Fifty years ago, the initial aim for electronic fetal monitoring (EFM) was to prevent stillbirth. That was reasonably successful. The main purpose of EFM was to decide who needed a fetal scalp sample to diagnose fetal acidosis. In the early 1980s, scalp sampling was abandoned as key leaders felt the EFM was equivalent. Then the hope was to expand EFM's scope to prevent neurological compromise and developmental delay, which even today's leaders have published has only about a 50% accuracy. Multiple attempts over the past three decades to improve EFM with computerization have also failed to hold up. We believe EFM must be considered and analyzed as a classic screening test and requires contextualization for improved performance. Our metric, the Fetal Reserve Index, does that and has demonstrated significantly improved performance metrics. It is working its way through the phases of development and diffusion towards widespread clinical implementation.