03/19/2026
Intermittent auscultation is better for most women.
Just because electronic fetal monitoring (EFM) looks more sophisticated doesn't mean it renders better results. EFM has NEVER been shown to improve outcomes.
The American College of Nurse-Midwives has released an updated Clinical Bulletin "Intermittent Auscultation for Fetal Heart Rate Surveillance" now available as an open access and member resource in 'sHealth
This Clinical Bulletin reviews the evidence supporting intermittent auscultation and provides clear recommendations for technique, interpretation, and documentation. In Canada and the United Kingdom, IA is the preferred method of fetal surveillance for individuals who enter labor at term without medical or obstetric conditions associated with uteroplacental insufficiency or increased risk of fetal acidemia. The American College of Obstetricians and Gynecologists likewise affirms that IA is acceptable for patients without complications.
The evidence base is clear: for appropriately selected individuals, intermittent auscultation is associated with equivalent neonatal outcomes compared with EFM and fewer cesarean and operative vaginal births. Operative births carry additional risks for both birthing people and newborns. IA also facilitates mobility, comfort, and physiologic labor progress, while supporting continuous labor support practices that are themselves evidence-based.
The bulletin outlines practical, implementation-ready guidance. IA should be used according to defined criteria, including clear parameters for when to convert to EFM. Recommended techniques include multiple-count methods (e.g., listening for 6 seconds and multiplying by 10, repeated several times), which appear more accurate than single-count approaches. Listening through contractions, rather than only between them, improves detection of periodic or episodic changes that may warrant escalation. Documentation should use approved terminology and reflect both auscultated characteristics and the broader clinical context of labor.
This updated Clinical Bulletin was developed under the guidance of ACNMâs Research and Standards Committee and reflects interdisciplinary collaboration and expert review. Authors: Kristen Ostrem-Niemcewicz CNM, DNP, FNP-BC, Jessica Holm CNM, MSN, Lisa Kane Low CNM, PhD
For clinicians, educators, administrators, and policy leaders, this resource provides research-grounded guidance to support safe, evidence-based, and autonomy-respecting intrapartum care.
Available now at JMWH.org
