The Monitor Everyone Gets But Doesn't Really Need
What the Research Actually Says About Continuous Fetal Heart Rate Monitoring
“Nearly every woman who gives birth in an American hospital gets strapped with a belt of sensors to track her baby's heartbeat.” It's routine. Expected. Presented as protection.
Thankfully, New York Times author Sarah Kliff did the leg work, and found… not a lot of evidence.
Here's what the research actually shows: it rarely helps. In fact, decades of studies say it causes more harm than good.
I know this might land hard if you're pregnant or planning a birth. That's not my intent. My intent is to give you real information—the kind that lets you make informed choices about your own body and your own birth. That's what we do here at Be Well Baby.
So let's talk about this.
The Stories That Matter
I want to start with Sanquaneice Hankerson-Pinkney, a lawyer in Florida. In March 2021, she went into labor. Her doctor looked at the fetal heart rate monitor and saw what looked like a concerning pattern—the heartbeat dropping. Based on that monitor readout, her doctor recommended an emergency C-section. Sanquaneice agreed. She says: "Seeing the heart rate dropping on the monitor, it made me sick to my stomach."
She had the surgery.
The next year, when she got pregnant again, something devastating happened. Her placenta grew into the scar tissue from that first cesarean—a condition called placenta accreta. This is rare, but it's becoming more common as C-section rates climb. It's life-threatening.
Because the placenta and uterus were fused together, natural labor could have killed her. She delivered five weeks early. Her newborn went on a breathing machine. And when doctors couldn't safely remove the placenta, they removed her entire uterus.
At 37 years old, Sanquaneice had to accept that she would never have another child.
She told The New York Times: "It was more traumatic than I would like to express."
And Sanquaneice is not the only person with a story like this. I have countless patients who have had something similar happen.
I had one client—we'll call her Alice—and here's her story. She was pregnant around 36 weeks when her water broke. She felt her body would easily go into labor when it was ready. But she had a specific hospital where she felt safest giving birth. When labor started, she was told that hospital was on divert—at capacity—and she'd need to go somewhere else.
She didn't feel safe with the other options. So she persisted. And the hospital told her: if she agreed to be induced right away, she could stay at the hospital where she felt safe.
That's medical coercion. We'll talk about that another time. But here's what happened: she chose induction even though it wasn't what she wanted for her birth. Her body wasn't ready yet.
Here's the thing about induction—sometimes babies don't tolerate it well. Pitocin and misoprostol are powerful drugs that force contractions. They work, but they're intense. Her baby didn't tolerate the induction well. The monitor showed what the hospital interpreted as fetal distress. She ended up with an emergency C-section.
But here's the question I keep asking: Was the baby actually in distress? Or was the baby responding normally to an intervention that shouldn't have happened in the first place?
And honestly? I lived through this myself. During my own first birth, at a certain point an OB came into the delivery room and started talking about a cesarean because of what my baby's heart rate was doing. I remember that moment—the fear, the shift in the room. But then she looked at the monitor again and said, "Oh... she's actually fine."
Same monitor. Same readout. Interpreted one moment as an emergency, the next moment as completely normal.
That's the subjectivity problem right there.
This is the pattern I see. And it's exactly why this research matters.
What Is This Technology Anyway?
Nearly every woman who gives birth in an American hospital gets strapped with a belt of sensors. Those sensors track the baby's heartbeat continuously throughout labor. The monitor produces a readout—literally squiggly lines on a screen—that shows how fast or slow the baby's heart is beating and how it's responding to contractions.
The promise was huge. In the 1950s, a Yale obstetrician named Dr. Edward Hon was studying fetal heart patterns, looking for signs of oxygen deprivation. When he published his work in the early 1960s, the technology was marketed as revolutionary. Life magazine in 1969 wrote that this new system "could save as many as 20,000 babies a year."
Device companies sold hospitals hard on another benefit: efficiency. One nurse could monitor eight patients at once instead of doing periodic stethoscope checks. The marketing was incredible. One ad said the monitor was "like keeping a nurse at every bedside." Except, you know, cheaper.
