Fetal Monitoring During Labor
As a doula, one of the most important roles I play is supporting expecting families through their labor and birth experiences. One of the key aspects of labor that we discuss is fetal monitoring—keeping track of your baby’s heart rate to ensure their well-being during labor. There are three main types of fetal monitoring: intermittent, continuous, and internal. Each has its own benefits, considerations, and role in supporting the health of both mother and baby. Let’s take a closer look at each type and what they involve.
1. Intermittent Fetal Monitoring
What it is:
Intermittent fetal monitoring refers to checking the baby’s heart rate at regular intervals during labor, but not continuously. It is typically done with a handheld Doppler device or a fetoscope (a special stethoscope designed for listening to the baby’s heartbeat). The provider listens to the baby’s heart rate for about 60 seconds at intervals, usually every 15 to 30 minutes during active labor, and less frequently during early labor.
Why it’s used:
Intermittent monitoring is a great option for low-risk pregnancies where the mother and baby are healthy. It allows for greater mobility and comfort during labor, as the mother doesn’t need to be tethered to a machine. It also allows the birthing team to monitor the baby’s heart rate without taking away from the family-centered experience of labor.
Benefits:
More freedom for the laboring mother to move around and change positions.
Less intrusive and more natural, especially for those who want a more hands-off approach to birth.
Typically used in low-risk pregnancies where there are no concerns about the baby’s health.
Considerations:
It may not provide real-time information if there’s a sudden change in the baby’s heart rate that needs immediate attention.
It requires the healthcare provider to be attentive and diligent about timing the monitoring intervals.
2. Continuous Fetal Monitoring
What it is:
Continuous fetal monitoring involves using an electronic fetal monitor (EFM) to keep a constant watch on the baby’s heart rate throughout labor. This type of monitoring typically requires the use of two belts placed around the mother’s abdomen. One belt holds a sensor that tracks the baby’s heart rate, while the other measures contractions.
Why it’s used:
Continuous monitoring is typically recommended for high-risk pregnancies or when complications arise. It’s often used when there are concerns about the baby’s well-being, such as a history of fetal distress, preeclampsia, or if the mother is receiving medication (such as Pitocin) that could affect the baby.
Benefits:
Provides continuous data on the baby’s heart rate and uterine contractions, allowing for quick action if needed.
Can be especially beneficial if there are risk factors that require close monitoring, such as preterm labor, multiple pregnancies, or certain health conditions.
Allows the medical team to spot early signs of distress and intervene if necessary.
Considerations:
It can limit the mother's ability to move freely and change positions during labor.
It may be uncomfortable for the mother due to the belts and wires.
Some mothers find it mentally and emotionally taxing to be constantly monitored, especially if everything seems to be going well.
3. Internal Fetal Monitoring
What it is:
Internal fetal monitoring involves attaching a small electrode to the baby’s scalp through the cervix to directly measure the baby’s heart rate. In addition to the scalp electrode, a pressure catheter may also be inserted into the uterus to measure the strength of contractions.
Why it’s used:
Internal monitoring is typically used when external methods (like continuous monitoring with belts) are not providing enough information or when more precise measurements are needed. It’s commonly employed when there is difficulty obtaining a clear fetal heart rate with external monitoring, or when the baby’s heart rate needs closer observation.
Benefits:
More accurate and reliable than external monitoring.
It’s often used if the external sensors can’t get a clear read due to the baby’s position or maternal obesity.
Provides more detailed information about the strength of contractions.
Considerations:
Requires breaking the amniotic sac (rupturing the membranes), which means that it can only be used once the mother’s water has broken.
It’s a more invasive procedure and can cause discomfort or concern for some mothers.
There’s a small risk of infection or injury to both the baby and the mother, though these risks are rare when the procedure is done correctly.
Which Type of Monitoring is Right for You?
The type of fetal monitoring that’s used will depend on various factors, including the mother’s health, the baby’s health, and the progression of labor. Here’s a quick rundown of when each method might be chosen:
Intermittent Monitoring: Great for low-risk pregnancies and mothers who desire a more natural birth experience with fewer interventions.
Continuous Monitoring: Best for high-risk pregnancies, or if there are concerns about the baby’s health that require close and constant monitoring.
Internal Monitoring: Used when more precise data is needed or when external monitoring isn’t providing reliable information.
Fetal monitoring is a tool that can help ensure the safety and well-being of both the mother and the baby during labor. As a doula, my role is to help the birthing person understand the options available, provide emotional support, and help them navigate the birth process in a way that aligns with their values and preferences. Whether you choose intermittent, continuous, or internal monitoring will depend on your unique circumstances, but having a clear understanding of each option allows you to make an informed decision about what’s best for you and your baby.
Remember, no matter what type of monitoring you choose, trust in the guidance of your healthcare team, and know that as a doula, I’m here to support you every step of the way.
