Ms. Goer,

I posted the "insulin" post.  I had one more consideration that I could really use your help with.

I really want to avoid continuous electronic fetal monitoring.  I've read there's no evidence that EFM improves outcomes for low-risk women. 

Does my requiring insulin make me high risk in and of itself? 

Even if I am high risk, is there any evidence that EFM improves outcomes for high risk women?

Thanks so much.  You provide an incredible service to women.

Sara

If your sugars are under control, I don't see how you or your baby would be at excess risk, but I am not a clinician. Regardless, continuous EFM has not proven beneficial for low- or high-risk labors with one exception: When high-dose oxytocin (A.K.A. Active Management of Labor) is being given, continuous EFM reduces the incidence of newborn seizure, although even here, no differences in long-term outcomes were seen. It may be wise, though, to err on the conservative side and accept continuous EFM when being given oxytocin regardless of dosage regimen. Here's the skinny on EFM:

Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2006;3:CD006066. 

-- Henci