The Truth About Continuous Monitoring – What Really Improves Birth Outcomes

Written By Emma Gleave

If you were told there was a piece of equipment that could make birth safer,
detect problems early,
and protect your baby — you’d probably want it, wouldn’t you?

That’s the promise of continuous fetal monitoring

Those belts and wires placed across the belly to record a baby’s heartbeat during labour.

They’re used in almost every hospital birth,
often described as reassuring, modern, or essential.

But what does the evidence actually say?

Continuous Monitoring:
The Promise vs the Reality

When electronic fetal monitoring (EFM) was first invented in the 1970s,
it was hailed as a breakthrough.

It seemed logical — more monitoring = information = better safety.

But it was never tested, before it was implemented and decades later,
large-scale reviews tell a different story.

Continuous monitoring
does not reduce the number of babies who die or develop brain injury
when compared with intermittent listening
(using a handheld Doppler or fetoscope).

What it does do is increase caesarean births and instrumental deliveries.

In other words, it creates more intervention — not more safety.

And when we look closer, the reason becomes clear.

EFM is notorious for false alarms.

A trace that looks “concerning” often leads to urgent action,
yet most of these babies are born perfectly healthy.

Meanwhile,
being attached to machines means women can’t move freely
— they stay in bed, often flat on their backs,
which makes contractions more painful and labour slower.

The Real Cost:
What Happens When Birth Becomes a Procedure

Continuous monitoring subtly - or not so subtly changes everything about the atmosphere of birth.

It replaces listening, connection and trust
with measurement and surveillance.

It replaces relationship with recording.

Many midwives enter the profession to “be with woman” —
that’s literally what midwife means.

But in the modern hospital environment,
they’re often required to spend more time watching screens than watching women.
Many hospital have the CTG monitors in the room at the end of the corridor
- so they don’t even need to come in the room to monitor women now.

And the consequences go deeper than statistics.
Birth becomes something done to women, not with them.

Confidence gives way to fear.
Normal birth skills fade away
because midwives no longer see normal birth unfold.

When you are constantly watched,
interrupted,
and undermined,
you lose confidence.

This happens to midwives too.

Imagine working in a system where you rarely see birth unfold naturally,
where a senior doctor can overrule your judgment with the press of a buzzer.

It’s no wonder that fear seeps into practice, and intuition gets buried under policy.

So What Does Improve Outcomes?

If continuous monitoring doesn’t make birth safer, what does?

The answer is clear — and it’s not high-tech.
It’s human connection.

Studies consistently show that the greatest improvements in outcomes come from:

✨ Continuous support from a known person

a midwife, doula / birthkeeper who builds trust and stays throughout labour.

✨ Choosing a homebirth setting

where interventions are less frequent
and safety is much higher for women
and often equally as high for babies.

✨ Freedom of movement and position

allowing the body and baby to work together.

✨ Respect, privacy, and calm

conditions that support the flow of oxytocin,
the hormone that makes birth work.

If these ‘interventions’ were a pill,
it would be unethical not to offer them.

In fact - I hesitate to say interventions -
because the real intervention was eliminating them from birth in the first place
- they are the norm.

This is how women have always birthed
surrounded by people they know and trust,
guided by those who understand birth as a physiological process,
not a medical emergency.

So do they reduce the length of labour,
lower the risk of caesarean,
increase satisfaction,
improve bonding,
support breastfeeding.

OR

Does hospital environments,
monitoring,
strapping women to beds,
strangers in the birth room -
actually worsen those outcomes?

If all of the these things
- make birth worse -
then why do women / Dr’s / Hospitals keep on doing them???

The Evidence for Connection Over Control

One large review of more than 15,000 women found that having continuous one-to-one support during labour led to:

  • 25% fewer caesarean births

  • 8% shorter labours

  • 10% fewer medical interventions

  • and a 31% increase in women reporting positive birth experiences

(Reference: Cochrane Review, Continuous Support for Women During Childbirth, 2017)

And the outcomes are even stronger for women who know their midwife or doula beforehand.

Continuity of carer —

The same familiar person throughout
pregnancy,
birth,
and postnatal care

— reduces preterm birth,
lowers intervention rates,
and improves both maternal and neonatal wellbeing.

This is not alternative
— it’s evidence-based,
cost-effective,
and ancient wisdom combined.

Returning to Birth
as It Was Always Meant to Be

For most of human history, women were attended by women they knew — sisters, friends, midwives who lived in the same village. Birth was intimate, instinctive, and supported.

We are the first generation to have handed birth almost entirely to strangers in institutions, surrounded by machines that hum and beep.

Perhaps the greatest act of rebellion is not rejecting technology altogether, but remembering what truly makes birth safe — the presence of someone who believes in you, trusts your body, and knows how to hold space when you need it most.

Taking Back Your Power in Birth

If you take one thing away from this, let it be this: you are the primary authority in your birth.

Birth is not something that happens to you.
It’s something that unfolds through you.

So start by asking questions — of everything.

Every scan, every monitoring device, every “policy.”
Because even the routine things — like ultrasound — were never fully tested for long-term safety.

When you begin to look deeper,
you’ll see that the real path to safer,
calmer birth isn’t more intervention — it’s more understanding.

