Dr Ellie Rayner explains all you need to know about baby monitoring in labour. 

During your pregnancy from around 16 weeks, you will be familiar with your midwife checking your baby’s heartbeat regularly using a small handheld device called a Sonacaid. During labour, to ensure your baby is coping well with your contractions, there are two main ways a baby can be monitored, either with a Sonicaid or with Electronic Foetal Monitoring (EFM). The type of monitoring you are recommended to have will depend on several different factors, such as your medical and pregnancy history and this may change during the course of your pregnancy or labour if any concerns or complications develop, so it is worthwhile knowing about both types.

Intermittent Auscultation

If you have had a low-risk, uncomplicated pregnancy, during your labour your midwife will recommend listening to your baby’s heartbeat with a small, handheld device called a Sonicaid, the same as your midwife will have been doing throughout your pregnancy and when performed in labour this is called Intermittent Auscultation or ‘IA’.

If you are in the first stage of labour, this will be listening every 15 minutes, after a contraction for the period of one minute. During the second stage of labour, so when you are fully dilated, the frequency is increased and you can expect your midwife to listen every 5 minutes after a contraction, for a period of one minute. This can be performed throughout labour, even if you are in the water, and can be done at home, at a midwifery-led-unit or in the hospital setting.

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Continuous Electronic Foetal Monitoring (CTG)

If you have certain medical conditions, have had problems in your current or a previous pregnancy, or develop problems during your labour then you may be recommended to have continuous electronic monitoring using a ‘CTG’ machine. CTG is short for ‘cardiotocography’ and stands for ‘cardio’ meaning heart, ‘toco’- meaning contractions and ‘graphy’ meaning writing – so this is a trace of the relationship of your baby’s heart rate to your contractions.

This involves having two plastic pads, about the size of the palm of your hand, strapped with elastic waistbands to your bump, connected to a small machine that will print out a tracing of your baby’s heart rate. You may have seen or had monitoring like this during your pregnancy already, for example, if you had reduced fetal movements or were unwell but not always. This type of monitoring is only normally performed in a hospital or a labour ward and therefore if you are at a homebirth or midwifery-led unit, such as a birth centre, and a concern develops over you or your baby’s heart rate, your midwife will recommend transfer to a Consultant-led unit. If you were previously low risk and after 20 minutes the monitoring is completely normal and there are no other issues, it can usually be stopped and your midwife can return to listening to your baby intermittently, although the monitoring can stay on if you would prefer.

Why have I been told to have CTG monitoring?

The commonest reasons you may be recommended to have CTG monitoring in labour include having had a previous Caesarean Section, have high blood pressure, you are expecting more than one baby, if you are being induced and on the syntocinon hormone drip, if you develop bleeding, a raised temperature or if your labour isn’t progressing as your midwife expects.

Some women worry about being immobile with the CTG monitoring but this is a common misconception, and you can still remain active. The cables are actually over one metre long so lots of parents are still able to move around their bed space or on a birthing ball. The majority of hospital units have both wireless, so no cables at all, called telemetry, or even waterproof pads to enable a water birth now so it is worth asking if either of those options are available to you.

What happens if they struggle to monitor my baby?

Sometimes, due to movement, or if you have a larger Body Mass Index (BMI), it can be challenging to monitor your baby and there may be short periods where the machine can’t pick up all of your baby’s heartbeat and this is called ‘loss of contact’. If this keeps happening your midwife might recommend performing a vaginal examination and attaching a small wire to your baby’s head called an FSE, or foetal scalp electrode. This will reduce this loss of contact happening so we can be certain we are never missing a beat and we can reassure you. Sometimes, you can also be more mobile with this in place.

It is entirely your choice whether you have either type of monitoring in labour and your midwife or doctor will explain in full their rationale for the recommendation, what it might show and what implications it might have for you or your labour and of course they will support your decision if you choose not to.

Dr Ellie Rayner, Obstetrician and Gynaecologist, Antenatal and Hypnobirthing Teacher and founder of The Maternity Collective.

Dr Ellie Rayner is a practicing Obstetrician and Gynaecologist and founder of The Maternity Collective. She is the only Obstetrician to offer private and group, expert-led Antenatal and Hypnobirthing Classes both Online and face-to-face. She is passionate about providing parent-centred, evidence-based care for all pregnancies and supports all methods of birth.

Follow Dr Ellie Rayner @maternitymedic for the latest evidence-based information on pregnancy, birth and women’s health issues.

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