By the 1970s, continuous monitoring became standard. It's still standard today. Nearly every woman who gives birth in an American hospital experiences it as just... how birth works. It's not questioned. It's not offered as an option. It's assumed.
But here's what decades of research actually shows.
What Does the Research Actually Say?
In 1976, researchers did a randomized controlled trial—the gold standard of evidence. They randomly assigned some women to continuous monitoring and others to regular stethoscope checks.
The findings? Continuous monitoring did not reduce stillbirths. It did not reduce newborn deaths. It did not prevent cerebral palsy. It did not improve outcomes for healthy babies.
The only clear finding was this: women who were continuously monitored had significantly more C-sections.
That trial was followed by more studies. In 2017, a rigorous review looked at all the evidence and found the same thing. Compared to periodic stethoscope checks, continuous monitoring did not prevent stillbirths or cerebral palsy in healthy pregnancies. It did slightly decrease neonatal seizures, but—and this is important—that didn't translate into better long-term neurological outcomes for babies.
But the C-section rate went up by 63 percent.
Sixty-three percent.
Here's the brutal truth: healthy babies have highly variable heart rate patterns. A completely healthy baby's heart can speed up, slow down, have irregular beats. That's normal. But when you're staring at a monitor all labor long, you see every variation. And many doctors interpret ambiguous signals as signs of distress.
An obstetrician at the University of Chicago, Dr. Emmet Hirsch, has been vocal about this. He calls continuous monitoring "the worst test in medicine." He's not alone. Other experts have called it "useless" and "pathetic."
One of the most striking quotes I found came from Dr. Steven L. Clark, an obstetrician at Baylor College of Medicine who has extensively studied this. He said: "We may be the only specialty that continues to do major abdominal surgery without a shred of evidence of benefit. We just plow blithely on."
Think about that. We have decades of research showing this doesn't prevent the outcomes it claims to prevent. And yet, we do it to nearly every birthing person in America.
So why does this keep happening?
The Gap Between Evidence and Practice
The answer isn't about patient safety. It's about business, legal liability, and institutional inertia.
The Legal Piece
Here's one reality: obstetricians get sued more than doctors in almost any other medical specialty. When there's an adverse outcome—a baby with cerebral palsy, for example—lawyers pull the monitoring strips as evidence.
Expert witnesses on both sides interpret those strips completely differently. One says, "Look, the baby was in distress here." Another says, "No, those patterns are completely normal." It's subjective. It's what one legal expert called "very squishy."
So some doctors have told researchers: even if I don't think the monitor helps, if I don't use it, a court could find me negligent. The monitoring becomes legal protection, not medical protection.
And here's the thing that should make you angry: recent malpractice cases have set record verdicts. $207 million in Pennsylvania. $950 million in Utah. These verdicts were driven largely by competing interpretations of monitor strips. Meanwhile, no studies have shown that performing a C-section based on fetal heart patterns can prevent cerebral palsy. But juries don't know that. So the system incentivizes more monitoring, more C-sections, more risk.
The Business Piece
There's also money involved. Big hospitals are opening "remote monitoring hubs" where nurses watch screens of heart data from dozens of miles away. They market this with language like "cutting-edge AI technology" and "highest benchmarks for safety."
One hospital estimated they saved $13.5 million in malpractice costs in the first two years of their remote hub. But here's the kicker: another hospital executive said the hub was helpful partly because "it just looks good, and that sometimes matters more than about anything" in legal disputes.
Not because it prevents injury. Because it looks good.
Software companies are selling AI algorithms that claim to decode fetal distress from the monitor data. One company, PeriGen, claimed on its website that 50 studies backed up their products. But when journalists asked about those studies? Not one of them actually showed that the AI improved birth outcomes. One was literally about how to suture a C-section scar.
The company removed the list after being questioned by The New York Times.
