Electronic Fetal Monitoring
Electronic Fetal Monitoring (EFM): What It Is, Pros & Cons, and Your Options for Birth
When preparing for labor, one of the most common interventions you may encounter is electronic fetal monitoring (EFM). While it’s routinely used in hospital births, many families aren’t fully informed about what it is, when it’s necessary, and what alternatives exist.
At Embers of Empowerment Doula Services, we believe informed choices lead to empowered births. Let’s walk through everything you need to know about EFM so you can feel confident, supported, and in control of your experience.
What Is Electronic Fetal Monitoring?
Electronic fetal monitoring (EFM) is a tool used during labor to track your baby’s heart rate and how it responds to contractions.
There are two primary types:
External fetal monitoring: Sensors placed on your belly with adjustable belts
Internal fetal monitoring: A small electrode attached to baby’s scalp (used after membranes have ruptured)
Monitoring can be:
Continuous: Tracking at all times
Intermittent: Checked at regular intervals
Why Is Electronic Fetal Monitoring Used?
EFM is designed to help providers assess how your baby is tolerating labor. It’s often recommended in hospital settings and may be especially encouraged in high-risk pregnancies.
Situations where EFM may be beneficial include:
Induction or augmentation of labor
Epidural use
High blood pressure or preeclampsia
Concerns about baby’s growth or well-being
Pros of Electronic Fetal Monitoring
There are times when EFM can be a valuable and reassuring tool.
Benefits include:
✔️ Continuous tracking of baby’s heart rate
✔️ Early detection of potential concerns in higher-risk situations
✔️ Helpful guidance for medical decision-making
✔️ Can provide reassurance for both providers and parents
When used appropriately, EFM can support timely interventions when they are truly needed.
Cons of Continuous Electronic Fetal Monitoring
Like many medical interventions, EFM also has drawbacks—especially when used routinely in low-risk labor.
Potential downsides include:
⚠️ Increased likelihood of interventions (including cesarean births)
⚠️ Limited mobility during labor, which can impact comfort and progress
⚠️ False alarms (suggesting distress when baby is actually doing well)
⚠️ Shifting focus away from your body’s natural cues
For low-risk pregnancies, research shows that continuous EFM does not significantly improve birth outcomes compared to intermittent monitoring—but it does increase intervention rates.
Alternatives to Continuous Fetal Monitoring
You have options. Understanding them allows you to advocate for a birth experience that aligns with your needs and values.
Intermittent Auscultation (IA)
This method uses a handheld Doppler or fetoscope to listen to baby’s heart rate at set intervals.
Why many families choose it:
Encourages freedom of movement
Supports physiologic (natural) labor
Associated with lower intervention rates
Wireless (Telemetry) Monitoring
Some hospitals offer wireless EFM, allowing for continuous monitoring while maintaining mobility.
Benefits:
Freedom to move, walk, and change positions
Ability to labor in upright or comfort-based positions
Access to hydrotherapy (in some cases)
Low-Intervention Monitoring Approaches
In birth centers and home birth settings, intermittent monitoring is often the standard unless concerns arise—supporting a more intuitive, body-led labor experience.
How to Advocate for Your Preferences
You deserve to be part of every decision made during your birth. Open communication with your provider is key.
Consider asking:
Am I considered low-risk or high-risk?
What type of fetal monitoring do you typically use?
Can I choose intermittent monitoring?
Are wireless monitors available?
How can I stay mobile if monitoring is recommended?
My Doula Perspective: Centering You in the Process
At Embers of Empowerment Doula Services, we view tools like EFM as just that—tools, not rules.
Birth is not one-size-fits-all. Your experience deserves to be guided by evidence, intuition, and support.
We’re here to help you:
Understand your options
Ask informed questions
Stay grounded in your preferences
Feel confident navigating hospital policies and recommendations
Because when you feel supported, informed, and heard—you step into your power.
Final Thoughts
Electronic fetal monitoring can play an important role in certain situations—but it’s not always necessary for every labor.
The most important thing is that you understand your options and feel empowered to make choices that align with your body, your baby, and your birth vision.
You deserve a birth experience where you feel safe, supported, and in control.
What Is Purple Pushing? And Do You Have to Push That Way?
For many of us, when we think of birth, we imagine a scene similar to what we’ve seen on TV: a woman lying flat on her back, screaming while a doctor urgently tells her to push. While television often exaggerates the drama of birth, some parts of this image do reflect what commonly happens in hospital settings.
