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| |    Low-Tech Fetal Monitoring in Labor by Lisa Rodriguez, R.N. and Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. While most babies do fine during the birth process, it's prudent to assess a baby during labor at frequent intervals, particularly in later labor, when the contractions are at their peak. What methods will the medical staff use to assess my baby's condition during labor? When you arrive at the hospital or birth center to have your baby, the healthcare team will measure your contraction pattern and the baby's heart rate. They may use an external fetal monitor, with its two belts that signal contractions and gauge the fetal heart rate, or they simply may listen to the heart rate with a Doppler instrument or a fetoscope (a type of stethoscope). Often, a 20-minute recording from the external fetal monitor is used to give the healthcare team an initial assessment of your contraction pattern and how the baby is tolerating labor. If the heart rate is within the normal range, shows good variability, and provides no evidence of worrisome slowing, it is said to be "reassuring," meaning that the baby seems to be in good condition and tolerating labor well. In that case, your practitioner may keep you on the monitor, or take you off the monitor and check the baby's heart rate at regular intervals. The latter method is known as intermittent auscultation; "auscultation" is the technical term for listening with a stethoscope. Whatever method of monitoring your practitioner may recommend, the healthcare team is looking at your baby's heart rate and how it relates to labor's contractions. What are the most natural, least medical methods for assessment of the baby during labor? Intermittent auscultation isn't just random; it means listening to the baby's heart rate at set times. Usually, this is done every 30 minutes in early labor, every 15 minutes in active labor, and after every push or at least every 5 minutes while pushing. Generally, intermittent auscultation is a good choice for healthy mothers who have had low-risk pregnancies. The fetal heart rate can be heard by any of these three different methods:
When intermittent auscultation is used to follow the baby, the contractions are not constantly monitored, as they would be with continuous electronic monitoring. The nurse can assess contractions the good old-fashioned way-by palpation. Typically, she will place her hands on your abdomen and feel your uterus from the beginning of the contraction to the end, as well as listen to your baby's heart rate in relation to that contraction. Another way to assess the contractions is to look at the effects-if the cervix is dilating, the contractions are doing what they should. What is a normal heart rate for my baby? A normal fetal heart rate is between 120 and 160 beats per minute, although brief or minimal variations are acceptable. What are the risks and benefits of intermittent monitoring? One big benefit to intermittent monitoring is that when you are not being monitored, you can move around as you please; in contrast, an electronic monitor would tether you in or near your bed. With intermittent auscultation, you can get into the shower or walk around, whatever works for you. This can be important as you try to remain comfortable in the later phases of labor. Intermittent auscultation also may give you a more natural birth experience, since you are not constantly connected to machines. There are no risks to intermittent auscultation as long as everything is going well. In fact, research has shown that babies do just as well using this sort of low-tech assessment as ones who are subjected to more high-tech techniques. In research done in the late 1980s, babies that were tracked on the external monitor were compared to those assessed with low-tech methods. Both groups showed the same Apgar scores and otherwise seemed just as healthy at birth. The one surprising finding was that intermittent auscultation seemed to actually decrease the chance of having a cesarean. It seems that continuous heart-rate monitoring sometimes shows abnormalities that turn out to be false alarms, leading to unnecessary (in retrospect) cesarean sections. If you are a low-risk mom-to-be, either way of monitoring your labor is medically acceptable. If you have a preference, feel free to discuss it with your practitioner. For you and your care team, the main goal at the conclusion of your labor journey should be to safely bring your healthy, happy baby into the world.
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