Continuous monitoring (also known as external fetal monitoring) of your baby’s heart rate during labor is the standard of care in hospitals throughout the US today. It is important to understand that there are risks and benefits for continuous monitoring. Continuous monitoring is required during labor induction to ensure your baby is tolerating labor ok. Continuous monitoring is also required if you decide to get an epidural or during the administration of any pain medications.
It is important to note that continuous monitoring is associated with an increased risk of unnecessary cesareans [1]. Research has found that there is no decrease in fetal death or incidence of cerebral palsy with external fetal monitoring. Cerebral palsy is a disease that was originally thought to be caused from lack of oxygen during delivery. If we cannot prevent this disorder with external fetal monitoring, why is it the standard of care? Liability is a big concern for healthcare providers today. A big increase in lawsuits against providers who delivered a child vaginally that later turned out to have cerebral palsy have increased the use of external fetal monitoring [1].
Many studies have shown that a decrease in heart rate of the fetus during labor and delivery are more often the result of a reflex response to changes in the baby’s circulation and such drops are normal and can do relatively little or no harm [1]. Today, we know that cerebral palsy is not caused by a lack of oxygen during delivery. Instead, birth defects, growth restriction, infections, inflammation and other unidentified factors can cause the condition [2].
It has been found that fetal monitoring strips read by experienced obstetricians tend to interpret the monitor reading very differently [1]. In fact, when an obstetrician was allowed to evaluate the same reading twice several months apart, the interpretation differed even more. It’s easy to interpret a good fetal heart rate tracing (cat. I) verses a bad tracing fetal heart rate tracing (cat. III) but everything in between (cat. II) can be very tricky. This type of inconsistency has made the United States Preventive Services Task Force rate electronic fetal monitoring as having the lowest grade of effectiveness possible [4]. So if you don’t want to be tied down to the bed during labor or if the monitoring device is bothering you, ask your midwife about intermittent auscultation. If you have had an uncomplicated pregnancy and are planning to have a natural birth this is likely an option for you [1].
What is intermittent auscultation?
Intermittent Auscultation is a method of listening to fetal heart tones with a fetascope (like a stethoscope) or a hand-held ultrasound device (doppler). During intermittent auscultation your midwife will listen closely to rate, rhythm, and variability of your baby’s heart rate for at least one full minute before, during, and after a uterine contraction. This process gathers information that is charted by your midwife to represent a baseline rate, presence or absence of accelerations, decelerations, and the presence or absence of variability. The purpose is to ensure the midwife in making information-based, logical management decision during labor and birth of your baby. Intermittent auscultation protect the well being of your unborn baby without exposing the mother to the risks of unnecessary interventions [2].
Using intermittent auscultation you can expect your midwife to listen to your baby’s heart rate every hour during the early phase of labor, every 30 minutes when you are actively laboring, and every 15 minutes while you are pushing. This provides the ability to move freely around during labor and not have devices on your abdomen that can be uncomfortable or irritating.
Remember that the goal of a midwife is to give you the information for you to make an informed decision. It is always your CHOICE what route you decide to go. If you are looking for a low intervention, natural approach, talk to your midwife about intermittent auscultation. Below are a list of links that provide more resources about external fetal monitoring and intermittent auscultation.
Resources
- https://cerebralpalsynewstoday.com/2016/12/09/electronic-fetal-monitoring-no-benefits-plenty-of-harm
- http://birthtools.org/Reducing-Primary-Cesareans
- http://onlinelibrary.wiley.com/doi/10.1016/j.jmwh.2010.05.007/full
- https://www.uspreventiveservicestaskforce.org
