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Monitoring in labour



If your labour is very long, or you have interventions such as an epidural or artificial oxytocin to augment labour, your midwife will recommend monitoring your baby’s heart rate. This is to ensure any distress in baby is picked up as early as possible.

Did you know that there are different ways your baby can be monitored in labour? Pinard or fetal stethoscope, handheld Doppler, continual fetal monitoring using Cardiotocography (CTG), Telemetry CTG (without wires) which can be used in the pool, and fetal scalp electrode are all different ways to monitor baby’s heart. .


Pinard or fetal stethoscope involves a midwife placing a trumpet like instrument against your bump to listen to baby’s heart. This can be done intermittently, meaning you can get up and move about between monitoring.


Handheld Doppler is a hand held ultrasound device which again can be used intermittently, as well as used under water.


CTG is where they strap two pads to your bump. One monitors baby’s heart rate, the other your contractions. As this is continual, it means the monitors stay attached, tracking your baby’s heart and your contractions and recording them, meaning you may be restricted to a bed. You can ask for monitoring to be carried out intermittently and pads removed between monitoring so you can get up and move or find a more comfortable position. Wireless CTG does not use wires so aides movement while monitoring continuously, and can be used in a birthing pool.

Fetal scalp electrode may be used if a good trace cannot be found using external pads. Electrodes are inserted up through the vagina and attached to baby’s scalp. This is a more accurate form of monitoring but it can be uncomfortable and can leave a small scratch on babys scalp, as well as small risk of infection. Studies have found that there is no difference between adverse outcomes between continual monitoring and manual hands on listening, but that women who had continual monitoring were 63% more likely to have a c-section, and 15% more likely to require an assisted delivery using forceps or ventouse.

Electronic fetal monitoring (EFM) was brought into labor rooms in the 1970s, despite the fact that there was no research evidence to show that it was safe or effective. Randomized trials have found that EFM has contributed to an increase in the Cesarean rate, without making any improvements in cerebral palsy, Apgar scores, cord blood gases, admission to the neonatal intensive care unit, low-oxygen brain damage, or perinatal death (which includes stillbirth and newborn death). EFM is linked to a lower rate of newborn seizures; however, newborn seizure events are rare and it is not clear how often they lead to long-term health problems.
Quote from evidence based birth

As with any intervention or procedure in birth, it is important to note that a woman can decline if she wishes. Each has a place in certain circumstances, but it’s important to know the benefits and risks of use for each before consenting to monitoring. NICE guidelines do not recommend continuous CTG for low risk women, but should be used if there are signs of infection (fever in the mother or high heart rate), meconium in the amniotic fluid (a sign of fetal distress) or use of artificial oxytocin to augment labour to name a few.


references:


https://evidencebasedbirth.com/fetal-monitoring/

https://www.rcog.org.uk/en/about-us/nga/fetal-monitoring-recommendations/


https://pathways.nice.org.uk/pathways/intrapartum-care/fetal-monitoring-during-labour


Photo credit to www.instagram.com/greenandgreyphoto


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