Monitoring your baby in labour and birth

Monitoring your baby in labour and birth

What is Fetal Monitoring and why do we offer it?

As well as checking on you throughout labour, your midwife will check how you baby is doing. They will do this by monitoring your baby’s heart rate.

It does not predict birth outcomes or what will happen during labour but gives us a snapshot of how your baby is at that moment.  

Fetal Monitoring might help detect changes in your baby’s normal heartbeat pattern, this is a way of understanding your baby’s wellbeing and demonstrate how your baby is coping with the stress of labour.

If Fetal Monitoring suggests that your baby is no longer coping with labour stress, then we can take action in a timely manner to aim to reduce the risk of harm. 

Your baby’s heartbeat can be monitored in two ways:

At regular intervals, by a handheld doppler or Pinard Stethoscope this is called Intermittent Auscultation.

OR 

By continuously by Continuous Electronic Fetal Monitoring (EFM) you may have heard it called a CTG Trace.

Intermittent Auscultation

Intermittent auscultation can be done in two ways: By using an instrument like an ear trumpet called a Pinnard stethoscope, or by using a handheld ultrasound machine called a Doppler, your midwife may also call it a Sonic aid. You may have seen your community midwife use these during pregnancy. 

In active labour your baby’s heartbeat is normally monitored every 15 minutes during the first stage of labour and every five minutes during the second stage of labour or the ‘pushing’ stage.

This method is recommended to listen to your baby’s heartbeat if you are in labour between 37 weeks – 41 weeks and 6 days pregnant and do not have any complications or risks in your pregnancy or labour.

This type of monitoring can be carried out at home, on the Meadow Birth Centre or on Delivery Suite. If we have any concerns, you may be advised to commence Continuous Electronic Fetal monitoring (CTG). Your midwife will explain why this is now recommended.

Continuous Electronic Fetal monitoring (CTG) can only happen on Delivery Suite or Maternity Triage.

Intermittent Auscultation allows you to be mobile during labour as you are not attached to anything, with snap shots of the baby’s heart rate taken at various times depending on how your labour is progressing.

CTG (Continuous Electronic Fetal Monitoring) Abdominal Transducer

Continuous Electronic Fetal Monitoring (EFM) (CTG) is advised when risks are identified to yourself and / or your baby either during pregnancy or labour.

This risk assessment is an ongoing process, if any changes happen and your risk or baby’s risk changes this will be discussed with you by the midwife or doctor at the time.

The Continuous Electronic Fetal Monitoring (EFM) records your baby’s heartbeat this then prints as a pattern on a piece of graph paper which is called a cardiotocograph (CTG) or a ‘trace’.

The midwife and the doctor will interpret the trace to get an idea of how the baby is coping with labour. They will be able to explain their findings to you.

Continuous Electronic Fetal monitoring (CTG) can be done in two ways:  

1. Transducers attached to your abdomen (tummy)

Two transducers are fastened around your abdomen (tummy). One transducer monitors the baby’s heartbeat while the other monitors your contractions. There are attached using a stretch belt and are usually linked to device by the side of the bed by wires.

Being attached to the monitor for continuous EFM can limit your ability to move around, however you will still be able to get off the bed, use a birthing ball and will be able to adopt a variety of positions.

We have wireless transducers available on delivery suite which allow better mobility during labour. If you would prefer wireless monitoring, please speak to your midwife about this when arriving on Delivery Suite.

2. Fetal Scalp Electrode

In some situations, the baby may not be able to be recorded well through the abdomen (tummy) this is for many reasons which can include your baby moving around and getting into position ready for birth.

This is normal however if the transducers on your tummy aren’t able to record your babies heart rate well then your Midwife or Doctor may suggest applying a Fetal Scalp Electrode (FSE) onto the baby’s head.

An FSE is a small spiral wire (that is less than 1mm thick) that is fastened on your baby’s head.

This is inserted through the vagina (the same as having an internal examination) and fastened to your baby’s head with a very small clip. It is then attached to a conductor which will be stuck on your leg (similar to a plaster) and a cable will then link it to the Electronic Fetal Monitor (EFM / CTG).

An FSE does not harm the baby although you may notice a small graze on the baby’s head after birth.

This electrode can then pick up the signals of the baby’s heartbeat more easily because it is directly attached to the baby, it will stay in place until the baby is born.

An FSE will only be offered to you if you are in labour, and your waters have broken. It would be used instead of the transducer on your abdomen that listens to your baby’s heartbeat. It is not always appropriate for an FSE to be attached; your Midwife will discuss this with you if that is the case.

Please note that transducer on your abdomen that records your contractions will still be in place on your abdomen.

What choices do I have for Fetal Monitoring in labour? 

It is recommended that all women have Fetal monitoring in active labour. 

If during your pregnancy you decide to choose a different method of Fetal monitoring in labour to the one that has been recommended to you, this will be discussed as part of your personalised care plan. You may be referred for further discussion if appropriate.  

Our recommendations regarding Fetal monitoring are based on our hospital and national guidelines, see below.  

PLEASE NOTE: We strongly advise against buying any equipment or apps to listen to your baby’s heartbeat at home. They are a piece of medical equipment and are to be used only by a trained medical professional.

If you have any concerns about yourself or your baby, then you should discuss with a midwife or doctor.

For further information please read the Movement Matters page on the Tommy’s website.

If you are concerned about your baby’s movements, please call Maternity Triage on 01905 733196.

Further information and references on guidance:

• https://www.nice.org.uk/guidance/NG229/chapter/Recommendations
• https://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf