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During labor and birth, nurses use electronic fetal monitoring (EFM) to monitor contractions and the fetal heart rate. EFM can be continuous or intermittent depending on the client's condition and facility policy. There are two types of monitoring: external and internal. External monitoring involves placing pressure-sensitive tocotransducer on the abdomen to detect contractions and using an ultrasound transducer to record the fetal heart rate. For internal monitoring, it is used for clients at risk or experiencing complications, as long as the amniotic membrane is ruptured and the cervix is dilated at least 2 centimeters. The nurse monitors a client's contractions and the fetal heart rate pattern during labor and birth. Electronic fetal monitoring can be continuous or intermittent, depending on the client's condition and facility policy. Electronic fetal monitoring, or EFM, produces a tracing of the fetal heart rate as well as uterine contractions. There are two types of monitoring, external and internal. Let's start with external monitoring. The tocotransducer is pressure sensitive. You place it on the upper abdomen over the uterine fundus, where it detects increases in uterine tone during contractions. The ultrasound transducer records the fetal heart rate. Position it between the client's umbilicus and symphysis pubis. However, if the fetus is in a breech position, you may place the transducer at or above the level of the client's umbilicus. For assessments using external monitoring, secure the two transducers to the abdomen using the soft, flexible straps. Now for internal monitoring. You can use internal monitoring for clients who are at risk for or are experiencing labor or birth complications, as long as the amniotic membrane is ruptured and the cervix is dilated at least 2 centimeters.