In many hospitals, the birthing person is asked to lie on their back with their legs in stirrups. A nurse or provider may then “coach” them on how to push. This usually involves holding your breath while pushing for a count of ten, pulling your legs back, and pushing as hard as possible. This sequence is repeated several times during each contraction.
This method of pushing is often referred to as “purple pushing.”
What Is Purple Pushing?
Purple pushing is a directed pushing technique used during the second stage of labor (the pushing phase). It involves holding your breath and bearing down for about 10 seconds while pushing.
The name “purple pushing” comes from the fact that holding your breath and pushing so forcefully can cause your face to turn red or purple.
While this method has become very common in hospital births, it’s important to understand that it isn’t the only way to push—and it may not always be the most beneficial approach.
Why Can Purple Pushing Be Problematic?
When you hold your breath while pushing, oxygen flow to both you and your baby is temporarily reduced. When this happens repeatedly during contractions, it can sometimes lead to signs of stress for the baby.
If a baby begins to show signs of distress during labor, providers may feel the need to intervene. This could include:
Assisted delivery using forceps or a vacuum
Additional medical interventions
In some cases, an emergency C-section
While these interventions can absolutely be necessary in certain situations, reducing unnecessary stress during labor may help decrease the likelihood of needing them.
You Don’t Have to Push This Way—Even With an Epidural
A common misconception is that if you receive an epidural, you must push using the purple pushing technique. However, this isn’t necessarily true.
When an epidural is working well, you should still be able to feel pressure from your baby’s head as it moves down the birth canal. This pressure can naturally signal when your body is ready to push.
Instead of holding your breath for long periods, many people find that following their body’s natural urges leads to shorter pushes or small grunts during contractions. You may briefly hold your breath during these pushes, but there are also natural pauses where you breathe normally—allowing oxygen to continue flowing to you and your baby.
This is often called physiological or instinctive pushing.
You Don’t Have to Push on Your Back
Another myth is that if you have an epidural, you must push while lying flat on your back. In reality, many positions are still possible and may even help labor progress more effectively.
Some alternatives include:
Side-lying position with a partner or nurse supporting your leg
Semi-sitting or upright positions
The “throne” position, where the hospital bed is raised fully so you are sitting upright while pushing
Upright or side-lying positions can help work with gravity and may feel more comfortable for many birthing people.
You Still Have Options in Birth
Giving birth is incredibly hard work, and it can also be painful. Choosing to get an epidural is a completely valid decision, and no one should feel judged for making the choice that feels right for them.
But it’s important to remember that having an epidural does not mean you lose all of your options.
Even if a doctor or midwife recommends a certain position or pushing method, you still have the right to ask questions, request alternatives, and make informed choices about your body and your birth whenever possible.
Why Birth Support Matters
Advocating for yourself during labor can be challenging—especially when you’re focused on bringing your baby into the world. This is where a support team can make a huge difference.
A partner, family member, or doula can help communicate your preferences and support the birth plan you created ahead of time.
Creating a birth plan before labor begins helps ensure that everyone on your support team understands your wishes and how best to support you if challenges arise.
Birth doesn’t always go exactly according to plan—but having knowledge, support, and options can help you feel more confident and empowered throughout the experience.
Why it is Important to have a Doula in Your 2nd Pregancy and Beyond
Many parents assume they don’t need a doula for their second pregnancy. After all, you’ve already given birth once — you know what to expect… right?
The truth is, hiring a doula for your second pregnancy can be just as valuable — and sometimes even more important — than the first time around. Every birth is different, and experienced moms deserve experienced support.
If you're considering birth support for baby number two (or three or four), here’s why a doula still makes a powerful difference.
1. Every Birth Experience Is Different
Just because you’ve given birth before doesn’t mean this experience will be the same.
Your second labor may:
Move faster
Feel more intense
Bring up emotions from your previous birth
Unfold differently than expected
A doula for your second birth provides:
Emotional processing from your first experience
Updated birth planning support
Evidence-based information for informed decisions
Continuous labor support
Whether your first birth was empowering or traumatic, this birth deserves intentional preparation and support.
2. You’re Parenting While Pregnant
Second pregnancies are different because you’re not just pregnant — you’re already a parent.
You may be:
Caring for a toddler while exhausted
Balancing work and family life
Feeling stretched thin emotionally
Wondering how to prepare your older child for a new sibling
Having a doula during your second pregnancy means you have someone supporting you while you support everyone else.
