Measuring your baby’s heart rate is a good way of checking their health and wellbeing throughout labour and birth.
During labour when the uterus (womb) contracts, the maternal blood does not flow as freely through the placenta and this reduces the oxygen supply. This is a very normal process and most babies cope very well with this. However, if your baby does not cope as well with this then he/she might show signs in the pattern of the heart rate.
Methods of fetal monitoring
Before listening to your baby’s heartbeat, your midwife will perform a risk assessment at the start of your labour to determine the most appropriate way to listen to your baby’s heartbeat. Your baby’s heartbeat can be monitored either by intermittent auscultation (IA) or continuous cardiotocograph (CTG).
Intermittent auscultation (IA)
This method uses a Pinard stethoscope or handheld Doppler to listen to your baby’s heartbeat (similar to when your midwife has listened to your baby’s heartbeat during your antenatal checks). IA is most appropriate for labour and birth where the pregnancy has been uncomplicated.
During labour, your midwife will listen to your baby’s heartbeat for 60 seconds immediately following a contraction every 15 minutes in the first stage of labour and every 5 minutes in the second stage of labour (see your pregnancy information booklet for details on the stages of labour).
Throughout labour if your baby’s heartbeat is monitored by IA, there will be a regular review and discussion with another midwife (sometimes called Fresh Ears/Fresh Review) to ensure that IA is still the most appropriate method of monitoring for your baby and that your place of birth is still appropriate (e.g. home/pool). This discussion should include you and your birth partner, taking into account your wishes.
With IA you have the ability to move around, change positions easily and also access the birth pool if you wish to.
Continuous cardiotocograph (CTG)
This method uses a cardiotocograph (CTG) machine to continuously monitor and record your baby’s heartbeat throughout labour and birth and is usually advised when there have been complications in pregnancy (such as diabetes or reduced fetal movements) or if any observations carried out by the midwife are not within the normal range (such as a high pulse or temperature).
The CTG machine prints out your baby’s heartbeat on to a strip of paper, along with your contractions. This is done by applying two sensors to your abdomen, held in place by elastic belts. The midwife and/or doctor will “read” and interpret this monitoring to see how well your baby is coping with labour.
There are many changes to your baby’s heart rate and interpreting these changes is a highly skilled job. Throughout your labour if your baby’s heart rate is monitored by continuous CTG, there will be a regular review with another midwife (sometimes called Fresh Eyes/Fresh Review/Buddy) to ensure the CTG is being interpreted correctly and discuss whether any doctors input is required. This discussion should include you and your birth partner, taking into account your wishes.
With continuous CTG monitoring, your ability to move freely will be more limited, however you will still be encouraged to adopt upright positions. If it is available, CTG monitoring via a wireless telemetry CTG machine may be used to encourage mobility and also use in the birth pool.
Occasionally, there may be instances where the abdominal sensor is not sufficient enough to monitor your baby’s heartbeat and a fetal scalp electrode (sometimes called a scalp clip) may be offered and applied to your baby’s head. It is applied by performing a vaginal examination and the electrode picks up your baby’s heartbeat directly.
It is usually considered if there are concerns with the baby’s heartbeat and there are difficulties monitoring abdominally, or more routinely in the case of twin pregnancy or raised maternal Body Mass Index (BMI).
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