Monitoring Your Baby During Labor

Monitoring Your Baby During Labor

Exploring Options to Monitor the Baby’s Heartrate

If you enter most labor and delivery rooms today, you will likely hear the “beep, beep, beep” of the electronic fetal monitor which is attached to the mother’s abdomen. What few parents realize is that this high-tech way of monitoring your baby’s heartrate was originally designed for the high-risk mother who required more monitoring than what nursing staff could provide. Now it has become the “norm” for many hospital labor and delivery floors across the world.

The convenience of being able to monitor many laboring women all at once from screens at the nurses’ station has come with a cost. There is a tendency to react to every blip of the baby’s heartbeat and so experts agree that it has likely contributed significantly to the rising cesarean rate.

As the mother is monitored with a typical electronic fetal monitor, her mobility may be limited in order to “get a good reading” of the baby’s heartrate. One can only wonder if her lack of movement may also affect the progress of labor and the baby’s ability to rotate and descend normally, especially if the mother is monitored throughout labor while in bed.

Let’s take a look at the many ways your baby can be monitored, ranging from the least invasive to the most invasive.

Dopplar/Auscultation

This is a hand-held device that is often used by midwives in homebirths and birth centers. Like other forms of monitoring, it uses ultrasound to detect the baby’s heartrate. The caregiver will typically want to listen to how well the baby is handling labor by checking the heart rate during and in between contractions at periodic intervals throughout labor. The one advantage is that in most cases, the mother does not need to be in certain positions in order for her baby’s heartbeat to be detected.

Electronic Fetal Monitoring

The external electronic fetal monitor is the monitor of choice in most hospitals. The mother wears the ultrasound device, secured by belts strapped around her lower abdomen. Another belt holds in place a pressure gauge which measures the frequency of contractions. The pressure gauge is not a reliable way to detect contraction intensity. Both of these devices are attached by cables to a display unit, where the contractions and baby’s heartbeat are recorded digitally, with an audible sound (hence the “beep, beep”) and also on a graph so that there is a permanent record.

Intermittent or Continuous Monitoring? 

The American College of Obstetricians and Gynecologists recommend that unless a mother is high-risk, intermittent monitoring should be used, rather than continuous monitoring. If a mother is receiving pain medication, being induced or is high-risk, it is known that these procedures carry with them greater risk to the baby, so they require continuous monitoring.

Telemetry Monitors 

Some hospitals have the option for a portable monitor which uses a radio signal to transmit the recording of the baby’s heartrate and the contractions to the display unit from other locations in the labor room or on the labor and delivery floor.

The same two devices are worn by the mother, however they are attached to a small radio powered device about the size of a cordless phone. The downside is that the radio signal is not always continuous and there may be gaps in the reading. The plus for mothers is much better mobility during labor.

Internal Monitors/Fetal Scalp Electrode

A more invasive type of monitoring, the internal monitor is inserted vaginally and attached with a tiny spiral electrode under the skin on the baby’s scalp. The cable on the outside is taped to the mother’s thigh and then attached to the same display unit for the external monitor. The internal monitor is considered to be a more accurate measurement of the baby’s well-being since it converts the ECG (electrocardiagram) to the heartrate.

However there are downsides in that a fetal scalp electrode can increase the risk of infection, the mother’s membranes need to be ruptured and her cervix must be dilated. The internal monitor does penetrate the baby’s presenting part (usually the baby’s scalp if the baby is head down) by 1.5mm.

Questions to Ask

  1. What monitor is typically used most often by your caregiver?
  2. Does the hospital have and use portable/telemetry monitors? Are the nurses trained in using them?
  3. Under what circumstances would an internal monitor be used?
  4. Do you have the option to be out of bed while being monitored externally?

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