Monitoring your baby’s heartbeat during labour

Most babies go through labour and are born without any problems, but there are a few babies who have difficulties. The best way of finding out when a baby is having problems is to listen to every baby’s heartbeat during labour.

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

• At regular intervals. This is called intermittent auscultation
• Continuously by electronic fetal monitoring (EFM)

When monitoring the baby’s heartbeat the midwife will check your heartbeat by
taking your pulse to make sure they can tell them apart.

How is it done?

Intermittent Auscultation

Intermittent auscultation means you can move around more. It can be done in two
ways:

• By using an instrument like an ear trumpet called a Pinnard stethoscope
• By using a handheld ultrasound machine called a Doppler, your midwife may
  also call it a Sonicaid.

You may have seen your community midwife use these during pregnancy to listen to your baby’s heartbeat.
When your midwife is supporting you in labour, the baby’s heartbeat is normally monitored every 15 minutes using intermittent auscultation and more often during the second stage of labour or the ‘pushing’ stage.
Please note: The only way your baby’s heartbeat can be monitored at home is with a Pinnard stethoscope or Doppler. If a problem is detected you may be advised to have continuous EFM which will mean going into hospital.

Continuous electronic fetal monitoring

Continuous fetal monitoring uses a cardiotocograph (CTG) machine which will be by your bedside. It has two receivers that are fastened round your tummy with a stretchy belt. One receiver monitors the baby’s heartbeat whilst the other receiver monitors the frequency of the contractions.

The monitor records your baby’s heartbeat as a pattern on a piece of graph paper which is called a cardiotocograph (CTG) or ‘trace’. The midwife and doctor will interpret the trace to get an idea of how your baby is coping with labour. They will be able to explain their findings to you.

Being attached to some types of monitor can make it difficult to move around freely, however, this should not stop you getting off the bed if you want to. There are monitors available that are wireless and therefore mean you can walk around the room more freely.

Occasionally it can be difficult to hear the baby’s heartbeat through the receiver on your tummy. In this case a more direct method may be recommended. A different receiver is used called a fetal scalp electrode (FSE).
This electrode is on the end of a very small wire that is passed up into the vagina (the same as when you have an internal examination) and fastened to the baby’s head by a very small clip. The electrode then picks up the signals of your baby’s heartbeat more easily because it is directly attached to your baby. It will stay in place until your baby is born.
Using a FSE does not harm your baby, but you might notice a small graze on your baby’s head after birth.

Why do I need fetal heart monitoring?

During contractions blood cannot get through to the placenta (afterbirth) so easily and your baby may get less oxygen than usual. This is normal and most babies cope with no problems.

But if baby is not coping the pattern of the heartbeat usually changes and this could mean that your baby needs to be born more quickly.
If you and your baby are healthy and have had a trouble free pregnancy then the recommended method for fetal heart monitoring is by using the Pinnard stethoscope or hand held Doppler. Current research does not support the need for continuous monitoring, even as part of the admission process.

If you have a health problem or any factor relating to your pregnancy that put you or your baby at increased risk, then the recommended method is continuous electronic fetal monitoring (EFM)
Examples of problems include:

• 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 an epidural as pain relief
• You have had any bleeding from your vagina before or during labour
• Your labour has been induced or accelerated
• Your baby is small or premature
• Your baby is breech (bottom first)
• If the midwife using intermittent auscultation detects a problem
• If, when your waters break, they are not clear in colour

If a problem is suspected the trace from the fetal heart monitoring will enable your midwife or doctor to see that your baby is not coping well.
If this happens further action may be taken. This can include encouraging you to drink more or simply move to a different position, but could also include carrying out a further test called Fetal Blood Sampling (FBS).

Fetal Blood Sampling (FBS)

Sometimes the trace can indicate that your baby is not coping well when in fact they are fine. Fetal blood sampling can help clarify this.
Fetal blood sampling (FBS) is a test where a few drops of blood is taken from the baby’s scalp via an internal (vaginal) examination and tested for oxygen levels to show if your baby is coping well with labour.

If your baby is coping well then it is less likely that you will require birth 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.
There may be reasons why FBS is not appropriate for you, for example if your cervix is not dilated enough or if you have certain infections. Your midwife or doctor should discuss this with you

What if I chose not to have any fetal heart monitoring?

The kind of monitoring you have while you are in labour is up to you. The majority of women like to be able to hear their baby’s heartbeat, while others find it worrying.
If you are reluctant to have any fetal monitoring it would be best to discuss this further with your midwife or doctor. They will be able to explain more about fetal monitoring and how it helps them understand how baby is coping in labour and you don’t have to decide before labour.
Your preferences will be recorded in your personalised care plan and you can change your mind at any time.
There are other ways that can show that your baby is coping well in labour. These include:

• The baby’s movements, but these can be difficult to observe in labour because your tummy tenses up
• The colour of the liquor (your waters) should be clear. If your waters break and the liquor is not clear, EFM would be strongly recommended.

Hopefully this page has answered your questions about fetal monitoring. If you do have further questions or want to talk further about monitoring your baby, please do not hesitate to contact your midwife.