Foetal Monitoring

The progress of science and its application in medicine has made it possible for doctors to monitor pregnancy and labour in great detail, and intervene when needed to safeguard the baby and the mother. Once such way of monitoring the baby during pregnancy, labour and childbirth is foetal monitoring.

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What Is It?

During labour and delivery, your doctor will be monitoring the baby’s heartbeat to check on the tiny heart’s status and its response to your contractions. This monitoring may also be done before labour as a part of regular check-ups during the pregnancy or when you notice any change in the frequency of baby kicks. Foetal monitoring can detect an abnormal heart rate which may be useful in detecting any health problems your baby could be facing. It is a reliable method of checking the baby’s heartbeat and helps the doctor take corrective measures.

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Why Is It crucial During Labour?

It is as critical for doctors to carry out foetal heart monitoring during labour as it is to monitor it through the entire pregnancy. This process helps the doctors keep track of the baby’s heart rate and times the duration of the contractions you are experiencing. It is an extremely reliable method for your doctor to know if your baby is doing well or facing any problems. The purpose of foetal monitoring during labour is to ensure that the foetal heart rate stays normal. This assures you and your doctor that the delivery can proceed normally if there are no other problems.

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The primary aim of foetal monitoring is to identify if the baby could be hypoxic (deprived of adequate oxygen levels) so that other assessments of foetal well-being can be carried out. If the results are positive, the doctor could decide to deliver the baby by caesarean section or instrumental vaginal birth.

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Foetal monitoring at home is also an option if the right kind of equipment can be made available. This is mostly done when the mother has been recommended to stay at home or to make minimum movements.

Types of Foetal Monitoring

There are three different methods of monitoring the baby’s heartbeat, and these are carried out depending on the need of the hour. These intrapartum foetal monitoring methods are divided into internal and external monitoring, and they are as follows:

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External Monitoring

  • What it is: Also known as Auscultation, this is a process where a small, hand-held device called a Doppler transducer or a special stethoscope is used to carry out foetal auscultation. In this process, the transducer is connected to a foetal heart rate monitor or the Doppler Foetal Monitor through a set of wires. Your doctor will place the transducer and move it all over your abdominal area till the device picks up your baby’s heartbeat, which is then transferred to the foetal or pregnancy monitor.
  • When it is done: This method is used to monitor what the doctor considers to be safe or low-risk pregnancies, and this is considered routine in this case. There are pre-set times when your doctor will check the baby’s heartbeat, such as during the routine check-ups, and the frequency will be increased if the doctor notices any abnormality in the heart rate.
  • Risks: While there are no known risks of auscultation as it is used only periodically during labour and delivery, the method of electronic foetal heart monitoring may pose some issues for the expectant mother. They are:
  • During EFM (Electronic Foetal Monitoring), you will need to restrict your movements as even a slight movement could interrupt the signals and the machine could spout incorrect readings.
  • It limits the movement of the pregnant woman which could be uncomfortable and make it difficult for the woman to deliver the baby naturally. However, with technological advances, portable devices that can be connected wirelessly to your body are also being increasingly used in hospitals.
  • Benefits:
    • The sound of the baby’s heartbeat is reassuring for the mother and may help dissipate uncertainty and stress
    • Detection of any anomalies may enable the doctor to take remedial action to protect the baby
  • Limitations:
    • The movement of the mother is limited during monitoring, and this may cause discomfort
    • Routine monitoring is not recommended in low-risk pregnancies

Internal Monitoring

  • What it is: In this method, an electrode is placed on that portion of the baby that is nearest to the cervix, which is usually the baby’s scalp, and the baby’s heart rate is monitored. However, in this method, since your contractions will not be monitored, the doctor will have to insert a pressure catheter into the uterus to understand its frequency.
  • When it is done: When your doctor is unable to receive the necessary data of your baby’s heartbeats through external monitoring, he may have to opt for the internal monitoring method.
  • Risks:
  • The electrode may cause a little abrasion or tiny bruises where it touches the foetus
  • You could feel uncomfortable when the electrode and the pressure catheter are inserted
  • This method is not recommended for mothers who are HIV positive or infected by herpes since the virus is likely to be transferred to the baby
  • Benefits: Internal foetal monitoring produces more accurate results than external foetal monitoring
  • Limitations: Internal monitoring can be carried out only after the amniotic sac has burst (after the water is broken) and this could cause delay in monitoring the baby’s heart rate

