What is fetal monitoring? Is continuous or intermittent monitoring best? (2024)

What is fetal monitoring?

Fetal monitoring is when your healthcare practitioner and nurse keep tabs on your baby's heart rate during labor. They do this to check how he's doing and see how he's tolerating your contractions.

The monitoring is typically done with one of these devices:

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  • an electronic fetal monitor
  • a handheld Doppler device (like the one your caregiver used to listen to your baby during your prenatal visits), or
  • a stethoscope-like device called a fetoscope

Your health provider will check your baby's heart rate either continuously with an electronic fetal monitor, or periodically (this is called intermittent auscultation). Intermittent monitoring is done with an electronic fetal monitor, a handheld Doppler device, or a fetoscope.

If you have a high-risk pregnancy or are having your labor induced or augmented with medication, you'll likely be hooked up to an electronic fetal monitor continuously throughout labor. If your pregnancy is low-risk and you go into labor spontaneously, your baby's heart rate may only be monitored intermittently.

What is continuous external electronic fetal monitoring like?

An electronic device called a transducer that is attached to wide, stretchy bands will be placed around your abdomen. This device monitors your baby's heartbeat. Another device that tracks your contractions is usually attached to a second band around your abdomen.

The transducers are connected to a machine near your bed that records this information on paper. You'll hear the galloping sound of your baby's heart if the monitor's volume is turned up. If you or your partner is interested, ask your nurse or practitioner how the machine works and how to tell when it registers a contraction.

Electronic fetal monitoring isn't painful. That said, some moms-to-be find it somewhat uncomfortable to have the transducers strapped to their belly during labor. Being tethered to a monitor can limit your movement and may make it harder for you to cope with contractions, too.

Some hospitals have devices that work wirelessly so you can walk around while you're being monitored. Ask your provider if this option is available at the place you’re planning to deliver.

How is periodic fetal monitoring (intermittent auscultation) done?

Your provider or labor nurse will hold the handheld Doppler device, external fetal monitor probe or fetoscope against your belly and listen to your baby's heartbeat, just as she did during prenatal visits. She'll also assess your contractions by laying her hands on your belly.

The nurse or provider will check your baby's heartbeat at specific intervals. This might happen every 15 to 30 minutes in the active phase of the first stage of labor, and every five to 15 minutes during the second (pushing) stage.

Here's what she'll be listening for:

  • "Baseline" heart rate: This is your baby's heart rate between contractions when he's not moving (normal is between 110 and 160 beats per minute).
  • Heart rate during and shortly after contractions: This will give your provider a sense of how your baby is tolerating labor.

In addition to the planned interval checks, your baby's heart rate will be evaluated as needed, such as when your water breaks. If your caregiver suspects a problem is developing, she'll check the heart rate more frequently. You may end up with electronic fetal monitoring for a time – or, if necessary, for the duration of your labor.

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Which is better: Continuous fetal monitoring or intermittent auscultation?

For low-risk pregnancies, experts agree there's no need for continuous fetal monitoring. Periodic monitoring (intermittent auscultation) is just as effective.

A few studies have found that babies may be marginally safer when monitored continuously, but results are inconclusive. What's more, using continuous monitoring in low-risk pregnancies can increase the risk of false readings that lead to the mother undergoing unnecessary procedures.

Here's what studies show:

  • Mixed results. One analysis of 13 randomized research trials showed that newborns were less likely to have seizures when monitored continuously rather than intermittently. But their Apgar scores were the same regardless of monitoring type, and the monitoring method did not influence babies' risk of death or long-term problems such as cerebral palsy.
  • Questionable findings. A large study that looked at birth certificate records found that continuous electronic monitoring was associated with a lower rate of newborn deaths. However, more than a few experts have criticized this study because of problems with the quality of the data and factors, such as the length of each pregnancy, that were not taken into account, and which may have affected the results.
  • False positives. With electronic monitoring. it's possible for readings to indicate a problem when the baby is actually fine. For the mother, continuous monitoring is associated with more deliveries by c-section and more assisted deliveries, using forceps and vacuum.

