What is fetal heart monitoring? 

During labour various assessments are made to ensure labour is progressing normally and your baby is not experiencing difficulties. One such assessment is listening to the baby’s heartbeat. Most babies go through labour and are born without any problems. But there are a few babies who have difficulties and the best way of finding out when a baby is having difficulties is to listen to their heartbeat regularly during labour.

During labour when the uterus (womb) contracts the blood does not flow as freely through the placenta and your baby has a reduced oxygen supply. This is normal and most babies can adjust without any problem. If your baby is having difficulty in adjusting this may be reflected in the pattern of the heartbeat.

Methods of monitoring: 

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

• Intermittent monitoring
• Continuous electronic fetal heart monitoring

Intermittent monitoring is the recommended method of monitoring babies for women who are healthy and who have had an uncomplicated pregnancy.

What do we use for Intermittent monitoring? 

Intermittent auscultation can be done in two ways:

• A Pinard stethoscope- a plastic or metal trumpet shaped object which enables the midwife to hear the baby’s heartbeat when held against your abdomen. 
• A Doppler/Sonicaid- a small hand-held device which is placed on 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. 

The process of intermittent monitoring: 

• Before starting to monitor your baby, the midwife will assess your pulse rate as well as the baby’s heartbeat to establish the difference between the two.
• When you are in active labour (regular contractions and 4cm cervical dilatation), your midwife will listen to your baby’s heartbeat every 15 minutes.
• When you are in the second stage of labour (10cm cervical dilatation or pushing), your midwife will listen to your baby’s heartbeat every 5 minutes or after every contraction.

Benefits of intermittent monitoring: 

• You can move around and will only be limited when the baby’s heartbeat needs to be listened to.
• You can use the pool for labour.
• When pregnancy has been straightforward intermittent monitoring reduces the chances of unnecessary intervention.
• If there is a concern about your baby’s heartrate continuous electronic heart monitoring is advised in such cases, if at home or at the birth centre this means you need to go into hospital.

Continuous electronic fetal monitoring: 

The monitor records your baby’s heartbeat 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 (EFM) can also be done in two ways:

• By fastening two devices around your abdomen (tummy). One device monitors the baby’s heartbeat while the other device monitors the frequency of the contractions and your pulse.
• By fastening one device around your abdomen to monitor the frequency of the contractions. The other device, called a fetal scalp electrode (FSE) is on the end of a very small wire which is passed up the vagina (the same as an internal examination) and fastened on to the baby’s head by a very small clip.
• A FSE does not harm the baby although you may notice a small graze on the baby’s head after birth. The electrode can then pick up the signals of the baby’s heartbeat more easily because it is directly attached to the baby. This electrode stays in place until the baby is born.

A few reasons why continous electronic monitoring is recommended: 

• Diabetes
• Infection
• Pregnancy induced hypertension (raised blood pressure due to the pregnancy)
• Problems with your heart or kidneys
• Your pregnancy is more than 42 weeks
• You are having as epidural as pain relief
• You have had any bleeding from your vagina before or during labour
• Your labour has been induced or accelerated

 

• You have previously had a caesarean section
• You have a multiple pregnancy
• Your baby is small r premature
• Your baby is a breech presentation (going to be born bottom first)
• When the midwife using intermittent auscultation detects a problem
• If when the waters break, they are not clear in colour
• A possible heartbeat problem has been picked up using intermittent auscultation which requires further investigation (this does not always lead to continuous monitoring and may only require a trace of limited time to be carried out)

Disadvantage of continuous fetal heart monitoring: 

Being attached to the monitor for continuous EFM can limit your ability to move, however you will still be able to adopt a variety of positions. There are a few telemetry machines available which are wireless toco and transducer which are attached to your abdomen, this allows you to mobilise around the room without being restricted. Telemetry can also be used in the pool.

Advantage of continuous fetal heart monitoring: 

Understanding how your baby is coping with labour can help the midwives and doctors looking after you make decisions with you about the best and safest care for you and your baby. If the baby is coping well then it is unlikely that you will require delivery by caesarean section, forceps or ventouse (suction cup). If the baby is not coping well then, the doctor will discuss a plan of care with you.

The other indications that a baby is coping well in labour include:

• The baby’s movements, but these can be difficult to observe during labour because your abdomen will be tense during contractions.
• The colour of the liquor (your waters) should be clear. However, the waters break (naturally or forced), if they are not clear this alone does not necessarily mean that the baby is distressed, in these cases we would strongly recommend EFM to achieve closer observation of the baby.

What if I choose not to have fetal heart monitoring?

The kind of monitoring you have while you are in labour is up to you. Most women like to be able to hear their baby’s heartbeat while others find it worrying. You can choose not to have your baby’s heartbeat monitored however this would mean that we would not be able to tell whether your baby is coping with labour. The risk of this is that if your baby were having any problems, we would not know about it. Some of these problems could affect your baby’s health or even be life threatening for your baby. If you are reluctant to have any fetal heart monitoring it would be best to discuss this further with your midwife/doctor. When they are confident that you have made an informed decision, a plan will be made and included in your notes to inform everyone who may care for you in labour.

You can find further information and resources below: 

National Institute for Clinical Excellence

Royal College of Midwives

This patient information is for guidance purposes only and is not provided to replace professional clinical advice from a qualified practitioner.

If you would like to speak to a midwife about any of the information on this page, please contact your named community midwife. Alternatively, a midwife on the labour ward will be happy to advise you.