Experienced moms still need care. You don’t have to do this alone.
3. Second Labors Are Often Faster (But More Intense)
Many second-time moms experience shorter labors. While that sounds appealing, fast labor can also feel overwhelming.
A doula helps by:
Guiding you on when to head to your birth location
Providing hands-on comfort measures immediately
Supporting your partner
Helping you stay grounded during rapid progression
Even if labor is shorter, continuous birth support improves outcomes and overall satisfaction.
4. Your Partner Benefits from Doula Support Too
Your partner may feel more confident this time — or they may feel pressure to “get it right.”
A doula:
Refreshes comfort techniques
Provides guidance in the moment
Offers reassurance during intense stages
Allows your partner to take breaks without leaving you unsupported
Second-time parents still deserve a supported birth team.
5. Postpartum with Multiple Children Is a Big Transition
Postpartum recovery looks different when you already have children at home.
You’re navigating:
Physical healing
Newborn care
Sibling adjustment
Household responsibilities
Emotional shifts
A postpartum doula can help you:
Protect your rest
Establish feeding routines
Ease sibling transitions
Reduce overwhelm
Feel seen and supported
Support after birth isn’t just for first-time moms — in many ways, it’s even more important for growing families.
6. You Deserve Support — Every Time You Give Birth
There’s a quiet pressure on experienced moms to “have it figured out.”
But birth is not something you need to prove yourself through.
Hiring a doula for your second pregnancy is not about needing help — it’s about choosing support.
You deserve to:
Feel confident
Feel informed
Feel heard
Feel cared for
No matter how many babies you’ve had, your birth experience matters.
Is a Doula Worth It for a Second Baby?
If you're asking whether you need a doula for baby number two, consider this:
Do you want a different experience than your first birth?
Do you want continuous support during labor?
Do you want extra guidance preparing siblings?
Do you want to feel more confident and less overwhelmed?
If you answered yes to any of these, hiring a doula may be one of the best investments you make for your growing family.
Welcome — I’m So Glad You’re Here
Birth is not a performance.
It’s not a checklist.
And it sure as hell isn’t something you’re meant to survive quietly.
It’s a threshold.
And you deserve to walk through it feeling powerful.
I’m Noelle Voltz-Mongold, BCD, a BEST certified doula and Certified Fertility Advocate serving families across the Shenandoah Valley. I founded Embers of Empowerment Doula Services with one mission: to help you ignite the strength that already lives inside you.
Because you already carry the fire. I’m just here to help you tend it.
How This Began
My journey into birth and reproductive support started in 2020 in Northern Virginia. That was the year I felt the undeniable pull toward this work — toward standing beside people in some of the most intense, transformative, and vulnerable moments of their lives.
Birth. Loss. Conception. Becoming.
These moments change us. And they deserve reverence, protection, and fierce support.
After moving to the Shenandoah Valley and settling into this breathtaking community, I knew it was time to build something rooted here — something bold, something honest, something that honored both the grit and the grace of this region.
That’s how Embers of Empowerment was born.
Why “Embers”?
Because empowerment isn’t something I hand to you.
It’s already there.
Even when you’re anxious.
Even when you’re overwhelmed.
Even when the system makes you feel small.
I believe every person holds embers of empowerment within them. Sometimes, those embers are glowing strong. Sometimes they’re barely flickering. My role is to protect that spark, feed it with evidence-based education and unwavering support, and help it grow into a steady, roaring fire.
Not toxic positivity.
Not blind “trust the process.”
Real preparation. Real advocacy. Real support.
What I Bring to the Fire
As a BEST certified doula and Certified Fertility Advocate, I support individuals through:
Fertility journeys
Pregnancy
Labor and birth
Immediate postpartum
The emotional terrain that comes with it all
I am not here to speak over you.
I am not here to replace your medical team.
I am here to make sure you feel informed, grounded, and powerful in your decisions.
Whether you’re planning a hospital birth, home birth, medicated, unmedicated, or still figuring it out — this is about your autonomy.
Your body.
Your baby.
Your experience.
My work here is about building a culture of informed choice, bold advocacy, and compassionate care. It’s about making sure you never feel alone in rooms where big decisions are being made.
You deserve support that is steady.
You deserve someone who isn’t afraid to speak up.
You deserve to feel like the main character in your own birth story.