Learn how the hormones of birth work together

Oxytocin, endorphins, and melatonin
— to create the most powerful, protective cocktail your body will ever make.

Understand how movement,
upright positions,
and deep rhythmic breathing all help your baby rotate and descend smoothly.

And recognise that unless you practice these techniques beforehand,
and have someone beside you who understands normal physiology and your wishes,
it’s almost impossible to use them when you need them most.

Because if you walk into a system unprepared,
it will manage you

— onto a bed,
onto a monitor,
and into a plan that was never yours to begin with
& won’t do you any good.

If you truly want to experience the power of birth — plan a homebirth.

That doesn’t mean ignoring medical help when it’s needed;
it means taking radical responsibility for your body,
your environment, and your choices.

It means surrounding yourself with people who believe in you
— an experienced doula or birthkeeper
(someone like me, or anyone you deeply trust),
your partner,
and if you can afford it,
a midwife who works for YOU not the system.

Read real birth stories.

Fill your mind with images of strong, connected women.

Remember that you can’t control birth — but you can protect it.

The way you give birth shapes how you step into motherhood.
It imprints the story of your strength,
your instincts,
and your trust in life itself.

So take your power back.

That doesn’t mean saying no to every intervention
— it means saying yes to the ones that serve you, and no to the ones that don’t.

It means starting now
— by nourishing your body,
calming your mind,
and choosing who stands beside you.

👉 Listen to podcasts like The Great Birth Rebellion and The Midwives’ Cauldron.
👉 Read the studies yourself — learn what the evidence really says.
👉 Build the kind of birth team that honours your instincts and your autonomy.

Because this is your birth
and your baby
And it’s time to protect them.

🔹 Key Evidence on Continuous CTG (Electronic Fetal Monitoring)

1. Cochrane Review – Alfirevic et al., 2017

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring for fetal assessment during labour.
Over 37,000 women across 13 trials.

  • No difference in perinatal deaths or cerebral palsy compared with intermittent listening.

  • Continuous CTG caused more caesarean and instrumental births.

  • Slight reduction in rare neonatal seizures, but no long-term benefit shown.
    🔗 Read summary on Cochrane.org

2. Cochrane Review – Admission CTG, 2017

Admission cardiotocography versus intermittent auscultation of fetal heart rate for assessment of fetal wellbeing during labour in low-risk women.

  • Increased caesarean rates with no improvement in outcomes for babies.

  • Routine admission CTG not recommended for healthy women.
    🔗 Read summary on Cochrane.org

3. American Family Physician Review, 2020

Intrapartum Fetal Monitoring: Nomenclature, Interpretation, and General Management Principles.

  • CTG has a high false-positive rate — most “abnormal” traces do not indicate a problem.

  • Interpretation varies widely between clinicians.
    🔗 Read on AAFP.org

4. BMC Pregnancy & Childbirth, 2025

Women’s experiences of continuous vs intermittent fetal monitoring during labour.

5. Guidelines – NICE (UK) & ACOG (US)

  • Both recommend intermittent auscultation for low-risk labours.

  • Continuous CTG only when there are complications or increased risk factors.
    🔗 NICE Intrapartum Care Guideline NG190
    🔗 ACOG Committee Opinion No. 766 (2019)

Summary:
Continuous CTG hasn’t been shown to make birth safer for healthy women. It increases intervention rates, restricts movement, and heightens stress. Intermittent listening, freedom to move, and continuous support from a trusted companion remain the safest, evidence-based approaches for physiological birth.

🎧 Podcast Episodes on CTG / Continuous Monitoring

  • Episode 113 – CTG use in labour and birth — The Great Birth Rebellion
    Mel and Kirsten discuss the use of CTG in labour and whether it really changes outcomes. melaniethemidwife.com

  • Episode 114 – Is CTG ever beneficial? — The Great Birth Rebellion
    A critical look at whether CTG ever has a justified use, with Dr Kirsten Small. melaniethemidwife.com

  • Episode 112 – Is CTG in pregnancy beneficial? — The Great Birth Rebellion
    Focuses on use of CTG during pregnancy (antepartum) and whether that yields benefit. melaniethemidwife.com

  • Episode 157 – Monitoring the Fetus in Labour — The Obs Pod
    Dr Kirsten Small and the host evaluate CTG monitoring in labour, its language and implications. Buzzsprout+1

  • “Continuous Foetal CTG Monitoring, with Dr Kirsten Small” — The BirthEd Podcast
    An episode focused on the evidence, pros and cons, and informed choice around CTG. Birth-ed | Pregnancy and Antenatal

  • “We’ve Been Bamboozled: Musings on CTG with Dr. David Hayes” — Birthing Instincts Podcast, episode 386
    A philosophical, critical conversation about CTG in the birth room and how technology gets elevated. Apple Podcasts

  • Episode 12 – CTG — do you need it?
    A shorter discussion led by Dr Kirsten Small about whether CTG is necessary in labour. Spotify

Summary:

Continuous CTG hasn’t been shown to make birth safer for healthy women.
It increases intervention rates, restricts movement, and heightens stress.
Intermittent listening, freedom to move,
and continuous support from a trusted companion remain the safest,
evidence-based approaches for physiological birth.

Emma Gleave
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