Fetal Monitoring During Labor

Topic Overview

What is fetal monitoring during labor?

Fetal heart monitoring is a way to check the heart rate of your baby (fetus) during labor. The heart rate is a good way to find out if your baby is doing well. It can show if there is a problem.

Monitoring may be done all the time during labor (continuous) or at set times (intermittent).

Most women have some type of monitoring. Talk with your doctor or nurse-midwife during your pregnancy to find out your options.

If you have a low-risk pregnancy-which means that you and your baby have no known problems-you can ask ahead of time to have intermittent monitoring. You can put your wishes in your birth plan. This is a list of what you would like to have happen during labor. It includes other things too, such as ways to manage pain. But if a problem happens during labor, your baby's heart rate may need to be checked all the time.

How is it done?

Monitoring can be external (done outside the body) or internal (done inside the body). For most women, it's external. External monitoring can be continuous or intermittent.

With intermittent monitoring, the nurse or doctor uses a handheld device to listen to your baby's heart through your belly. Sometimes the nurse or doctor will use a special stethoscope. The heart rate is checked at set times during labor. For example, in a pregnancy with no problems, the baby's heartbeat might be checked every 30 minutes during the first stage of labor. Then it would be checked every 15 minutes during the second stage. A woman who has a problem during pregnancy-but who is not high-risk- would have the heartbeat checked more often.

When your baby's heartbeat is not being checked, you may be able to walk around.

With continuous monitoring, your baby's heartbeat is checked all the time. Elastic belts hold two flat devices (called sensors) on your belly. One sensor records the baby's heart rate. The other shows how long your contractions last. You have to stay close to the monitor next to your bed. You can get out of bed and sit on a chair or stand near the monitor. But you can't walk around or take a bath.

Sometimes the baby's heartbeat can be checked without wires. This method would allow you to walk around during labor. But it's not available everywhere. And it might not work if you walk too far away or if the device falls off while you're walking.

Internal monitoring is only done in certain situations during labor. A thin wire from the sensor is placed through your vagina and cervix into your uterus. It's attached to your baby's scalp.

When might you have each type of monitoring?

Monitoring at set times (intermittent) is an option in a low-risk pregnancy. Low-risk means that you and your baby have no known health problems and the pregnancy has gone well.

Doctors advise monitoring throughout labor (continuous) in a high-risk pregnancy. High risk might mean, for example, that you have preeclampsia or type 1 diabetes or that your baby has a health problem. A pregnancy can become high risk during labor when a problem occurs. Then the baby's heartbeat would be checked all the time.

If you choose to have epidural pain relief, you will have monitoring all the time in labor.

Your doctor's preference also can affect what type of monitoring you have. Talk with your doctor about what he or she usually uses.

What are the benefits of each type of monitoring?

Intermittent

• You aren't attached to wires all the time. So you can leave the bed and walk around during labor.
• It can reassure you and your partner that the labor is going well.
• It can show the doctor or nurse-midwife that labor can go on at its own pace.

Continuous

• It can reassure you and your partner that the labor is going well.
• It can show a problem right away.

What are the risks of each type of monitoring?

Intermittent

• This kind of monitoring is very safe. But there is a chance that a problem might not be found right away.

Continuous

• You can't move around as much, unless you have wireless monitoring.
• Changes in the baby's heartbeat might suggest that there's a problem when there isn't one. Studies show that monitoring may be linked to an increase in cesarean deliveries and in the use of a vacuum or forceps during delivery.^{footnote 1} Monitoring doesn't cause a cesarean. But it does show all the changes in the baby's heartbeat. Some of those changes might be a sign of a problem. But some of them might not mean anything is wrong. A doctor has to interpret those results. The doctor might suggest a cesarean if he or she is concerned about something during monitoring.