Your baby’s heartbeat can tell us a lot about how much oxygen they are receiving during labour, which is a marker of their overall wellbeing. Monitoring your baby’s heartbeat can help us to keep you and your baby safe and help you to make informed choices about your care during labour. We will also keep a close eye on you to make sure you are not becoming unwell during labour.
NHS Lothian follow the guidance of the National Institute for Health and Care Excellence:
Overview | Fetal monitoring in labour | Guidance | NICE
Your baby’s heartbeat can be monitored at intervals, with a Sonicaid doppler device or pinard (intermittent auscultation)
What is it? If your pregnancy is uncomplicated, research suggests that listening to your baby’s heartbeat every 15 minutes during the first stage of labour, and every 5 minutes during the second stage, is as safe and effective as continuously monitoring their heartbeat. This is known as intermittent auscultation.
How does it work? We would use either an electronic Sonicaid device (like your community midwife uses during your antenatal appointments), or a pinard to do this. Midwives are trained to pick up small changes in your baby’s heartbeat that may suggest your baby is becoming stressed. If this happens, we recommend switching to continuous monitoring to give us a clearer picture of your baby’s wellbeing.
Where can it be used? Intermittent auscultation can be done at home, in the midwife-led unit (Birth Centre) or the maternity team unit (Labour Ward).
Benefits: You can move around more freely during labour and use a birth pool.
Things to consider: You do not get to continuously hear how your baby is doing, which some women and birthing people find reassuring. We may recommend continuous monitoring if we have any concerns about you or your baby during labour.
Your baby’s heartbeat can be monitored continuously, using a cardiotocograph (CTG)
What is it? If there are certain medical concerns for you or your baby which may make labour more complex and potentially higher risk, we would recommend continuous monitoring of your baby’s heartbeat using a CTG. A CTG uses two transducers which are secured to your tummy by elastic belts to monitor your baby’s heartbeat, and the strength and duration of your contractions. It produces a continuous read-out of these two measures which allows us to look for patterns which may suggest how your baby is coping. This is only available on the tabour Ward. Occasionally we cannot get a clear reading from your baby’s heartbeat, usually due to the position they are in at the time. If this happens, we may recommend a fetal scalp electrode (FSE) is attached to your baby to ensure we are monitoring their heart rate properly. An FSE is a small, clip-like device that attaches to the top of your baby’s head to pick up their heartbeat
CTG monitoring is recommended in (but not limited to) the following circumstances:
- If you have a medical condition, e.g. diabetes or high blood pressure
- If you have developed a condition in pregnancy such as gestational diabetes, pre-eclampsia, obstetric cholestasis, vaginal bleeding, reduced fetal movements, or significant abdominal pain
- If your BMI is over 35
- If you have had a previous caesarean section
- If you have a multiple pregnancy
- If your baby is presenting breech
- If your baby’s growth is thought to be below the 10th centile, or there is reduced amniotic fluid around your baby
- If you go into labour at less than 37 weeks gestation
- If you are having an induction of labour, or if your pregnancy is beyond 42 weeks gestation
- If your waters broke more than 24 hours before your labour started
- If you have meconium-stained liquor (Meconium is the poo which forms in your baby’s bowel before birth). Babies can sometimes pass this before birth, where it dissolves in the amniotic fluid, turning it a yellow/dark greenish colour. If your baby becomes stressed during labour, this can cause them to gasp and inhale some of the meconium-stained liquor, which can cause them to develop lung infections. We recommend CTG monitoring in this instance to ensure we are closely monitoring your baby’s wellbeing to detect early signs of stress.
- If you choose to have an epidural for pain relief in labour
- If you become unwell during labour
Benefits: We can more closely observe how your baby is coping with the labour process and use the information to safely plan your care with you. This is particularly important if you have any factors which may make labour more complex.
Things to consider: CTG devices are usually attached by wire to a machine which can restrict your movement in labour, however we can usually get a bit creative with this to allow you to keep upright and mobile.
What if I would prefer not to have my baby’s heartbeat listened to unless I ask? – Whilst we do not recommend this, as it means we are not able to monitor how your baby is coping during labour, we will respect your decision.