Why would I need continuous electronic fetal monitoring?

You'll have continuous electronic fetal monitoring if:

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  • You have pregnancy complications or develop any during labor
  • You have a preexisting medical condition, such as chronic hypertension, diabetes or heart disease
  • You get an epidural
  • You require oxytocin (Pitocin) to induce or augment labor

Even if your pregnancy and labor are low risk, chances are high you'll receive continuous fetal monitoring. Intermittent auscultation is more labor intensive for hospital staff, so hospitals and practitioners generally prefer continuous fetal monitoring for all laboring women, regardless of risk factors.

That said, if you have a low-risk pregnancy and no complications during labor, the American College of Obstetricians and Gynecologists considers intermittent auscultation an acceptable method. And it's the preferred method of the American College of Nurse-Midwives for women with no risk factors. That's because intermittent auscultation is associated with fewer c-sections and forceps and vacuum deliveries, and there's no proof that it makes any difference for the babies.

Can I ask for intermittent instead of continuous fetal monitoring?

Yes, if you're planning an unmedicated childbirth and don't have any high-risk conditions.

Discuss your preference with your practitioner. Find out ahead of time about her views, the hospital policy, and whether or not there's typically enough staff available for the intermittent checks. In most practices in which intermittent monitoring is an option, your provider may still want to connect you to the monitor for an initial 20- to 30-minute check when you're admitted to the hospital in labor.

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If you're laboring in a birth center or at home, you'll definitely be monitored intermittently. You'll have a caregiver with you at all times so the checks can be performed as frequently as needed. If you develop a condition that requires continuous monitoring, you'll need to be transferred to a hospital.

When is internal fetal monitoring used?

Your practitioner may do internal fetal heart rate monitoring if the external monitor isn't picking up well (which sometimes happens if you're moving around a lot or are obese) or she has concerns and wants a more accurate reading,.

An internal heart rate monitor is connected to a wire electrode that is inserted through your cervix and placed onto the part of your baby that is closest, usually the scalp.

Your practitioner may also decide to get more information about the strength of your contractions by inserting a special catheter-like gauge through your cervix for internal uterine monitoring.

What will my practitioner do if she has concerns about my baby's heart rate?

If your baby's heart rate is persistently flat, slow or fast your provider may try some simple interventions. These include:

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  • asking you to change your position
  • giving you more fluids through an IV
  • giving you supplemental oxygen.

Depending on your situation, other interventions may be necessary, too. These might include

  • stopping oxytocin (Pitocin) if your labor is being induced or augmented;
  • giving you medication to relax your uterus and decrease your contractions;
  • if your membranes are ruptured, infusing sterile fluid into your uterus through a slender catheter to help cushion the umbilical cord from incidental pressure.

If your baby's heart rate continues to be questionable or takes a turn for the worse, and your practitioner is uncomfortable letting him stay in the birth canal any longer, you might have an assisted delivery if you’re already 10 centimeters dilated, or a c-section if delivery is not imminent.

Keep in mind that some dips in a baby's heart rate are normal. Also, certain heart rate changes are considered a sign of well-being. For example, when your baby moves, his heart rate should go up, just as yours does when you exercise.

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Don't panic if you've been listening to the galloping of your baby's heartbeat and it suddenly stops. Most likely, the transducer on your belly has shifted out of place and lost contact with the heartbeat. Call the nurse so she can adjust it.

Throughout labor, your practitioner will evaluate your baby's heart rate frequently and watch for anything that could signal a problem. Even if someone is not present with you in your room, don't worry. Most hospitals have central monitoring where providers and nurses can watch fetal heart rates from afar.

What is fetal monitoring? Is continuous or intermittent monitoring best? (2024)
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