Monitoring your baby

During labour various assessments can be used to ensure your labour is progressing normally and your baby is not experiencing difficulties.  One thing we recommend is listening to your baby’s heartbeat.

During labour when the uterus (womb) contracts the maternal blood flow does not flow as freely through the placenta and your baby has reduced oxygen supply.  This is completely normal and babies are able to adjust to this without any problems.  Occasionally babies have difficulty in adjusting and this may be reflected in the pattern of the heartbeat.

Methods of monitoring

Before we start to monitor your baby the midwife or doctor will ask you if we can assess your heart rate as well as the baby’s heart rate so we can establish the difference between the two. The baby’s heart beat can be monitored in two different ways:

• By intermittent monitoring (auscultation)
• Continuous electronic fetal monitoring (CTG)

Intermittent monitoring

Intermittent monitoring means listening to your baby’s heart beat with a pinard stethoscope or hand held doppler at different time intervals (you will have seen these be used by the community midwife). A Pinard stethoscope is a plastic or metal trumpet shaped object, which enables the midwife or doctor to hear the baby’s heartbeat when held against your abdomen.  A “Doppler” is a small hand-held device which looks like a microphone.  When placed against your abdomen it magnifies the sound of the baby’s heartbeat enabling the midwife and you to hear the baby’s heartbeat at the same time.

With intermittent monitoring you have the ability to move around and will only be limited when the baby’s heartbeat needs to be listened to.  This will happen more frequently as labour progresses.

Intermittent monitoring is the recommended method of monitoring babies for women who are healthy and who have had a trouble-free pregnancy. There may be times when your midwife will recommend changing from intermittent auscultation to continuous fetal monitoring.  This will be discussed with you and an individualised plan of care will be made. 

Continuous electronic fetal monitoring

Continuous monitoring records the baby’s heartbeat throughout the entire labour period. This is carried out using a piece of equipment called an electronic fetal heart rate monitor.

The system works whereby two sensors are held against your abdomen using elastic belts. One sensor detects the baby’s heartbeat; the second sensor records the frequency of any contractions or surges.  

These can have “wireless” connections so you are able to move around more freely and are waterproof so can be used in the birthing pool.  When wearing a wired monitor you can adopt different positions, use the birthing ball and stand.  The monitor records your contractions and the baby’s heartbeat pattern on a strip of paper, this may be referred to as a “trace” or a “CTG” (cardiotocograph).  The midwife will read and interpret the trace to monitor how well your baby is adjusting to the labour.

The CTG will be reviewed hourly by two midwives or a doctor.  You may hear this referred to as “Fresh Eye’s”.  Changes in the pattern of the heartbeat are normal, for example when the baby is sleeping or moving around.  Your midwife or doctor will be able to give explanations of the various interpretations of the trace.  There may be times when your midwife will recommend a fetal scalp electrode, this will be discussed with you first and an individualised plan of care will be made.  This monitoring device is applied to your baby’s head and the electrode picks up the baby’s heartbeat directly.  It is attached to the baby’s scalp, during a vaginal examination, and the leads are then connected to the monitor.  Being attached to the monitor may limit your ability to move around. However, small movements from sitting to standing may be possible and are encouraged.

Reasons for recommending intermittent monitoring:

• Pregnancy greater than 37 weeks
• No complications in the antenatal period
• Midwifery led care
• Women who are at low risk of complications in the first stage of labour (This list is not exhaustive)

Reasons for recommending continuous monitoring:

You have health problem such as:

• Diabetes
• Infection
• Pre-eclampsia (high blood pressure) factors relating to the current or previous pregnancy
• The pregnancy has lasted longer than 42 weeks
• An epidural is being used for pain relief
• There is vaginal bleeding before or during labour
• The labour is induced or strengthened with an intravenous infusion (drip)
• Intermittent monitoring has detected a possible abnormal fetal heart rate
• It is a twin / triplet pregnancy
• You have had a previous caesarean section
• Your baby is small for dates or premature
• Your baby is presenting in the breech position (bottom first)
• Your baby has passed meconium (opened his/her bowels) which is evident when your waters break.
• Problems with baby’s heart of kidney
• There is reduced amniotic fluid around your baby. (This list is not exhaustive)

Further information

Please ask your midwife if you have any further questions.  Further information regarding fetal monitoring can be obtained from doctors and midwives in the integrated teams, on labour suite or at antenatal clinics. At around 34 to 36 weeks of your pregnancy you will have the opportunity to discuss monitoring in labour, and make a plan that is individual to you.

References

Gibb D and Arulkumaran S (2008) Fetal Monitoring in Practice Butterworth-Heinemann Ltd, London NICE (2017) Intrapartum Care: care of healthy women and their babies during childbirth. National Institute of Clinical Excellence (NICE) 2017