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A Brief Overview of Electronic Fetal Heart Monitoring

Dr. James C Johnston

Dr. James C. Johnston is a board certified neurologist and attorney, the founding partner of Global
Neurology and Director of Global NeuroCare. Over the course of his career, Dr. James C. Johnston has published over one hundred peer-reviewed articles, papers and book chapters on various subjects related to neurology, including the use of electronic fetal heart monitoring.

Electronic fetal monitoring (EFM) is a medical procedure utilized for fetal surveillance during labor. It was developed over fifty years ago and in a very short time became virtually the sole monitoring method in the developed world countries. Today is used in over 85% of deliveries in the United States, despite overwhelming and damning scientific evidence that it is based on myth, has never reduced the rate of cerebral palsy (CP) or any other birth related neurological malady, and causes more harm than good to mothers and babies.
EFM has a 99.8% false positive rate, triggering unnecessary cesarean sections or instrumented deliveries with all of the attendant complications of those procedures. And yet obstetricians continue to use EFM, ignoring scientific evidence-based medicine, under the misconception that it provides some defense to a malpractice suit. This is, of course, another birth myth, well documented in the medical and legal literature for years.
The manner in which EFM is used today is not only medically harmful, but eviscerates patient autonomy by ignoring the principle of informed consent.
Dr. James C. Johnston and his colleagues have published a number of peer-reviewed articles discussing the ethical and legal concerns of EFM, and how the procedure should be taught to physicians in training.
The following links provide access to some of the articles, which are also available on
under the profile for Dr. James C. Johnston:
Maternal Health, Neonatology and Perinatology:
J Maternal, Fetal and Neonatal Medicine:
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