Even the newly updated guidelines from the American College of Obstetricians and Gynecologists—released this fall—acknowledged that AI software for fetal monitoring is "unproven." Yet they still recommended continuous monitoring overall.
Meanwhile, other wealthy countries? Canada and Britain have cautioned against routine use of continuous monitoring in healthy pregnancies. They're saying, "The evidence doesn't support this."
The Status Quo Piece
And then there's something simpler: inertia. Many obstetricians practicing today have never worked without a monitor. It's just how they practice. Some genuinely believe it helps them, even if studies haven't shown it. Others say, "Well, it's in hospital policy, so the question is moot."
One doctor put it bluntly: "It's just easier to keep patients hooked up continuously. It's an ease-of-manpower issue over the science."
That's honest. But it's not a medical reason.
So What Does This Mean for Informed Choice?
This is what fires me up about this topic. Because it's a perfect example of what happens when we accept things as "just how birth works" without asking hard questions.
At Be Well Baby, we're all about informed choice. Not judgment. Not a preference for one birth path over another. But real, honest information so you can make decisions that align with your values and what actually serves you and your baby.
Continuous monitoring is presented as "standard of care." As protection. As something that looks out for your baby.
But if the research shows it doesn't prevent the outcomes it claims to prevent, and if it significantly increases the likelihood of major abdominal surgery that comes with real medical risks—infection, hemorrhage, complications in future pregnancies—then is it really protection? Or is it risk?
The honest answer is: for a healthy pregnancy, the research suggests it's more likely to cause harm than prevent it.
That doesn't mean no one should have continuous monitoring. Some situations do warrant closer surveillance. High-risk pregnancies, certain medical conditions, specific complications—these might absolutely call for it. But "everyone, automatically" isn't supported by the evidence.
And that matters for informed choice.
What Can You Actually Do?
If you're pregnant or planning to be, here's what I want you to know:
Ask your provider these questions:
"What's the evidence for continuous fetal monitoring in my specific situation?"
"Are there alternatives, like intermittent monitoring with a Doppler?"
"Under what circumstances would continuous monitoring be recommended for me specifically?"
These aren't confrontational questions. They're informed-choice questions. A good provider will have thoughtful answers.
Know that you have options. In many cases, intermittent monitoring—where a provider checks the baby's heart rate periodically rather than continuously—gives you the same information without keeping you tethered to a machine for hours. Some birthing people find that difference profound for their birth experience and their ability to move and labor. Movement matters. Freedom matters.
Understand your hospital's culture. Some hospitals are more flexible about monitoring protocols than others. Some have dedicated staff who support different approaches. Understanding this ahead of time helps you make informed decisions and advocate for yourself.
And if you do end up with continuous monitoring: That's okay. Birthing is unpredictable. Circumstances change. But knowing why it's happening—knowing that it's actually necessary for your specific situation and not just routine—makes a huge difference in how you experience it. It's the difference between "this is being done to me" and "this is being done for me."
The Bigger Picture
One out of every three deliveries in America happens via C-section. That rate far exceeds public health recommendations. And the most common reason given for C-sections in healthy pregnancies? "Fetal distress"—a diagnosis made by a monitor that research shows often misinterprets normal, healthy baby heart rate patterns.
We can do better. We should do better.
Because informed choice isn't just about respecting what people want. It's about giving them real information so they can make decisions that actually serve them and their babies. Not what's easiest for the system. Not what looks good in a lawsuit. What actually serves them.
That's how we move from survival to thriving.
And that's what this is all about.
If you're navigating birth decisions and want to dig deeper into evidence-based approaches to pregnancy, birth, and postpartum recovery, that's exactly what we're building here at Be Well Baby and in the Beyond Birth Blueprint program. You deserve real information. You deserve to feel confident in your choices. And you deserve support that honors both the science and your own autonomy.
You're not broken. You're not broken by needing to question standard practices. You're informed. And that matters.
Love,
Emily
P.S. Resources!
