Monitoring Labor: Am I Hooked Up To Machines?

Monitoring during labour is a common procedure to ensure the safety and health of the baby and the mother. The baby's heart rate and the mother's contractions are monitored to check how the baby is tolerating the contractions. There are two types of fetal monitoring: Intermittent Auscultation and Electronic Fetal Monitoring. While the former involves listening to the baby's heartbeat at set times throughout labour, the latter involves continuous monitoring of the baby's heartbeat and the mother's contractions. The type of monitoring depends on various factors such as risk factors, labour duration, and hospital or practitioner policy.

Electronic Fetal Monitoring (EFM)

EFM is typically used when there are risk factors, such as an epidural, or complications during labour. It can be useful for babies who are at risk or when there is a known issue. However, in most cases, continuous EFM is not very useful in uncomplicated labour, and it can limit the mother's movement.

Some hospitals have wireless devices that allow mothers to walk around while being monitored. Internal fetal monitoring is another option, which involves inserting a tiny electrode through the vagina onto the baby's scalp. This method is slightly more accurate but is only used when necessary due to the small risk of infection.

False alarms are common with EFM, and the machine may start beeping loudly if the transducer slips out of place, the baby shifts position, or contractions suddenly increase in intensity.

If you are hooked up to monitors during labour, you will probably be able to move around at least a little. There are various positions that can be adopted, such as sitting on a birthing ball, kneeling on the bed, or squatting on the edge of the bed.

Intermittent monitoring

The benefits of intermittent monitoring include increased freedom of movement for the mother, and more opportunities for care providers to physically check the health of the mother. It also requires less equipment and is therefore a more affordable option. However, there is less research evidence supporting the use of intermittent monitoring compared to continuous monitoring.

Continuous monitoring

Internal fetal monitoring is sometimes used when there is a risk of fetal distress or when the external monitor is not picking up accurate readings. This involves inserting a tiny electrode through the vagina onto the baby's scalp to monitor the heartbeat, along with a catheter or an external pressure gauge to measure contractions. Internal monitoring provides slightly more accurate readings but restricts the mother's movement and carries a small risk of infection.

While continuous monitoring can be reassuring for both the mother and the practitioner, it can also limit the mother's mobility and ability to cope with contractions. It may also increase the likelihood of false alarms, which can lead to unnecessary procedures. For low-risk pregnancies, periodic monitoring or intermittent auscultation is considered just as effective and is associated with fewer interventions.

In some cases, telemetry monitoring may be used, which allows for constant monitoring while still permitting the mother to move around freely. This technology is not available in all hospitals.

Telemetry monitoring

Benefits of Telemetry Monitoring

The main advantage of telemetry monitoring is that it provides constant monitoring without restricting the mother's mobility. This can be especially beneficial during labour, as movement can help make the labour process more comfortable and even shorten the duration of labour.

Availability of Telemetry Monitoring

It is important to note that telemetry monitoring equipment is not available in all hospitals. If you are interested in this option, it is recommended to discuss it with your healthcare provider and find out if it is available at your chosen delivery location.

Alternative Monitoring Methods

If telemetry monitoring is not available, other methods of fetal monitoring can be used. These include:

• Intermittent Auscultation: This involves periodically listening to the baby's heartbeat at set times using a special stethoscope or a Doppler device.
• Electronic Fetal Monitoring (EFM): This method uses ultrasound waves to continuously monitor the baby's heartbeat and the frequency and power of contractions. While EFM provides constant monitoring, it may restrict the mother's movement due to wires and cables.
• Internal Fetal Monitoring: In some cases, an internal monitor may be used to provide a more accurate record of the baby's heart rate and contractions. A small electrode is inserted through the vagina and placed on the baby's scalp. This method is usually reserved for situations where external monitoring is not effective or when there is a concern for fetal distress.

Internal monitoring

During internal monitoring, movement may be more restricted than with external monitoring, but it is still possible to move from side to side. The baby may have a small bruise or scratch where the electrode was attached, which will disappear within a couple of days.

A study by Lorie M. Harper et al. found that the use of intrauterine pressure catheters (IUPC) was associated with an increased risk of maternal fever, but did not reduce the risk of a cesarean delivery. On the other hand, the use of fetal scalp electrodes (FSE) alone was associated with a decreased risk of cesarean delivery and did not increase the risk of maternal fever. The combined use of FSE and IUPC was associated with a slightly increased risk of cesarean delivery.

In summary, internal monitoring is a more invasive procedure that is used when there are specific concerns about the baby's well-being. It provides more accurate data on the baby's heart rate and the strength of contractions, but it may restrict the mother's movement during labour.

Frequently asked questions