The use of EFM has long been argued about whether it is truly needed or even useful. EFM in the beginning was only used on high risk mothers in an attempt to decrease cerebral palsy(CP) in infants who were deprived of oxygen due to lack of oxygen. It has since grown into a standard of care for all birthing women. Many women do not question why this has become a requirement for everyone. In most hospitals in the US it is now stand practice for all women to be continually monitored for the entire labor, even those who are classified as "low risk". Many women do not question this practice at all, they agree, thinking that this is one more thing that will guarantee them a healthy baby. But the this is far from the truth. Since EFM has become standard care, the rate of CP in infants has NOT gone down, but the cesarean rate has drastically risen. The reason given for the raise in the cesarean rate by doctors? Maternal request. No one would admit that the over use of EFM could possibly be a problem. But finally an OB is speaking about EFM and had quiet a bit to say about just how unreliable and poor this procedure is. This is what Alex Friedman, a fellow
in maternal-fetal medicine at the Hospital of the University of Pennsylvania said.

But fetal heart monitoring is an appallingly poor test. The test misses the majority of babies with cerebral palsy, the condition researchers hoped it would prevent. It causes increased rates of a painful and invasive surgery: cesarean section. Even worse, almost all women undergo continuous heart monitoring during labor, not just those at highest risk.

He also said:

The complication we feared most was hypoxia, the baby not getting enough oxygen during labor. Going too long without adequate oxygen could result in a serious permanent injury, such as cerebral palsy, or even death.

No test is perfect. But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry.

Were we saving lives and averting disaster? Or were we performing unnecessary surgery?

If EFM is so unreliable, then I ask why is it still even used, or at least why is it standard for all birthing patients? This to me does NOT look like evidence based medicine. Why?

Steven Clark and Gary Hankins, two prominent obstetricians, voiced my frustration. "A test leading to an unnecessary major abdominal operation in more than 99.5 percent of cases should be regarded by the medical community as absurd at best," they wrote in the American Journal of Obstetrics and Gynecology. "Electronic fetal heart rate monitoring has probably done more harm than good."

If you would like to read the entire article, written by Alex Friedman see link included. http://www.philly.com/inquirer/magazine/20100426_Test_leads_to_needless_C-sections.html