Maternity Information Leaflet. Fetal Heart Monitoring in Labour. Version 2

Transcription

1 Maternity Information Leaflet Fetal Heart Monitoring in Labour Version 2

2 What is fetal heart monitoring? Most babies go through labour and are born without any problems. But there are a few babies who have difficulties and the best way of finding out when a baby is having problems is to listen to the baby s heartbeat regularly during labour. This is called fetal heart monitoring. Your baby s heartbeat can be monitored in two ways: at regular intervals, this is called intermittent auscultation continuously by electronic fetal monitoring (EFM) When monitoring the baby s heartbeat, the midwife will check your heartbeat by taking your pulse to make sure they can tell them apart. How is it done? There are 2 methods in which this can be done: 1. Intermittent Auscultation This can be done in either of two ways: a) by using an instrument like an ear trumpet called a Pinard stethoscope b) by using a hand held device called a Doppler You may have seen your community midwife use these during pregnancy. The baby s heartbeat is normally monitored every 15 minutes during the first stage of labour and more often during the 2

3 second stage of labour or the pushing stage. This method of monitoring is the recommended method for uncomplicated labours. 2. Continuous Electronic Fetal Monitoring (EFM) This can be done using either of two methods: a) By fastening two receivers around your tummy. One receiver monitors the baby s heartbeat while the other receiver monitors the frequency of the contractions. Or if we have difficulties monitoring in this way: b) By fastening one receiver around your tummy to monitor the frequency of the contractions, and another receiver, called a fetal scalp electrode (FSE), which is on the end of a very small wire and is passed up the vagina (the same as an internal examination) and fastened on to the baby s head by a very small clip. An FSE does not harm the baby although you may notice a small graze on the baby s head after birth. The electrode can then pick up the signals of the baby s heartbeat more easily because it is directly attached to the baby. This electrode stays in place until the baby is born. The monitor records your baby s heartbeat as a pattern on a piece of graph paper which is called a cardiotocograph (CTG) or a trace. The midwife or doctor will interpret the trace to get an idea of how the baby is coping with labour. They will be able to explain their findings to you. 3

4 Why do I need fetal heart monitoring? If you are healthy and have had a trouble-free pregnancy, the midwife using intermittent auscultation (see page 2). Current research does not recommend continuous monitoring for low risk labourers. If you have a health problem or any factor relating to your pregnancy that put you or your baby at increased risk, then the recommended method for fetal heart monitoring is continuous monitoring. Examples of Reasons for Continuous Monitoring Diabetes controlled with medication Infection Raised blood pressure Medical problems e.g. problems with your heart or kidneys Your pregnancy is more than 42 weeks You have had abnormal bleeding from your vagina before or during labour Your labour has been induced or accelerated using a hormone drip You have previously had a caesarean section You have a multiple pregnancy Your baby is small or premature Your baby is a breech presentation (going to be born bottom first) If a problem is detected using intermittent auscultation 4

5 What are the risks of fetal heart monitoring? Being attached to the monitor for continuous EFM can limit your ability to move, however you will still be able to adopt a variety of positions. What happens if a problem is suspected? Occasionally the trace can make your midwife or doctor suspect that your baby is not coping well when in fact they are fine. Fetal blood sampling can help to clarify this and may avoid you having an unnecessary Caesarean Section. Compared with the monitor alone, it is a more accurate way of checking if your baby is not coping well. Fetal blood sampling involves taking one or two drops of blood from your baby s scalp (through your vagina). This blood is tested for oxygen levels to show if your baby is not coping well with labour. The test can take between ten and twenty minutes. This test does not harm the baby but may leave a small graze on the baby s head once born. There may be reasons why fetal blood sampling is not appropriate for you, for example if you have certain infections. Your midwife or doctor should discuss this with you. For further information about fetal monitoring, and all other aspects of pregnancy and childbirth, talk to your midwife or doctor. If the baby is coping well then it is less likely that you will require delivery by caesarean section, forceps or ventouse (suction cup). If the baby is not coping well then the doctor will discuss a plan of care with you. 5

6 If you would like to speak to a midwife about the information in this leaflet, please contact your named community midwife. Alternatively a midwife on antenatal clinic or labour ward will be happy to advise you National Institute for Clinical Excellence 11 Strand London WC2N 5HR MIDIRS Informed Choices Freepost 9 Elmdale Road Clifton Bristol BS8 1ZZ Every pregnancy is a unique journey BabyCenter Royal College of Obstetricians and Gynaecologists Royal College of Midwives - Normal Birth Campaign. NHS Choices Website 6

7 Please use this page to write down any questions you may have for discussion with your midwife or doctor: 7

8 Further Information NHS Choices Website National Institute for Clinical Excellence Contact details: St Richard s Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE Labour ward: Antenatal Clinic: ext Worthing Hospital, Lyndhurst Road, Worthing West Sussex, BN11 2DH Labour Ward: Antenatal Clinic: ext We are committed to making our publications as accessible as possible. If you need this document in an alternative format, for example, large print, Braille or a language other than English, please contact the Communications Office by: Communications@wsht.nhs.uk Or by calling ext Department: Maternity Issue date: January 2014 Review date: November 2016 Author: Joint Obstetric Guideline Group 8