Fetal Monitoring in Labour

Intermittent Auscultation

The standard method for checking on baby in labour is “intermittent auscultation”, where your midwife listens to your baby’s heart rate using either a handheld doppler (electronic) or pinnard stethoscope (manual) every 15 minutes.

This is done so that any issues with baby’s health can be picked up and acted on quickly, to avoid potential issues.

Most women find this relatively unobtrusive and reassuring during their labour.

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Pros:

  • Can provide reassurance to you and your healthcare provider that all is well during labour

  • Can potentially pick up on issues

Cons:

“While hearing a ‘normal’ fetal heart rate can be reassuring for both midwife and mother, there are a number of issues associated with the [Intermittent Auscultation]:

  • The frequency of [listening] has been plucked out of the air and increases without evidence

  • IA involves doing something to the birthing woman – anything you do may interfere with the physiology of birth (ie. stimulate the neocortex [cause stress] and disrupt instinct).

  • The woman may have to move from an instinctively perfect position so that you can ‘get in’ to listen.

  • IA can create anxiety and concern if the heart rate is difficult to find or not ‘normal’. In the pushing phase of labour, 75% of babies will have an ‘abnormal’ heart rate due to normal physiological processes such as head/neck compression (Sheiner et al. 2001). Abnormal patterns in the ‘second stage’ are only significant if there were abnormal patterns in the ‘first stage‘ of labour (Sheiner et al. 2001; Loghis et al. 1997; Wu, Chen & Wang 1996).” (Dr Rachel Reed)

Continuous Fetal Monitoring

“Clinical guidelines recommend CEFM for ‘high risk’ women and warn against it for ‘low risk’ women. Despite recommendations, CEFM is a cultural norm in many birth settings for all women. CEFM is yet another intervention that was introduced without evidence to support its effectiveness at improving outcomes.” (Dr Rachel Reed)

NOTE: You may find this offered to you even if you’re low risk on a labour ward, as some midwives will treat it as standard practice. You do not have to accept it. If you’ve not been given a reason as to why it’s being offered to you, ASK WHY. If you’re not happy with the reasons, decline (you can ask for intermittent auscultation instead: this should be the standard offering if there are no concerns).

If having continuous fetal monitoring is restricting your movement and making labour more difficult for you, it will be increasing your stress levels, and therefore the stress on your baby. It’s important to weigh up the pros and cons of any intervention like this. Would baby be happier and your labour going better if you reverted to intermittent auscultation - maybe mroe frequently than every 15 minutes if that makes you feel more comfortable - instead of having to lay down in a fixed position?

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Fetal Scalp Electrodes (Internal Fetal Monitoring)

This is often presented to parents as “we just need to put a little clip on baby’s head”. What is actually is, is an offer - which you can of course decline - to attached a fetal scalp electrode, a small wire which screws into baby’s scalp.

It’s generally offered when healthcare professionals are trying to carry out continuous fetal monitoring using external monitors as above, but are struggling to maintain the “trace” - i.e. pick up baby’s heart rate and movements consistently (usually to do either your or baby’s positioning, or both).

One major pro is that, as the monitor is attached to baby and the monitor stuck to your inner thigh, is that you can regain some mobility and change position, whereas with continuous external monitoring you may have been restricted in your movements and positioning. This will not usually be pointed out to you, though, so it’s good to know in advance!

Article: An In-Depth Look at Internal Fetal Monitoring

Images: 1) A Fetal Scalp Electrode, 2) FSE Attached to baby at Birth, 3) A Scab After FSE Use on Baby’s Scalp