Continuous Electronic Foetal Monitoring

  • What it is: This monitoring is conducted using a special Foetal Monitor. A set of wide, stretch bands is used to hold two electronic disks, also known as transducers, in place. These transducers have two different functions to perform when they are held against the abdomen. While one transducer tracks your baby’s tiny heartbeats, the other transducer monitors your labour contractions and times it to perfection.  The readings are transferred from the transducers to the monitor which records and prints it on a chart for doctors to check and take necessary action. This monitor can also reproduce the sound of the baby’s heartbeat for parents-to-be to hear. This method is also known as the Continuous Electronic Foetal Monitoring method due to the frequency at which the monitoring of the baby’s heartbeat is carried out.

  • When it is done: Continuous foetal monitoring is done in late pregnancy and during labour
  • Risks: A woman who opts for continuous foetal monitoring is more likely to have an assisted birth, as doctors are likely to suggest an emergency C-section even if the risk to the baby is only a perceived one.
  • Benefits: Continuous monitoring not only comforts you as you can hear the baby’s heartbeat but is also believed to reduce chances of a seizure after the baby is born. A seizure is a symptom of brain damage which may have occurred due to lack of oxygen.
  • Limitations: Electronic Foetal Monitoring does not cause any pain to the mother or the baby in any way. However, the to-be mothers can experience a certain amount of discomfort due to the limited movement it causes.

Intermittent Auscultation

If you are an expectant mother, you must already have experienced this method during your prenatal visits to the doctor. In intermittent auscultation, during the first stage of labour, the nurse or doctor checks the heart rate every 15 to 30 minutes and then increases the frequency to every 5 minutes during the second stage. The doctor keeps a check on the baby’s heart rate in between your contractions, to gauge if it falls between 110 to 160 beats per minute. This also allows the doctor to get a sense of the baby’s tolerance to your contractions.

Comparing Continuous Monitoring to Intermittent Auscultation

While both are external foetal monitoring processes, they differ in the frequency of monitoring done. Intermittent auscultation records the foetal heart rate at pre-decided intervals or periods, while, as the name suggests, continuous monitoring is done throughout the labour or delivery.

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Intermittent auscultation uses a device known as a Doppler transducer to measure the heart rate, while the foetal heart tracing (heart rate) in continuous monitoring is reviewed by the doctor on a regular basis using transducers and monitors for the display of information and data.

Intermittent foetal monitoring is carried out for women who are considered to have low-risk pregnancies. When the doctor anticipates issues related to the delivery, he carries out continuous monitoring so that corrective action can be taken at the right time.

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What Is Category 2 Foetal Heart Tracing?

All Foetal Heart Rate patterns that do not fall in either the normal (Category I) or the abnormal (Category II) range are considered to be category two foetal heart tracing. These tracings are then classified as atypical. If your doctor comes across such a pattern, he may attempt to change your position to reduce the cord compression and enhance blood flow to the placenta.

What if My Baby’s Heart Rate Is Abnormal?

Your doctor will evaluate your baby’s heart rate throughout labour and keep a watchful eye for any signals that indicate a problem. He will be monitoring the baby’s baseline heart rate to know if it’s normal and evaluate the changes if any.

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In the event of your baby’s heart rate being abnormal, the doctor will advise a few more checks and tests before arriving at a decision. Remember, an abnormal heart rate does not always indicate that something is wrong with your baby, and the tests which follow will determine the actual issue.

If your baby moves, its heart rate will go up during that time, and this is normal. It mirrors the increase in your heart rate when you exercise. It is only the unchanged fast heartbeat that can be disconcerting for the doctor.

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As a corrective measure, the doctor may take steps to change your position or provide additional oxygen to you. Giving you the necessary fluids through an intra-venous method can also give positive results. In case these measures do not yield the expected result, the doctor may decide to deliver the baby using the caesarean method or by applying forceps or vacuum to draw the baby out.

Foetal monitoring is an important way to monitor the health of the baby before birth. Some level of monitoring is performed on a regular basis, and even if the doctor recommends extra monitoring, it should not give you any cause for concern. Make sure you speak to your doctor if you are worried, and take his advice to ensure your baby’s safety.

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Also Read: Foetal Echocardiography