Paper short abstract:

Why are electronic fetal monitors common in childbirth despite weak evidence? Interpreting the monitors is not simply a medical decision, but a judgment about which bodies should be susceptible to risks. I highlight the consequences of how providers weigh risks for babies against risks for mothers.

Paper long abstract:

Electronic fetal monitors are the most commonly used obstetrical intervention in American childbirth, utilized in at least eighty-five percent of all deliveries. The monitors, which provide continuous data on the fetal heart rate and maternal contractions during labor, are so commonplace that they require no consent process from women, even though other monitoring options may be available. Interpreting the fetal heart rate tracings is such an important part of an obstetrician's workflow that one provider snidely remarked, "My whole job is just to look at tracings and write about them." Despite the ubiquity of these monitors on labor floors across the United States, many birth providers feel considerable unease about their use. When compared with less invasive and less frequent monitoring, electronic fetal monitors have not been shown to improve perinatal health outcomes, but are linked to an increase in cesarean sections, a form of delivery that is more dangerous for women than vaginal delivery. As one provider noted, "The literature is very clear that doing electronic fetal monitoring is not in anybody's best interest, but it's done on everybody." Based on interviews with ninety-four birth providers across the United States, this paper explores why electronic monitors are so common despite weak clinical evidence, and highlights the uneven consequences of this practice as providers weigh the risks for babies against the risks for mothers. Interpreting fetal heart rate tracings is not simply a medical decision, but a normative judgment about which bodies should be susceptible to which types of risks.