This information leaflet has been produced to provide information to women and their families about monitoring of their baby during labour.
Why monitor a baby’s heart rate in labour?
Most babies go through labour and birth without any problems but there are a few who may have difficulties. To find out if a baby is having any problems the best way is to listen to their heartbeat regularly, throughout labour. During labour, the baby and placenta are squeezed during contractions and are both are designed to cope well with this. However, in some cases, babies are less able to cope and this can be identified by changes in the heart rate pattern.
Alongside the use of fetal monitoring your midwife and team will assess other indicators to understand your baby’s ability to cope in labour. These include the history of your pregnancy as well as factors that can change during labour, for example:
- The colour of your waters may suggest that your baby has opened their bowels (meconium stained liquor)
- Your observations are out of the normal range (blood pressure, temperature, pulse and respiratory rate)
- You have bleeding, other than a show
- You have an oxytocin drip (to induce labour or to progress a labour that has slowed)
- You have an epidural as pain relief
What are the methods of monitoring the baby?
The baby’s heartbeat can either be monitored at regular intervals throughout labour (intermittent auscultation) or continuously through labour (continuous electronic fetal monitoring). While monitoring the baby’s heartbeat the midwife will check your pulse in order to distinguish between the baby’s heart rate and your own.
Intermittent auscultation
If your pregnancy has been straight forward and you have no additional risk factors, then the recommended method to listen to your baby would be intermittent monitoring using a pinard stethoscope or a handheld Doppler. During the first stage of labour this is done every 15 minutes and during the second stage (pushing stage) it is done at least every 5 minutes.
Continuous electronic heart rate monitoring
There are some factors which mean monitoring your baby’s heart rate continuously during labour will be recommended- for example if your baby is thought to be small or you have previously had a caesarean section. This may also be recommended if any problems with the baby’s heartrate are detected during intermittent auscultation or any risk factors change during your labour.
Continuous monitoring is performed using two elastic belts around your abdomen to hold on two sensors. One detects baby’s heartbeat and the other monitors the timing of your contractions. The midwife caring for you will continuously assess your baby using both the heart rate pattern and your individualised risk/progression of labour. Every hour a second midwife or doctor will also perform the assessment- this is known as “Fresh Eyes”.
If there are problems picking up the baby’s heart rate continuously you may be asked to try alternative positions or you may be advised that a fetal scalp electrode (FSE) is appropriate. This is a small wire electrode which is attached directly to the scalp of the baby’s head during a vaginal examination. This usually stays in place until the birth of the baby. Sometimes a small mark can be seen on baby’s head following birth but usually disappears within a few days.
Choice of fetal monitoring
It is important to have conversations during your pregnancy with caregivers so that you are fully informed of your available choices. Having an understanding prior to labour of what is available and also what can change during labour helps you to feel more involved in the planning of your care. Often women and their support person like to hear the baby’s heartbeat but some find it worrying. Having clear conversations with your midwife helps them to help you. Discussing your wishes with your birth partner also helps everyone to understand your choices.
Confidentiality
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For further information on confidentiality contact the Information Governance Team:
Information.Governance@ncic.nhs.uk | 01228 603961
Feedback
We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:
pals@ncic.nhs.uk | 01228 814008 or 01946 523818
If you would like to raise a complaint regarding your care, please contact the Complaints Department:
complaints@ncic.nhs.uk | 01228 936302