The “Worst Test in Medicine” Is Fueling America’s Sky‑High C‑Section Rate

Electronic fetal monitoring (EFM)—the practice of watching a baby’s heart rate around the clock during labor—has become almost universal in U.S. hospitals. Yet, despite its prevalence, decades of research show that the test rarely improves outcomes for mother or child. Instead, it often triggers false alarms that push obstetricians toward unnecessary cesarean sections.Why does a tool with such a poor track record remain the standard of care? The answer lies less in medicine than in business and legal pressures. Hospitals and physicians fear malpractice lawsuits, and insurers reward the use of “high‑tech” monitoring as a defensive measure. As a result, continuous fetal monitoring is performed in nearly every delivery, even when a low‑risk mother would be just as safe with intermittent auscultation.Studies consistently link routine EFM to higher rates of operative deliveries—both C‑sections and instrumental vaginal births—without a corresponding drop in infant mortality or long‑term neurological problems. The monitor’s heart‑rate patterns are notoriously ambiguous; a spike that looks like distress often turns out to be a harmless variation. When clinicians act on these ambiguous signals, they frequently opt for surgery rather than waiting to see if the baby recovers on its own.The consequences are significant. Unnecessary C‑sections expose women to greater risks of infection, hemorrhage, blood clots, and complications in future pregnancies, such as placenta previa or uterine rupture. Babies delivered surgically also face higher chances of breathing difficulties and longer hospital stays.In recent years, a growing coalition of obstetricians, midwives, and patient‑advocacy groups has begun to question the routine use of EFM. Some hospitals are piloting “selective monitoring” protocols, reserving continuous tracing for cases with clear medical indications—such as maternal hypertension, fetal growth restriction, or abnormal early labor patterns. Early data suggest that these targeted approaches can safely reduce the number of C‑sections without compromising newborn health.Nevertheless, changing entrenched practices is slow. Legal concerns continue to drive a culture of defensive medicine, and many clinicians feel pressured to document continuous monitoring as a safeguard against potential lawsuits. Until liability reforms and clearer clinical guidelines take hold, the “worst test in medicine” is likely to remain a mainstay of American obstetrics, perpetuating the nation’s already elevated cesarean‑section rate.