Monitoring your Baby’s Heartbeat in Labour

This leaflet tells you about monitoring (checking) your baby’s heartbeat during labour and explains why and how this can be done.

It is based on guidance from the National Institute for Health and Care Excellence (NICE). NICE is part of the NHS and produces guidance for both the NHS and patients about medicine, medical equipment and clinical procedures and where they should be used.

Why is my baby’s heartbeat monitored during labour?

When you are in labour, some checks will be offered to you and your baby. These will include listening to, or monitoring, your baby’s heartbeat.

Most babies go through labour without any problems. During contractions, blood cannot get through the placenta (afterbirth) easily. This is normal and most babies cope without any problems. If your baby is not coping well, this may be shown by the pattern of his or her heartbeat.

One of the best ways of finding out if your baby is having difficulties during labour is to listen to his or her heartbeat regularly. This is known as fetal heart monitoring. Your baby’s heartbeat can be monitored in a number of different ways.

How will my baby’s heartbeat be monitored?

Your baby’s heartbeat can be monitored either at regular intervals (intermittent auscultation) or continuously (electronic fetal heart monitoring using a cardiotocograph machine, a CTG).

Before starting any monitoring, your midwife or doctor will check your heartbeat as well as your baby’s to make sure they can tell which is which.

Current research evidence does not support the need for your baby’s heartbeat to be routinely monitored using an electronic fetal heart monitor (CTG) if your pregnancy is assessed as low risk¹.

What is intermittent auscultation?

Intermittent auscultation involves listening to your baby’s heartbeat with either:

• A Pinnard stethoscope. This is a trumpet shaped stethoscope that is placed on your abdomen (tummy) to allow your midwife or doctor to listen to your baby’s heartbeat.

• A hand-held Doppler, (which looks like a microphone). When this is placed on your abdomen it allows you, your midwife or doctor, to listen to your baby’s heartbeat.

If you are healthy and have had a trouble-free pregnancy, either of the above methods are recommended ways of monitoring your baby’s heartbeat during labour. This will happen every 15 minutes during the early stages of labour, increasing to every 5 minutes (or once every contraction) in the later stages.

With intermittent monitoring, you can still stand and walk around freely. This may also be possible during electronic fetal monitoring by using a telemetry (wireless) machine.

When would continuous monitoring be recommended?

Sometimes your midwife or doctor may recommend continuous monitoring – a CTG. This may be for a number of reasons relating to your baby’s health. Your midwife or doctor will explain the reasons why they recommend using continuous monitoring.

If continuous monitoring is recommended and you are at the midwife led unit at Hartlepool or at home, you will be transferred to the Consultant-led Unit at the University Hospital of North Tees.

Continuous monitoring may be recommended if your Midwife or Doctor has listened to your baby’s heartbeat using a Pinnard stethoscope or Doppler and your baby isn’t coping well.

Continuous monitoring may also be recommended if you have a health problem, such as:

• diabetes
• infection, or you have a raised temperature
• if your waters are stained with the baby’s bowel movement (meconium stained liquor)
• pre-eclampsia (high blood pressure)
• problems with your heart or kidneys.

Your Midwife or Doctor may recommend continuous monitoring if there were problems related to your current pregnancy or a previous pregnancy, such as:

• your pregnancy has lasted more than 41 weeks
• you are having an epidural (pain relief injected into your back)
• you have had bleeding from your vagina during late pregnancy
• your labour is induced (started off) or speeded up with a drip (see leaflet, “Induction of labour”)
• you have a twin or triplet pregnancy
• your baby is small or premature (born early)
• your baby is breech (born bottom first)
• if you have had a previous Caesarean section.

What is continuous monitoring?

Continuous monitoring keeps track of your baby’s heartbeat throughout your labour. This is done using equipment called an electronic fetal heart rate monitor or CTG which records your baby’s heartbeat.

Your baby’s heartbeat is picked up by:

• Sensors (special pads containing small electrodes) placed against your abdomen which are held in place by an elastic belt. These sensors pick up your baby’s heartbeat and are connected to a monitor.

The monitor records your baby’s heartbeat as a pattern on a strip of paper. This is sometimes called a ‘trace’ or a ‘CTG’.

• A fetal scalp electrode (sometimes called a clip). A small electrode is attached to your baby’s scalp through your vagina and this is then connected to a monitor. The electrode picks up your baby’s heartbeat and records the pattern on a strip of paper.

Your midwife or doctor will explain the reasons they recommend the use of a fetal scalp electrode.

