Most women expect to have monitoring when they go into labour and are admitted to hospital.
Fetal monitoring is very much a routine part of labour care.
But there are some differences in the types of monitoring and the impact they can have on your labour and birth.
Intermittent Or Electronic Monitoring – What’s Best For Hospital Admission?
It’s important to be well informed about admission monitoring so you can make an informed choice about what’s best for you and your baby.
Why Monitor The Fetal Heart On Admission To Hospital?
The reason for fetal heart rate monitoring is simple: to check the baby’s wellbeing during labour. In most babies who aren’t coping, for any number of reasons, their distress is usually signalled by an abnormal heart rate.
Hospitals perform admission monitoring when mothers first come in; this gives them a baseline against which they can compare future heart rates.
Babies whose heart rates are within the normal range are considered to be doing well. Babies who have heart rates that are outside the normal range are considered to be at higher risk of being distressed.
How Is Admission Fetal Monitoring Done?
Monitoring can be done in two ways:
- Electronic fetal monitoring: two belts are strapped to your belly for around 20 minutes, monitoring both your contractions and the fetal heart rate
- Intermittent auscultation: your care provider uses a Doppler or fetoscope against your belly to listen to the fetal heart rate, while assessing contractions by placing a hand on your belly.
Taken at face value, monitoring for 20 minutes when you are admitted to hospital doesn’t seem like a big deal. In fact, it seems like a really good idea. You can be reassured things are going well, and get on with having your baby.
Unfortunately, many women aren’t aware that the type of monitoring used can have an impact on their birth outcome.
Current evidence shows EFM should not be used on women who are low risk and have a healthy baby. Using EFM at hospital admission increases the risk of having continuous EFM (constant monitoring during labour). This increases the chances of having interventions in labour, such as a c-section.
What Happens If My Baby’s Heart Rate Isn’t Normal?
It’s important to be aware of one of the biggest problems with EFM: the high rate of false-positive results. This is when the monitoring indicates a problem, even though your baby is actually fine, and your care provider will want to do further checks.
On admission, if the fetal heart rate indicates a higher risk of distress, your care provider will recommend continuous EFM. The idea is to monitoring the fetal heart rate continually, so care providers will pick up any signs a baby isn’t coping and prepare to intervene immediately.
Having interventions might not seem like a terrible thing, especially when you’re told your baby might not be coping too well with labour.
The problem with interventions, however, is they lead to more interference, known as the cascade of interventions. If your baby is actually fine, this can lead to genuine fetal distress (e.g. after artificial oxytocin is administered).
Or, in some cases, if a woman’s body, and her baby, aren’t ‘fitting in’ with the medical model of birth, more and more interventions are used, potentially leading to c-section or assisted birth (forceps or vacuum).
Is There Any Difference Between The Types Of Monitoring?
The type of monitoring you have on admission to hospital is very likely to affect your birth outcome.
Research shows there’s no difference in outcomes when using EFM rather than intermittent monitoring.
However EFM leads to an increased risk of continuous EFM. Continuous EFM leads to increases in interventions and c-sections.
In developed countries such as the UK, US and Australia, the c-section rate is at least double that recommended by the World Health Organization. The WHO states c-section rates should be at 10-15% to ensure women and babies are not being exposed to risks of unnecessary surgery.
What If My Care Provider Only Does EFM Monitoring?
Many women are told they must have EFM monitoring on admission and accept this as the norm. If you choose to have intermittent monitoring because you wish to avoid the associated risks of EFM, then ask your care provider.
The American College of Obstetricians and Gynecologists (ACOG) recommends intermittent monitoring as safe and appropriate for low risk women. ACOG also recommends care providers are trained in intermittent monitoring using handheld Dopplers, to encourage women to move freely during labour and to enhance their comfort.
Freedom of movement is an important way of ensuring women are able to work with their bodies during labour. It also allows babies to move into the optimal position for birth. Being strapped to a bed, even for short periods of time, can interfere with the process of labour in many ways. It can also reduce oxygen flow to babies, which can cause alterations to the heart rate.
Intermittent monitoring, also known as intermittent auscultation, is not the same thing as having 20 minutes of EFM every hour. Intermittent auscultation involves your care provider using a Doppler or a fetoscope to listen to the baby’s heart rate while placing a hand on your belly to feel your contractions. You can remain in a position that feels most comfortable.
Intermittent auscultation requires your care provider to be present and to observe you during labour. Many hospitals today are set up to cope with larger numbers of birthing women and fewer staff. This is why they often rely on EFM and continuous EFM.
Be aware of the options you have at your chosen birth place, and discuss them with your care providers well in advance, to make sure they respect your wishes.
Every maternity service should focus on bringing c-section rates down. Surgery should be reserved for cases of genuine medical necessity. To achieve this, care providers must ensure women have access to best practice, such as intermittent monitoring, so that unnecessary interventions do not compromise maternal and fetal wellbeing.