04 Jan Fetal Monitoring in labour
Your baby’s heartbeat will be monitored by your midwife whilst you are in labour, this is to ensure that your baby is coping well. Most babies cope completely fine during labour but if they were to become a little unhappy or stressed with the pressure of contractions then this would show in their heart rate pattern. Therefore your midwife will be monitoring your babys heart rate closely throughout the duration of your labour and this can be done by three different methods.
If you have a low-risk pregnancy then you will be offered intermittent auscultation. This is where your midwife will use a handheld doppler to listen to your babys heart rate (The same handheld doppler your midwife uses when you go for your antenatal check-ups). Your midwife will listen to your babys heart rate for at least 1 minute following a contraction at 15-minute intervals whilst you are in labour. When you start the pushing stage of labour when you are fully dilated, your midwife will then check more frequently, around every 5 minutes. If you have a home birth this is the method of monitoring you will have.
The benefits of intermittent auscultation are:
- You are able to stay mobile and move freely around the room, we can usually monitor your baby in most positions you choose to labour in!
- If your pregnancy has been low risk then it reduces the risk of unnecessary interventions
- Suitable for use in water births.
If there is any concern about your babys heartbeat during intermittent auscultation then they will then transfer you to continuous monitoring straight away.
Continuous monitoring is done using a machine called a cardiotocograph, or CTG for short. This can be kept on for as long as necessary and will give a continuous reading and a print out showing babys heartbeat and pattern. It will also monitor any contractions you are having. Two transducers are placed on your abdomen. One will monitor your babys heart rate and the other will monitor the frequency of your contractions. These are held into place with straps which go around round your abdomen. It will be recommended for you to have CTG monitoring if you have any risk factors during your pregnancy, such as gestational diabetes or raised blood pressure. If there have been any complications during your labour, such as meconium (babys first bowel movement) in your waters, slow labour progress or baby showing signs of distress. If you have an induction or you have an epidural then these are also reasons for needing CTG monitoring.
The advantages of CTG monitoring include:
- It can be reassuring for you and your birth partner to continuously see a reassuring heart rate
- The midwife can see any changes in your babys heart rate pattern and take quick action if non-reassuring.
Disadvantages include not being able to move as freely around the room as you will be attached to wires on the machine. However, you may still be able to sit on a birthing ball next to the machine, discuss with your midwife different positions you can try whilst on the CTG so you do not have to be lying on the bed.
Sometimes it can be difficult to monitor your babys heart rate using the CTG and there can be some loss of contact, for example for women with a larger BMI or a baby in an unusual position. Therefore it may be necessary to use something called a fetal scalp electrode to monitor your babys heart rate. This is a small clip, applied during a vaginal examination that goes onto your babys head.
Your consent will always be required for any form of fetal monitoring during your labour however midwives and doctors will always have yours and your babys safety at the forefront of their decisions and will suggest the method which is most suitable for you to ensure the best possible outcome for your labour and birth.