So what are my options when it comes to fetal monitoring in labour? Will I be able to move around? Can I use the pool? The answer is often yes!
Intermittent auscultation and continuous fetal monitoring are the two main ways in which we monitor babies during labour.
Intermittent auscultation involves using a Doppler/sonicaid to listen to your baby’s heartbeat for at least 1 minute every 15 minutes during active labour and every 5 minutes when you start pushing. It is a flexible and easy way to check in on your baby during labour and is not restrictive to you in any way. (NB. This is the device your community midwife uses to listen to your baby at your antenatal appointments.)
Continuous monitoring will involve using a cardiotocograph (CTG) machine which will be attached to your abdomen throughout labour. Like the one in the photo. One is measuring your baby’s heartbeat, the top one is measuring your contractions.
If both of these methods are not suitable for you, for example if the CTG machine is not providing your midwife with a clear enough reading of your baby’s heartbeat they may recommend using a fetal scalp electrode (FSE). These cannot be used in the pool. An FSE involves attaching a small clip onto your baby’s head to very closely monitor your baby. FSE’s ensure we are always recording your baby’s heartbeat and are not affected by external factors such as mobilising. You may notice a small scratch on your baby’s head when they’re born but don’t worry, it doesn’t hurt them and this will disappear very quickly.
The type of fetal monitoring that’s recommended for you in labour will depend on whether you and your midwife/obstetrician have deemed your pregnancy to be ‘low’ or ‘high’ risk. If there is a medical reason why your baby may need to have a closer monitoring, then you’d be advised to have a CTG throughout your birth. This may be for reasons such as prematurity, pre-eclampsia, obstetric choleostasis or an induction, to name but a few. These babies have things going on already that may mean they get more stressed out in labour. Intermittent auscultation is recommended for those of you who are considered low risk as your baby is less likely to find labour stressful.
Both a CTG and using a sonic aid for monitoring your baby in labour should not affect your ability to move around, you will still be able to access the pool (they’re waterproof) and all methods of pain relief are still available. Most women worry about being strapped down to a bed when they are offered continuous monitoring, but in Gloucester, there are no cables attaching you to the CTG machines on delivery suite so you can move around as much (or as little) as you like! If you choose to have continuous monitoring of your baby, midwives like to make sure that they do that efficiently. This may mean, adjusting them or asking you to change position so the monitors pick up your baby’s heart rate clearly.
Continuous monitoring was brought in during the 1970s to reduce the amount of baby’s effected by cerebral palsy. However, the evidence doesn’t support that it’s done this. When midwives/obstetricians look at a baby’s heart rate pattern we know that if it is showing no signs of distress then your baby is well. If your baby is showing signs of distress, then 50% of these babies will be in distress, the other 50% won’t. What happens then is that cesareans/interventions are advised. 50% of these are necessary, 50% would not have been. We are continuing to study the patterns of a baby’s heartbeat whilst they’re inside to understand them to reduce the unnecessary intervention from them. You are advised against a CTG if you are low risk for this reason- to avoid the chances of unnecessary intervention.
However, if you are advised to have a CTG but you’d rather not then please discuss this with your midwife. Similarly, if you’d like a CTG but are advised against it, please speak to your midwife.
If you’d like to have continuous monitoring then here are some tips for you to ensure that it doesn’t interfere with your birth…
⚡️Ask for 2 straps to tie to the fetal heartbeat monitor. This will reduce the amount of times a midwife will ask you to readjust the monitor on your abdomen. It also means that you can move around more freely without thinking about it coming loose.
⚡️ If you find the noise is causing you to feel anxious then ask for the volume to be turned down. Baby’s heartbeat in labour can drop. This can be very normal for a baby to do but can cause concerns for you to hear.
⚡️You can ask for the machine to be turned away from you, for the same reason above.
⚡️Continue to move, discuss a waterbirth if that was one of your preferences and most importantly discuss with your midwife WHY you are being advised to be on the CTG and then use your EBRAN to decide if it’s something that you’d like to go ahead with.
If you want to do some extra reading on fetal monitoring and what will be best for you and your baby in labour you can find it on NICE website. If you’re attending a class with ourselves (Mia and Beth) or Hannah we’ll be happy to delve deeper into the nitty gritty too.
Mia and Beth x