Your midwife or doctor will read the trace to help them see how your baby is coping with labour. It is routine for midwives to ask for a ‘fresh pair of eyes’ of another midwife or doctor every couple of hours, or sometimes sooner.

It is normal for the pattern of the heartbeat to change, for example, when your baby is sleeping or moving around. If you wish to ask for more detail, your midwife or doctor will explain the trace to you.

The trace may make your midwife or doctor suspect your baby is not coping well, when in fact he or she is fine.

Fetal blood sampling (see next page) can help to clarify this and may avoid you having an unnecessary Caesarean section. Compared with the sensors, it is a more accurate way of checking how well your baby is coping with labour.

Continuous monitoring means you will be attached to a CTG monitor. This will limit your ability to move around. While you may be able to stand up or sit down and move around the room, it won’t be possible to move from room to room. However, we do have “cordless” monitors that allow you to walk around and keep mobile during labour.

If you wish to use a cordless monitor to help you to have a more active labour and birth, please ask your midwife to find out if there is one available. It is also possible to use the cordless monitors in the birthing pool in certain circumstances. Please speak to your midwife to find out more about pool birth.

Can I ask to have continuous fetal monitoring?

The use of continuous monitoring is not usually recommended for non-medical reasons. It can lead to an increased risk of assisted deliveries, for example, forceps, Ventouse or Caesarean deliveries, with higher risks for you and your baby.

If you wish to have continuous monitoring for your own reasons, please discuss this with your midwife or doctor.

What is fetal blood sampling?

Fetal blood sampling involves taking 1 or 2 drops of blood from your baby’s scalp (through your vagina). This blood is tested for oxygen levels to show how your baby is coping with labour. The test can take between 10 – 20 minutes. The results are available within a few minutes of taking the sample.

Your midwife or doctor will tell you the results and discuss what they mean.

If the blood sample shows your baby is not coping well with labour, your doctor may decide your baby needs to be delivered urgently by the method thought to be most suitable at the time. This may be by forceps, Ventouse (suction) or Caesarean section.

Sometimes fetal blood sampling is repeated during your labour to help your doctor find out how your baby is coping.

Once your baby is born, you will be able to see the small scratch marks on his or her scalp, however, these should heal quickly. You can wash your baby’s hair as normal.

There may be reasons why fetal blood sampling is not suitable for you, for example, if you have certain infections. Your midwife or doctor will discuss this with you.

Contact numbers

University Hospital of North Tees

Community Midwives
Monday – Friday, 8.30am – 9.30am
Ragworth Children’s Centre
St John’s Way
Stockton
Telephone: 01642 383442 or 01642 383439

Non-urgent messages can be left on answering machine and will be picked up throughout day.
If your call is urgent you should contact the hospital where you are due to have your baby.

Antenatal Day Unit
Telephone: 01642 624239
Monday – Friday, 8.30am – 9.30pm
Saturday and Sunday, 9.00am – 5.00pm

Outside these hours calls are transferred to the Delivery Suite.

Delivery Suite
Telephone: 01642 382718
24 hours a day, 7 days a week

Antenatal/Postnatal Ward
Telephone: 01642 382722
24 hours a day, 7 days a week

University Hospital of Hartlepool

Community Midwives
Telephone: 01429 522279
7 days a week, 9.00am – 10.00am
Non-urgent messages can be left on answering machine.

Antenatal Day Unit
Telephone: 01429 522879
Monday – Friday, 9.00am – 5.00pm

Outside of these hours, calls are transferred to the Antenatal Day Assessment Unit or Delivery Suite at North Tees.

Birthing Centre
Telephone: 01429 522876

Calls may be transferred to Delivery Suite at North Tees

East Durham
Based at Peterlee Community Hospital
Telephone: 01429 522270

Monday – Friday, 9.00am – 10.00am

Further information is available from:

NHS Choices
Telephone: 111 (when it is not an emergency)
Calls to this number are free from landlines and mobile phones
or via the website at www.nhs.uk

Royal College of Obstetricians & Gynaecologists
27 Sussex Place
Regents Park
London
NW1 4RG
Telephone: 0207 772 6200
Or via the website at www.rcog.org.uk

National Institute for Health and Care Excellence
10 Spring Gardens
London
SW1A 2BU
Telephone: 0300 323 0140
Or via the website at www.nice.org.uk

References

1. NICE Guideline CG190, December 2014 – Intrapartum Care for Healthy Women and Babies.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

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Email: [email protected]

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Telephone: 01642 617617

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Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]