Continuous Fetal Monitoring & C-Sections: What Expectant Parents and Doulas Should Know

A quiet shift in birth rooms across America

For decades, hospital births have followed a familiar rhythm: a birthing person arrives, is connected to monitors, and labor begins under the steady beeping of machines. Those monitors, called Electronic Fetal Monitors (EFMs), track a baby’s heart rate and the mother’s contractions continuously.

Originally introduced to protect babies from complications like oxygen deprivation, EFMs were meant to make birth safer.
But today, a growing body of evidence — highlighted by the New York Times in November 2025 — is raising an uncomfortable question:

Could this very technology, meant to save lives, be quietly contributing to America’s soaring cesarean (C-section) rates?

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What the research shows

The promise of continuous fetal monitoring has always been early detection of fetal distress. Yet, decades of studies show that routine use of continuous monitoring does not improve outcomes for low-risk pregnancies.

Instead, it has an extraordinarily high false-positive rate — meaning it frequently signals distress when there is none. When the monitor shows “non-reassuring” patterns, clinicians often feel pressure to act fast. And in a hospital culture shaped by fear of liability and institutional caution, “acting fast” often means a C-section.

The New York Times article underscored what birth professionals have known for years:

Continuous EFM rarely prevents long-term complications like cerebral palsy — but it does lead to a sharp increase in cesareans and instrumental deliveries.

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A system under pressure

It’s not that clinicians want unnecessary surgery. Rather, they work in a system that rewards intervention over intuition.
Continuous monitoring generates data — and data becomes potential evidence in malpractice cases.
So when a fetal heart rate tracing looks concerning, even for a moment, doctors may feel safer recommending surgery than waiting — even if the baby is fine.

This isn’t about blame; it’s about system design. Technology has become the default, and hospital policy often leaves little room for individualized, low-intervention care.

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What It Means for Doulas, Birth Professionals & Maternal Support

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Informed dialogue with clients

When working with pregnant clients (especially low-risk ones) Doulas can help them understand that continuous fetal monitoring is not always benign — that it’s a medical technology with pros and cons. Encourage them to ask their provider: “Is continuous monitoring required? Am I eligible for intermittent monitoring? What happens if a non-reassuring trace appears?”

This empowers clients to be part of the decision-making as opposed to passively following hospital norms.

Supporting physiological/evidence-based birth

This article reinforces that we need to question default interventions and standard hospital protocols — and seek birth environments (when safe) that allow for physiologic labour with less intrusiveness, more mobility, fewer interventions, when appropriate.

Risk stratification and advocacy

It’s important to distinguish: for high-risk pregnancies (pre-eclampsia, fetal growth restriction, etc.), monitoring has a clearer role. For low-risk labours the benefit is less certain.

As a doula you can support the birthing person in clarifying their risk status, preferences for monitoring style, how to respond if monitoring shows something unexpected, and how they want decision-making to happen (including conversations about cesarean threshold).

The cascade effect reminder

Continuous monitoring can lead to “alerts” — decelerations, variability changes — which lead to interventions (position changes, fluids, supplements) which lead to decisions to do cesarean. Each step escalates.

Helping clients understand the possibility of that cascade and how to stay centered, ask questions, and revisit options is part of good support.

Postpartum implications

More cesareans means longer recovery, more pain, higher risk of certain complications, delayed bonding, sometimes more postpartum support needs. In your postpartum/doula/postnatal work, awareness of how prenatal & intrapartum decision-making influences postpartum care is vital.

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A balanced perspective

It’s important to acknowledge: continuous fetal monitoring can be lifesaving in high-risk pregnancies — for instance, when there are concerns about fetal growth, preeclampsia, or induction. The goal isn’t to reject technology, but to use it wisely, guided by context, evidence, and shared decision-making.

Birth work today isn’t about choosing between “natural” and “medical.” It’s about ensuring every family experiences safety, respect, and informed choice.

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The Newmom.me approach

At Newmom.me Academy, we believe the future of birth work lies in education that evolves with evidence. Our curriculum integrates current research — like the findings on fetal monitoring and C-section trends — so that our doulas graduate ready to serve in real-world birth environments with confidence and credibility.

We train doulas to ask the “why” behind every routine, to communicate effectively with care teams, and to create calm in moments of uncertainty.

That’s how we change birth — one informed, supported family at a time.

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Disclaimer: This blog's content is provided for informational purposes only, and does not intend to substitute professional medical advice, diagnosis, or treatment and you should not rely solely on this information. Always consult a professional in the area for your particular needs and circumstances prior to making any professional, legal, medical and financial or tax-related decisions.

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