Monitoring your pēpi's heartbeat during labour (fetal monitoring)

During your pregnancy and labour, the placenta supplies oxygen to your pēpi. When you are having contractions during labour, less blood reaches the placenta. This is normal and most pēpi cope well with this. If your pēpi is not coping well, the pattern of their heartbeat may change. This change can be detected during monitoring. 

There are 3 methods of monitoring pēpi. Your midwife or doctor may use more than 1 method during your labour. 

Manual monitoring

Your midwife or doctor will listen to the heartbeat of pēpi through a hand-held ultrasound device (a doppler). Their heartbeat is checked every 15 to 30 minutes at the beginning of labour and more often as you begin to push.

If you are well and healthy and have had no complications while you are pregnant, manual monitoring is the preferred method.

 
Cardiotocograph (CTG)

A cardiotocograph records the heartbeat of pēpi and your contractions. Two sensors are placed on your tummy and held in place by elastic belts. One sensor picks up your contractions and the other your pēpi’s heartbeat. The CTG machine produces a continuous graph of both of these. You may be given a CTG when you first arrive and it will be stopped if there are no risk factors. 

If you are considered a higher-risk pregnancy, a CTG is the recommended method.

 
Fetal scalp electrode (FSE or clip)

FSE will be used if a CTG does not give a clear record of your pēpi's heartbeat. The FSE goes under the skin on the head of pēpi, and is small like a pinprick. It is attached to the scalp during a vaginal exam once your waters have broken and your cervix is dilated. After pēpi is born, you may notice a small scratch on their head from where the FSE was attached. 

Even if you have a healthy pregnancy, risk factors may appear in labour. These will change which method of monitoring is best for you and pēpi.

Risk factors may include:

• fever
• very long labour
• abnormal heart rate of pēpi
• high blood pressure of the person giving 
  birth
• fetal growth problems
• if you have been given epidural pain 
  relief
• if your labour has been induced.

Small changes such as slowing your contractions or changing your position may help. If these do not help, your midwife or doctor will discuss your birth options with you. You may need a caesarean section, or an assisted birth. A blood sample may be taken from the scalp of pēpi to understand if pēpi is distressed before deciding if a caesarean is needed and how urgently.