A Selective Review of the Literature


  • Susan Holmes Snydal SNM, BSN

    Corresponding authorSearch for more papers by this author
    • Susan Holmes Snydal was graduated from the University of California, Berkeley with an A.B. in English, and from San Jose State University with a B.S. in nursing. She is currently a nurse-midwifery student in the UC3F/UCSD Intercampus Graduate Studies Program, and a staff nurse in labor and delivery at the Kaiser Santa Clara Medical Center. Until recently, she taught childbirth education classes as an ASPO-certified teacher, and served as a birth assistant to a nurse-midwife with a home birth practice in San Jose, California.

73 Birch Lane, San Jose, CA 95127.


A review of the history of fetal heart rate monitoring is followed by detailed analysis of eight randomized, controlled trials and of a recent prospective study of electronic fetal monitoring compared with intermittent auscultation. No significant differences between the methods were reported in perinatal mortality rates, neonatal infection rates, and Apgar scores. Mixed results were reported for length of labor, maternal analgesic use during labor, maternal genital tract infection rates, umbilical cord pH values, and admissions to neonatal intensive care units. Auscultation was associated in two trials with a significantly increased rate of neonatal seizures. Electronic fetal monitoring was correlated with a significantly increased cesarean delivery rate in the first four trials, and with a significantly increased rate of operative delivery (forceps plus cesarean delivery) in three later trials. A decision tree is presented to assist the clinician in selecting the appropriate fetal monitoring method for a given client.