Monitoring your baby during labour

Midwife, Anne Richley, explains your options for keeping tabs on your baby while giving birth

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What kind of monitoring is there?

There are two kinds. The first is called intermittent monitoring and means regular, but not continuous, monitoring of your baby’s heart rate.

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If you’re healthy and have had a trouble-free pregnancy, this is the recommended method. It should happen every 15 minutes during the early stages of labour, increasing to once every five minutes, or following every contraction in the later stages.

It’s done using a Pinard (trumpet-shaped stethoscope) or a Doppler (a small hand-held device, which your midwife may have used during your antenatal checks). It allows you and your midwife to listen to your baby’s heartbeat using ultrasound waves.

Intermittent monitoring won’t restrict your ability to move around, as the midwife can listen wherever you are and whatever position you choose.

The other kind is called continuous monitoring, which involves using an electronic foetal heart-rate monitor. This prints out the results, often referred to as a CTG (cardiotocograph), and keeps track of your baby’s heartbeat for the whole labour.

The sensors, which are usually held in place on your abdomen with elastic belts, and are connected to the monitor, detect your baby’s heartbeat.

Occasionally a foetal scalp electrode(may be called a ‘clip’ or FSE) is used. This picks up your baby’s heartbeat, as it’s attached to his scalp through the vagina during an internal examination.

Continuous monitoring may be advised if:

  • Your midwife or doctor has listened to your baby’s heartbeat with a Pinard stethoscope or Doppler and thinks that he may not be coping well
  • You have a health problem such as diabetes, or an infection
  • You’re having an epidural
  • You‘ve had bleeding from your vagina during labour
  • Your labour’s induced (ie.started artificially) or strengthened using a drip (oxytocin)
  • You have a twin/triplet pregnancy
  • Your baby is small or premature

What does it mean?

Your midwife or doctor interprets the trace on the print-out to see how well your baby’s coping with labour. It’s normal for there to be variations in your baby’s heartbeat, such as when he’s sleeping or moving around, for example.

When a baby’s active his heartbeat increases. During a contraction his heartbeat may slow down, as the blood flow is reduced to the placenta. But it should return to normal rate afterwards.

If changes in the heart rate suggest that your baby’s not coping well with labour, you may be asked for your permission to take a sample of blood from your baby’s scalp during an internal examination. The oxygen levels can then be tested to try to avoid an unnecessary caesarean section.

Which should I choose?

Current research suggests that, if you’re considered low risk, your baby’s heartbeat doesn’t need to be monitored with an electronic foetal heart monitor when you arrive at the hospital.

Being attached to this monitor can limit your freedom to move around, and you won’t be able to have a bath, for example. This lack of mobility can cause anxiety and slow labour down, as well as making it more difficult to cope with the contractions. Occasionally, the trace can make a midwife or doctor suspect that your baby’s not coping well when, in fact, he’s fine.

Research has shown that the use of continuous monitoring doesn’t improve the outcome for babies, but
it does increase the caesarean rate. This is why intermittent monitoring is recommended in a normal labour. Ultimately, of course, the choice is yours, and you should discuss your own circumstances with your midwife, who can give you more information.

View from the clinic…

Last week I cared for a woman on the labour ward who’d been advised to have continual monitoring of her baby’s heartbeat during labour.

Despite having her mum and partner with her for support, they seemed more interested in watching and listening to the machine, warning her “you’ve got a contraction coming…”

It was a bit like having the TV on in the room, with them both staring at it, while paying little attention to the woman they loved, huffing and puffing through her contractions!

During your labour your midwife will be watching and monitoring the wellbeing of you and your baby. Most babies come through labour without any problems, but there are a few who don’t cope so well.

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One of the ways of keeping track of your baby is by regularly checking the pattern of his heart rate. This is known as foetal- heart monitoring, and there are various ways of doing this.

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