Monitoring your baby
during labour
Information and advice for mums-to-be
Maternity
Duringlabouritisimportantthatwe
monitoryourbabytocheckforany
problems.Mostbabiescopeverywell
withlabourbutafewbabieshave
somedifficulty.Ifyourbabyishaving
anyproblemsduringlabourthismay
bereflectedinthepatternoftheir
heartbeat.
How will my baby be monitored
during labour?
Oneofthebestwaysofmonitoringyour
babyduringlabouristolistentotheir
heartbeatregularly;thisisknownas
fetalmonitoring.Thereare2mainways
thiscanbedone:
1. Intermittentauscultation
2. Continuouselectronicfetal
monitoring
What is intermittent auscultation?
Intermittentauscultationiswhere
yourbaby’sheartbeatislistenedtoat
intervalsduringyourlabour,usingeither
alittletrumpet-shapeddevice(Pinard
stethoscope)orahand-heldmicrophone
(Doppler).Yourmidwifewilllistento
yourbaby’sheartbeatforlongenough
eachtimetochecktheirheartrateand
thepatternoftheirheartrate.
Yourmidwifewillalsoplaceherhandon
yourtummy,wherethetopofthewomb
(fundus)is,tofeelwhenyourwomb
contractsandrelaxes.
Thisisthebestformofmonitoringif
youarehealthyandhavehadalow-risk
pregnancy.Ifyouaregivingbirthat
homeorintheSerenityorHalcyonbirth
centresthisiswhatthemidwifewilldo
throughoutyourlabour.
What are the benefits of intermittent
auscultation?
• Youcanmovearoundfreelyduring
labour.
• Youcanusethepoolforlabour.
• Youcanhearyourbaby’sheartbeat
too.
What are the risks of intermittent
auscultation?
Thereisariskthatverysuddenchanges
inyourbaby’sheartratewillnotbe
detectedbyintermittentauscultation
buttheseareveryrareinhealthybabies.
Ifthereisaconcernaboutyourbaby’s
heartratethenyouwillbeadvised
tohavecontinuouselectronicfetal
monitoring.
What is continuous electronic fetal
monitoring?
Continuouselectronicfetalmonitoring
iswhereyourbaby’sheartrateis
monitoredcontinuously.Thisisdone
usingeitheracardiotocograph(CTG)
machineorwirelesstelemetry.
Adisc,thatmonitorshowoftenyour
wombcontracts,isplacedatthetop
ofyourtummywherethetopofyour
womb(fundus)is;anotherdiscisplaced
onyourtummywhereyourbaby’s
heartbeatcanbemonitoredclearly.The
discsareheldinplacebyelasticbelts.
IfyouarehavingCTGmonitoring,
themonitorisconnectedtotheCTG
machinebywires.Ifyouarehaving
wirelesstelemetrymonitoringthisis
notattachedtoanywires,themonitor
transmitsthereadingtothereaderbox.
TheCTGmachineandtelemetryreader
produceaprintedgraph(sometimes
calledatrace)toshowthepatternof
yourbaby’sheartrateandyourmidwife
willexplainthepatterntoyou.
Sometimesyouwillnoticethatyour
baby’sheartratesoundsfasterorslower
thanatothertimes;thisisperfectly
normalandyoushouldexpectthisto
happen,particularlyifyouhavehad
somepainreliefsuchasPethidine.Your
midwifewillexplainthistoyouatthe
time.
ContinuousEFMisrecommendedif:
• yourpregnancyhaslastedmorethan
42weeks
• youarehavinganepidural
• youhavehadbleedingfromyour
vaginabeforeorduringlabour
• yourlabourisbeinginduced(started
artificially)orstrengthenedwitha
drip(oxytocin)
• youhaveatwin/tripletpregnancy
• youhavepreviouslyhadacaesarean
section
• yourbabyissmall,prematureorisin
breechposition(bottomfirst)
• yourwaterswerediscolouredor
smelly
What are the benefits of continuous
EFM?
• Youwillbeabletoseethepattern
ofyourbaby’sheartratewhichcan
bereassuringforyouandyourbirth
partner.
• Yourbaby’sheartrateismonitored
continuouslysothemidwifeordoctor
cancheckthatitishealthy,which
isveryusefulifthereisareasonfor
themtobeconcernedaboutyour
baby.
• Ifyouhaveawirelessmonitoryou
willstillbeabletowalkaroundfreely
andusethebirthingpoolforpain
relief.
What are the risks of continuous EFM?
TherearenoriskstocontinuousEFMbut
adisadvantageisthat,ifthemonitor
youhaveisnotwireless,youwon’tbe
abletomovearoundverymuch.
Are there any alternative ways of
monitoring my baby’s heartbeat
during labour?
Ifyourbabyisinanawkwardposition
andcontinuousEFMisnotpossibleyour
midwifemayadviseyoutohaveafetal
scalpelectrode(FSE)attachedtoyour
baby’sscalptomonitortheirheartbeat.
Yourmidwifecanattachtheelectrode
toyourbabyduringaninternal
examination.
What happens if there is
a problem with my baby’s
heartbeat?
Ifyourmidwifebecomesconcerned
aboutyourbaby’sheartratetheywill
askaseniormidwifeanddoctortoassess
youandyourbaby.
Sometimestheymayneedtotakea
sampleofblood(FBS)fromthetopof
yourbaby’sheadduringaninternal
examinationtomeasurethelevelof
oxygeninthebaby’sblood.Thiswillhelp
thedoctorstodecidethebestwayto
helpyourbabythroughlabour.
Thesampletakes10–20minutesto
collectandtheresultisobtainedquite
quickly.
Further information
Formoreinformationaboutmonitoring
yourbabyduringlabourpleasespeakto
yourmidwifeordoctor.
Formoreinformationaboutour
hospitalsandservicespleaseour
websiteswww.swbh.nhs.ukand
www.swbhengage.comorfollowuson
Twitter@SWBHnhsandFacebook
www.facebook.com/SWBHnhs.
Youcanfindmoreinformationabout
pregnancyandchildbirthonthe
maternitypagesofourwebsite.
Sources used for the information
in this leaflet
• NationalInstituteforHealthand
ClinicalExcellence,CG55‘Intrapartum
care’,September2007
• TheRoyalCollegeofMidwives,
MidwiferyPracticeGuideline‘Fetal
heartratemonitoring’,May2008
Ifyouwouldliketosuggestanyamendmentsor
improvementstothisleafletpleasecontactthe
communicationsdepartmenton01215075420
oremail:
[email protected]
A Teaching Trust of The University of Birmingham
IncorporatingCity,SandwellandRowleyRegisHospitals
©SandwellandWestBirminghamHospitalsNHSTrust
ML3990
IssueDate:December2012
ReviewDate:December2014