• eFM: fetal heart monitoring
    eFM: fetal heart monitoring
    eFM: fetal heart monitoring
    • Provides training in all aspects of intrapartum electronic fetal monitoring
    • Equips you to interpret CTGs correctly, thereby minimising medical and legal risks
    • Uses sophisticated interactive simulator containing case studies with real traces

An e-learning tool for midwives and obstetricians

eFM provides comprehensive training in all aspects of intrapartum electronic fetal heart monitoring. It equips both obstetricians and midwives with the knowledge and skills to interpret cardiotocographs (CTGs) correctly, thus minimising medical and legal risks.

An online course for obstetricians and midwives

eFM is a valuable resource whether you're a trainee or a fully qualified healthcare professional. The programme has been developed in the UK by the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and Health Education England e-Learning for Healthcare. So, it meets the highest quality standards.

During the programme, you can complete:

  • knowledge-based sessions that cover subjects such as normal and abnormal CTGs, the impact of labour interventions and risk management
  • self-assessment tests
  • real-life case studies that feature fetal heart rate recordings from actual labours
  • an extensive e-library of relevant articles 

Test your interpretation skills 

Using the interactive case studies, you can review the clinical information, test your interpretation skills and look at:

  • whether there are any risk factors for intrapartum fetal hypoxia
  • classifying and defining the EFM
  • distinguishing between normal and abnormal traces
  • explaining the reasons for the FHR appearance
  • recognising the types of decelerations
  • understanding the different types of hypoxia and anticipating any CTG changes that may result
  • choosing appropriate management options.

Each case study takes around 30 to 45 minutes to complete. On completion, you can compare your performance with that of leading clinical experts.

A comprehensive e-library

You can also access an extensive e-library, which includes clinical guidelines, Cochrane reviews and articles from the International Federation of Gynecology and Obstetrics and other professional organisations.

This high-quality programme, which has won a UK e-learning award for innovation, is setting the standard for the training of midwives and obstetricians. 

Any questions?

If you have any further queries on our programmes, please take a look at our frequently asked questions or contact us.

Course Content

eFM is arranged into five courses by subject theme:

Course 1 – Background and Practical Issues

  • History of fetal heart rate (FHR) monitoring, the importance of intrapartum (IP) fetal hypoxia and using the FHR as a screen for IP fetal hypoxia
  • Indications for continuous electronic FHR monitoring (EFM) in labour (risk for fetal hypoxia) and the role of the admissions test
  • A review of the evidence of the value of EFM in terms of maternal, fetal and neonatal outcomes

Course 2 – Care in Normal Labour

  • Care of women
  • Appropriate fetal monitoring in women at low risk for IP fetal hypoxia

Course 3 – Normal and Non-normal CTGs

  • The normal CTG (control, terminology, definitions and basic interpretation)
  • The impact of IP fetal hypoxia on the FHR (two sessions)
  • More complicated FHR traces (e.g. sinusoidal)
  • Interpretation in special circumstances, including breech, pre-term and multiple pregnancy (two sessions)

Course 4 – Management Issues

  • Labour interventions that can affect the FHR (e.g. oxytocics, medication and regional analgesia)
  • Interventions intended to improve the FHR (e.g. maternal positions, oxygen and reducing uterine contractions)
  • Additional tests that help clarify fetal status (e.g. fetal pH and ECG)
  • NICE guidelines

Course 5 – Education and Governance

  • Educational methods for improving EFM interpretation and management
  • Risk management issues, including governance and audit

In addition to the knowledge-based sessions, you can complete self-assessment exercises and interactive case studies.


Below you will find examples of a knowledge-based session and a case study. To work your way through these, simply click on the 'Next' button on the top right-hand corner of each page and follow the instructions.

The History of, and Rationale for, Electronic Fetal Monitoring

This session describes the history of, and rationale for, fetal heart rate monitoring.

Case Study

This interactive case study allows you to test your CTG interpretation skills using fetal heart traces from real labours and examine the associated clinical notes.


Multiprofessional and multidisciplinary management sits at the heart of maternity care. eFM is the perfect example of a multiprofessional training package developed by a multidisciplinary team of experts in the field of maternity and perinatal care.

eFM is an essential training tool for clinicians to help them hone their CTG interpretation skills and, hence, reduce complications related to CTG misinterpretation and unduly delayed intervention.
Professor Khaled Ismail, Honorary Director of eLearning, RCOG

eFM is an additional resource to help supplement doctors’ knowledge about the use of electronic fetal monitoring in obstetric care. These CTG machines have an important role in risk management and have helped to improve maternal and fetal outcomes. It is therefore essential that maternity professionals know how to interpret CTG readings so that timely care can be offered. I would encourage all my labour ward colleagues to complete eFM.
Dr David Richmond President, Royal College of Obstetricians and Gynaecologists (RCOG)

eFM is a fabulous resource for midwives, student midwives and doctors. It provides a great platform and demonstrates the benefits of professionals learning from the same resources to enable a shared understanding of the issues around fetal monitoring.
Professor Lesley Page, President, Royal College of Midwives


Single-user access to the eFM e-learning programme for 12 months costs £100 (excluding VAT where applicable). You may also pay by monthly or quarterly subscription. To purchase a licence, please click on the ‘Register’ button below.

Once you have submitted your details and your payment has been processed, your account details (user name and password) will be emailed to you within two to three working days.

For organisations requiring in excess of 25 licences, please This email address is being protected from spambots. You need JavaScript enabled to view it. to find out more about our institutional pricing packages.