Articles

Key takeaways

• Monitoring checks your baby's health during labour.
• Intermittent listening allows you to move freely.
• Continuous monitoring is for higher-risk pregnancies.
• Discuss monitoring options with your midwife.

What is fetal monitoring in labour?

Your midwife will check on your baby's well-being during labour. They do this by monitoring your baby's heart rate. This helps to check your baby's health and strength, and can also pick up any problems early on.

There are two main ways to monitor your baby's heart rate. One is listening at regular times (intermittent auscultation). The other is constant checking with a machine (continuous electronic fetal monitoring, or EFM).

Intermittent auscultation

This means your midwife will listen to your baby's heart rate at regular times. Your midwife will use a small handheld device called a Sonicaid – sometimes called a doppler. This device uses ultrasound to pick up your baby's heartbeat. They might also use a Pinard stethoscope – a trumpet-shaped device placed on your bump. Both methods are safe and effective.

If you have a low risk of complications, your midwife will use these methods. They will listen to your baby's heart every 15 minutes in the first stage of labour. In the second stage, they will listen at least every 5 minutes.

This type of monitoring allows you to move around freely during labour. You can change positions easily. If you use a birthing pool, waterproof Sonicaids can be used in the water.

This method is often used for labour without complications, especially in the first stage. It is a good way to make sure your baby is doing well.

Continuous electronic fetal monitoring (EFM)

This type of monitoring involves constantly checking your baby's heart rate using a machine (continuous electronic fetal monitoring, or EFM).

It works by strapping two plastic pads to your bump. One pad monitors your contractions and the other monitors your baby's heartbeat. These pads are attached to a monitor that shows both readings.

For a more accurate reading, a special clip can sometimes be attached to your baby's head (a fetal scalp electrode). If your baby is breech, it can be attached to their bottom.

Your midwife or doctor might suggest continuous EFM if there are concerns about you or your baby. This is also called continuous monitoring. It might be offered if you have certain complications during pregnancy or labour.

When continuous EFM is recommended

Continuous EFM may be suggested if you have:

• A type of diabetes that can develop during pregnancy (gestational diabetes)
• High blood pressure
• A baby who is small for their dates
• Had a caesarean birth in the past

It is also recommended during labour if:

• You have a type of pain relief that is injected into your back (an epidural).
• You have an oxytocin drip to speed up labour.
• There is baby poo (meconium) in the amniotic fluid.
• You develop high blood pressure, a high pulse rate, or a high temperature.
• You start bleeding in labour.
• Your labour does not seem to be progressing.
• There are concerns about your baby's heartbeat, position, or movements.

Continuous monitoring provides ongoing data about your baby's heart rate. However, it can sometimes restrict your movement. It may make changing positions tricky.

It's worth knowing that continuous monitoring is sometimes linked with a higher chance of other interventions, such as an assisted birth. Your midwife can talk you through why this might be.

Making an informed choice about monitoring

Your midwife will check on you and your baby regularly during labour. This helps to make sure you are both well. Regular checks can help to find any potential issues early.

Your midwife should explain how and why they are monitoring your baby's heart rate. They will support your choices about how your baby is monitored. If they need to change how they monitor your baby, they will let you know.

You can discuss the benefits and risks of each monitoring option with your midwife or doctor. This discussion should consider your personal health history and birth preferences.

It is your decision whether to have EFM or not. If it is recommended, your midwife should explain why it is needed.

You can include your preferences for monitoring in your birth plan. Your birth plan goes into your maternity notes or app.

Remember that birth plans sometimes need to change for your safety and your baby's safety. Your midwife will give you the information you need to make a choice that feels right for you.