Electronic fetal monitoring requires accurate interpretation and clear communication between staff nurses, advanced practice nurses, midwives, and physicians.
The Certified Electronic Fetal Monitoring (C-EFM) designation is one of only a few multidisciplinary certifications, according to Megan Beglin, BSN, RNC-OB, C-EFM, a women’s center RN at the George Washington University Hospital in Washington, DC.
“A large component of fetal monitoring education is the communication component,” Beglin, a speaker for the Nurse.com Electronic Fetal Monitoring Certification Review Course, said. “The certification in electronic fetal monitoring helps to ensure that different providers and different practitioners are speaking the same language.”
Nurses who plan to spend any part of their careers at the bedside in labor and delivery should consider the C-EFM preparation course and certification, according to Paula Fitt, BSN, BA, RN, C-EFM, IBCLC, a labor and delivery nurse since 1998 and a speaker for the Nurse.com course, which covers fetal heart monitoring technology and interpretation, gestational complications, and more topics.
“A lot of facilities now are looking at the RN C-EFM … as the baseline entry for employment on their units,” Fitt said.
The course and certification eliminate a lot of potential confusion from what nurses and others might see on a monitoring strip or what they might be hearing when they are using auscultation, according to Fitt.
Getting the assessment and ultimate communication right is important. Sentinel events in obstetrics often occur because of poor communication, she said.
An Evolving Specialty
Nurses will find the most current electronic fetal monitoring recommendations, language, and definitions in The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring: Update on Definitions, Interpretation, and Research Guidelines, published in the Journal of Obstetric, Gynecologic and Neonatal Nursing.
“[The 2008 report] was the last really big landmark change in how we discuss fetal monitoring,” Beglin said. “I would say, however, in the last decade there has been a really big push for more of that multidisciplinary education – more of having providers of all different degrees sitting around the table and receiving the same orientation in assessment training as it pertains to fetal heart monitoring.”
Fetal monitoring technology has not changed much, but the way it is used in practice has evolved.
It used to be that nearly every laboring patient would get electronic fetal monitoring, but the evidence suggests using fetal monitoring as a surveillance device for almost all babies increases the cesarean-section rate, said Fitt.
Researchers wrote in a review Electronic Fetal Monitoring and Cesarean Birth: A Scoping Review published in 2016 in the journal Birth that many U.S. hospitals use electronic fetal monitoring continuously during labor for all patients, regardless of risk status. The monitoring can trigger interventions which increase risk of cesarean birth among low-risk women, according to the review.
Presently, some nurses might only use this type of monitoring intermittently or for a short time in patients with no risk factors, Fitt said.
Common Settings for Electronic Fetal Monitoring Use
Nurses and other providers most commonly use electronic fetal monitoring during intrapartum care or active labor. Providers …read more
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