Fetal Monitoring During Labor

A. What it means

"Fetal monitoring" refers to the process of checking the health of your unborn little one (fetus) during pregnancy and labor by tracking their heart rate and sometimes uterine contractions, usually done using a special device that listens to the little one's heartbeat through the mother's abdomen, allowing healthcare providers to assess if your little one is doing well and identify potential problems; this can be done through external monitoring (on the outside of the belly) or internal monitoring (with a small electrode placed on the little one's scalp) depending on the situation.

B. How it is done

Primarily the baby's heart rate, and sometimes the strength and duration of uterine contractions.

Monitoring during labor is typically done using a method called electronic fetal monitoring (EFM), which involves placing a transducer on the mother's abdomen to continuously record your little one's heart rate and uterine contractions, either through external monitoring (on the belly) or internal monitoring (through the cervix if necessary) depending on the situation and level of information needed; a healthcare provider can also periodically listen to your little one's heartbeat using a handheld Doppler ultrasound device, known as intermittent auscultation.

C. What information it provides

Helps identify potential problems with your little one's oxygen supply, allowing healthcare providers to take necessary actions if needed.

Fetal monitoring during labor provides information about your little one's heart rate and the strength and frequency of uterine contractions, allowing healthcare providers to assess your little one's well-being and identify potential problems by observing how the heart rate responds to contractions, which can indicate if your little one is receiving adequate oxygen supply.

D. Constant monitoring

Continuous fetal monitoring, also known as electronic fetal monitoring (EFM) or cardiotocography (CTG), is a procedure that tracks a little one's heart rate and uterine contractions. It can help identify if your little one is in distress during labor.

A midwife attaches two plastic pads to the mother's abdomen with elastic straps

The pads are connected to a monitor that displays the baby's heartbeat and contractions

When it's used:

EFM is often used during labor and delivery

It's recommended for pregnancies that are at high risk of complications, such as gestational diabetes, high blood pressure, or the little one being small for their dates

Benefits and risks

EFM can help identify fetal hypoxia during labor

However, it's also associated with increased rates of C-sections and operative vaginal deliveries .

The evidence on the effect of EFM on neonatal mortality is mixed

E. Intermittent monitoring

Intermittent fetal monitoring is a method of listening to a little one's heart rate at regular intervals during labor. It's usually performed externally using a handheld device, such as a stethoscope or Doppler ultrasound.

How it's done:

The little one's heart rate is recorded at the start of a contraction and then for 30 seconds after the contraction ends

The heart rate, rhythm, and accelerations are documented

The depth, timing, and duration of any decelerations are documented

The mother's contractions are felt and documented

When it's used:

Intermittent monitoring is the primary method of checking your little one's well-being at planned home births and freestanding birth centers

It's also an acceptable method of assessment for women without complications

When to increase monitoring

If there is an increase in the little one's heart rate baseline of 20 beats a minute or more from the start of labor

If a deceleration is heard

If the woman develops a condition that requires continuous monitoring

If a condition requires continuous monitoring, the woman will need to be transferred to a hospital.