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| |    Fetal Monitoring in Labor by Lisa Rodriguez, R.N. and Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. In the days before fetal heart rates were checked during labor, some babies were in distress that wasn't detected. Now, whether you give birth at a hospital or a birth center, the staff is sure to assess your baby's heart rate during labor, either by listening periodically with a stethoscope (technically known as intermittent auscultation) or by using a fetal monitor. What is a fetal monitor? A fetal monitor is an electronic device that keeps an ongoing record of your baby's heart rate and contraction pattern. It times the frequency and length of the contractions and helps to reassure your healthcare team that the fetus is getting enough oxygen. Studies done in the 1980s showed that continuous electronic fetal monitoring wasn't necessary in healthy, low-risk pregnancies, but many doctors and nurses (and some parents) feel more comfortable being able to assess these measurements on a moment-to-moment basis. The alternative to continuous monitoring is intermittent fetal assessment. If the baby is at risk for fetal distress due to an abnormal heart rate pattern, medical problems such as maternal high blood pressure, or use of medications such as Pitocin or epidural anesthesia, continuous electronic monitoring is usually recommended. If an external monitor isn't giving adequate information, internal fetal heart-rate and/or internal contraction monitoring may be recommended. How does the external fetal monitor work? The external fetal monitor has two stretchy straps that go around your belly to hold two small electronic sensors. One notes the contractions and the other measures the baby's heart rate. The monitor's tocodynamometer, or toco for short, is a pressure-sensing device that can detect the changes in your abdomen as your uterus tightens during a contraction. It marks how often contractions occur and the length of each, producing a graph that looks like a series of hills rolling across the bottom of the printout. The external contraction monitor can't tell how strong a contraction is, since the size of the "hill" is affected by the tightness of the belt and if you are thin or heavy. If a precise measurement of the strength of the contraction is needed, an internal-pressure monitor can be placed inside the uterus. The other component of the fetal monitor is a strap that is placed directly over the fetus to detect your baby's heart rate. Using sound waves, it works much like the Doppler device that may have been used to listen to your baby's heartbeat during routine prenatal exams. The heart-rate graph looks like a wavy or jagged line near the middle or top of the printout produced by the monitor. Often the baby moves out from under the monitor for a few minutes, causing a break in the line since no heart rate is recorded during that time. This is normal and not an indication that there is a problem with the baby. If your baby does this quite often or if continuous heart-rate readings are needed, an internal heart-rate monitor may be placed on the baby's scalp.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 normal, too. It's pretty common for the fetal heart rate to go through a phase where it looks a bit worrisome. If the healthcare team detects a potential problem, they may ask you to change positions, generally shifting you to your left side. This can relieve compression on the umbilical cord or on the blood flow back to your uterus. In addition, you may be given oxygen for a short time and extra fluid through your intravenous (IV) line. (The latter may make your arm feel cold around the IV site.) Often, these simple actions are all that is needed to make the baby appear stable and healthy once again. Do I have to stay in bed if I'm on the monitor? If continuous fetal monitoring is recommended, most moms-to-be typically do stay in bed. The cords from the monitor reach about eight feet, so sometimes you can pace around near the monitor or sit in a rocker at the bedside. Some childbirth centers have portable telemetry units, which attach in the same way as a standard monitor but transmit the signal to a base unit without cords. Telemetry allows the mother who requires continuous monitoring to walk around during labor. Keep in mind that you have a right to question anything that you are unsure about. If you're uncomfortable or would like to walk around and telemetry isn't available, it's worthwhile to ask whether continuous monitoring is necessary in your case. Sometimes the monitor is used for convenience but isn't really that important, and your healthcare team can switch to intermittent fetal assessment with equal benefits.
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