While you are in labour, it is recommended that your midwife check in on baby to make sure they are coping with labour. There are two main ways of doing this – intermittent auscultation and continuous electronic foetal monitoring. Like all interventions in pregnancy, labour, and postpartum, it is your choice if and how these are carried out.
Intermittent auscultation
This is when your midwife listens in to your baby at intervals, usually with a sonicaid/Doppler machine, although it can be done with a fetoscope/Pinard if you prefer. It is recommended every 15-30min in the first stage of labour, and every 5min or every contraction while you are pushing.
Intermittent auscultation is recommended for most people, unless they have a complication that means that they are recommended to birth in hospital with continuous monitoring.
Continuous electronic foetal monitoring
Continuous electronic foetal monitoring uses a cardiotocograph (CTG) machine to create a graph of your baby’s heartbeat and your contractions. While the monitor is continuous, it is not usually continuously looked at as midwives are generally doing more than one thing at once! However, they are able to review the printout or computer display (depending on where you are – some hospitals or primary units have one or the other, some have both) to see what the pattern looks like over the time you are monitored.
You will be offered a CTG in labour if you have certain risk factors, such as gestational diabetes, pre-eclampsia, foetal growth restriction, meconium stained amniotic fluid, or a multitude of others that your midwife will discuss with you if they occur.
CTG monitoring can be done using traditional abdominal monitors, ‘pod and patch’ systems, or internal foetal scalp electrodes.
Abdominal monitors strap to your belly using special belts. There are two transducers – one will be positioned over your baby’s heart to pick up their heartbeat, and the other will be placed at the top of your uterus to monitor contractions and pick up your heart beat. It uses ultrasound technology to pick up the heartbeats.
A ‘pod and patch’ system uses a single-use sticky patch attached to a reusable magnetic pod. The patch has five sensors that use ECG technology to pick up baby’s heartbeat. It does not need belts, and because it sticks on it can be easier to move around while using this. TENS machines interfere with the ECG technology, so they cannot be used with a pod and patch.
A foetal scalp electrode is a small coiled wire that is inserted into your baby’s scalp while they are inside you. It is very accurate at picking up baby’s heart rate, so it can be offered if abdominal monitoring is not working well. It connects to an abdominal contraction transducer, so you will need to wear one belt with a monitor attached. You may notice a pin-prick scratch on baby’s head from the monitor once they are born, but this usually heals quickly.