Safety and interventions

Monitoring your baby’s heart rate in labour

6 min read

Monitoring with CTG, stethoscope or scalp electrode helps midwives and doctors know how your baby is coping with labour. Find out about your options for intermittent or continuous monitoring.

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Why will my baby’s heart rate be monitored?

During labour, the oxygen supply to your baby varies and this is a normal part of any birth. Sometimes the baby may not get enough oxygen and, if this happens, their heartbeat will change.

Monitoring these changes allows action to be taken quickly if any problems are detected.

How is a baby’s heart rate monitored?

Your baby’s heart rate can be monitored:

  • continuously throughout labour, or
  • intermittently a few times per hour.

Which method you’ll be recommended depends on your health, how your labour is progressing and how your baby’s coping.

Intermittent monitoring

With intermittent monitoring, the midwife will check your baby’s heart rate at least every 15 minutes when you’re in established labour. They’ll listen to the heartbeat during a contraction and after, to make sure your baby’s heart pattern is as expected.

This type of monitoring is all that is needed and recommended for a straightforward labour where you don’t have any risk factors.

Intermittent monitoring is available in all birth settings; at home, in birth centres and in labour wards.

Continuous monitoring

Continuous monitoring allows midwives and doctors to see your baby’s heart rate second by second, which can help paint a picture of how your baby’s coping with labour over a longer time period.

You’re likely to be advised to be monitored continuously if:

  • you’re having an epidural
  • you’re being induced or having labour sped up with a drip
  • your baby is breech, small or premature
  • you’ve had a previous c-section
  • you have pre-eclampsia
  • there’s meconium in your waters.

However, it’s important to note that there are many other reasons why continuous monitoring may be recommended. You should have the opportunity to talk through your options with your health providers before making the decision on how to be monitored.

Continuous monitoring is only available at the labour ward. Sometimes, your midwife may pick up a problem with your baby’s heart rate which means that they recommend you should have continuous monitoring.If this happens and you’re giving birth at home or in a birth centre, you’ll need to be transferred to the nearest labour ward for the monitoring.

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Foetal heart rate monitoring equipment

There are a number of different methods for monitoring – here’s a quick guide to the equipment your midwife or doctor might use during your pregnancy or birth.

Classic stethoscope

This can be used by your midwife for intermittent monitoring, whatever position you’re in and also if you’re in a birth pool.

Electronic stethoscope (‘doppler’)

A modern alternative to a classic stethoscope which allows your baby’s heart rate to be heard by your midwife placing an ultrasound stick on your stomach. It’s used during intermittent monitoring and it also works if you’re in a birth pool.

Cardiotocography (CTG)

The most common form of continuous monitoring. Two straps with sensors are attached around your stomach, and send information about your baby’s heart rate to a connected machine. This can’t be used in a birth pool.

Telemetry monitoring

A wireless type of CTG. You’ll still have the straps and sensors, but it’s not connected to a machine with wires. This allows you to move around more freely in labour, and it can also be used in a birth pool.

Blood sampling

A few drops of blood are drawn from your baby’s head, through your vagina. The blood sample is then analysed to see how much oxygen your baby’s getting. It’s sometimes used if CTG readings are unreliable.

Scalp clip

An electrode connected to a wire is attached to your baby’s head through your vagina to measure their heart rate. This is sometimes used if CTG readings are unreliable.

Are there any issues with monitoring?

Monitoring is considered a really important part of measuring your baby’s wellbeing during labour. However, that doesn’t mean that it’s without any concerns.

For example, using continuous monitoring in women without risk factors has been shown to increase the number of emergency c-sections and assisted births.

Beyond that, women can have very different experiences of monitoring. To many giving birth, continuous monitoring can feel restrictive and mean that they end up on their backs on a bed.

Some women also think that foetal blood sampling and scalp electrodes are very invasive procedures because of the way they are performed, so feel uneasy with that type of monitoring for that reason.

“I’d really wanted to have an upright labour, but I got up on the bed to be monitored and I wasn’t able to get off again. With each contraction, the sensor belt moved off my tummy and the staff kept saying that they just needed a couple more minutes to monitor the heartbeat.” Read Laura’s birth story

Your monitoring choices

If you have questions or concerns about monitoring during labour, a good starting point is to raise these at an antenatal appointment, or when you go for a tour of the maternity unit

Finding out about your unit’s policy and equipment in advance can help you (or your birth partner) be more assertive during the birth, should it be necessary. It can also be a good idea to note down your monitoring preferences in your birth plan

While women are often told that they have to stay on the bed with continuous monitoring, many midwives do encourage women to be mobile while being monitored and have ways to help you achieve that.

Your midwife may be able to tell you that the bed in the delivery room can be lowered and heightened, so you can stand next to the bed and lean on it while still being connected to the CTG machine.

Likewise, if you’re really keen to use a birth pool but know you’re recommended to be monitored continuously, ask if your maternity unit has wireless (telemetry) monitoring, how often it’s in use and what your best chances of getting to use it are.

Always remember that you have the right to decline any monitoring you don’t want, or ask for monitoring to stop, at any point during the birth.

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References

These are the sources of information used in this article:

Alfirevic Z, Devane D, Gyte GML, Cuthbert A, Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour, Cochrane Database of Systematic Reviews (2017)

National Collaborating Centre for Women’s and Children’s Health, Intrapartum care: care of healthy women and their babies during childbirth. NICE Clinical Guideline 190, London: National Institute for Health and Clinical Excellence (2014)

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