Why monitor a baby’s heartbeat in labour?
During labour, the baby and the placenta (after birth) are squeezed during the contractions. This is normal and it is common, as a normal response, for this to lead to changes in the baby’s heart rate pattern. Babies are designed to cope with this and most of them do. However, if a baby is not coping well, this may also show in the pattern of the baby’s heartbeat. If the heartbeat is listened to regularly during labour, the majority of these changes will be identified, and we will then be able to identify those babies who are not coping.
Your baby’s heart beats at about twice the speed of your own so it is important that the midwife is sure that it is your baby’s heart she is monitoring and not your own. Before starting any, monitoring the midwife will check your pulse and will do so at intervals throughout the labour.
There are other indicators that show a baby is coping well in labour which include:
- The baby’s movements, but these can be difficult to monitor during labour due to the contractions
- The colour of your waters.
We recommend continuous monitoring if you have certain medical problems or have a pregnancy that has caused concern. This includes:
- Your baby seems smaller than expected or is premature
- Your pregnancy has lasted more than 42 weeks
- You have high blood pressure
- You have diabetes
- You are expecting twins/or more
- You have had a caesarean birth in the past
- You have an epidural for pain relief
- Your midwife or doctor thinks there may be a problem when listening to your baby with a Pinard or Doppler
- You have any bleeding in labour
- You have a raised temperature
- Your baby has had it’s bowels open (meconium stained liquor)
- You have a Syntocinon drip for induction of labour
- If your labour isn’t progressing and you need a Syntocinon drip to speed up labour
- If you are at home and your midwife thinks there may be a problem with the heartbeat she will recommend you go into hospital for continuous monitoring
What are the methods for monitoring the baby?
The heartbeat may be listened to at regular intervals throughout labour (intermittent) or we may decide to monitor the heartbeat continuously (electronic fetal monitoring).
If you are healthy and have had a trouble free pregnancy this is the recommended method of monitoring the heartbeat during labour. This should happen every fifteen minutes during the first stage of labour (after a contraction) and more frequently (at least every five minutes) in the second stage when you are pushing. The midwife will use either a trumpet-shaped device called a Pinard, or a hand-held ‘microphone’, known as a doppler.
- Being able to move around freely
- Being able to use the pool for labour / delivery
- Where your pregnancy has been straightforward, intermittent monitoring reduces the chances of unnecessary intervention.
If you are having a home birth or water birth, the only way to monitor your baby’s heart beat is with a Pinnard or doppler. If a problem is detected, you will be advised to leave the pool, or come in to hospital to allow continuous monitoring.
Continuous electronic heart rate monitoring
Sometimes your midwife or doctor may recommend continuous monitoring. This may be for a number of reasons relating to you or your baby’s health. The reasons for using continuous monitoring should be explained to you.
Continuous monitoring keeps track of your baby’s heartbeat for the whole of your labour. Elastic belts are used to hold the sensors against your abdomen (tummy). These sensors detect your baby’s heartbeat and are connected to the monitor. The monitor records the heartbeat as a pattern on a strip of paper. This is called a cardiotocograph (CTG) or ‘trace’.
Your midwife will read and interpret the trace to identify how the baby is coping with the labour. It is normal that there are changes in the patterns, for example when the baby is sleeping or moving around.
Fetal Scalp Electrodes (FSE)
Sometimes use of a FSE (sometimes called a “clip”) may be recommended. This is usually recommended when the external CTG gives a poor record of the baby’s heart beat. The reasons for doing this should be discussed with you. The electrode picks up your baby’s heartbeat directly. It is attached to your baby’s scalp via a vaginal examination and is then connected to the monitor.
Fetal Blood Sampling (FBS)
Occasionally the trace may make your midwife or doctor suspect that your baby is not coping well. If this happens, further action may be recommended. This could include immediate delivery of your baby or the need for further tests such as FBS.
FBS helps the team caring for you to decide whether the changes in the heartbeat are genuine signs of your baby not coping or whether they are a ‘false alarm’. FBS may avoid unnecessary intervention such as a caesarean section.
FBS involves taking one or two tiny spots of blood from your baby’s head (via an internal examination). This blood is tested to establish whether the oxygen levels are satisfactory, if these are reduced it may show your baby is not coping well. This test takes about 15 minutes to perform. In some cases FBS may not be possible or suitable, for example, your cervix has not dilated enough to allow the procedure, or if you have certain infections – the midwife or doctor will discuss this with you.
How can I find out more information?
Please discuss any queries or concerns with your midwife or consultant during your appointment; alternatively if you need any more information please do not hesitate to contact the Maternity Pregnancy Assessment Unit to speak to a midwife.
- National Childbirth Trust
- Royal College of Obstetricians and Gynecologists
- National Institute of Clinical Excellence
NICE (2007) Intrapartum Care: Care of healthy women and their babies during childbirth. National Institute of Health and Care Excellence
Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.
In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service