LISTENING TO YOUR BABY S HEARTBEAT DURING LABOUR (FETAL HEART MONITORING)

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1 LISTENING TO YOUR BABY S HEARTBEAT DURING LABOUR (FETAL HEART MONITORING) Information Leaflet Your Health. Our Priority.

2 Page 2 of 7 Introduction This leaflet will give you information on how Midwives and Doctors listen to and monitor your baby s heartbeat during labour and will explain the advantages and disadvantages of the different methods. It is based on national evidence based clinical guidelines about Electronic Fetal Monitoring. The Midwife caring for you in labour will listen to and record the baby s heartbeat to help identify if there are any problems. This information is intended to help you to make choices about how your baby s heartbeat is monitored in labour. Why monitor the baby s heartbeat in labour? Wherever you choose to give birth, various checks will be offered to you and your unborn baby. This will include listening to or monitoring your baby s heartbeat. Most babies come through labour without any problems but there are a few who don t cope so well. During contractions blood cannot flow through the placenta (afterbirth) so easily and the baby may get less oxygen than usual. This is normal and most babies cope without any problems. If a baby is not coping well with the effect of the reduced oxygen, this may show up in changes to the rate and pattern of the baby s heartbeat. It is generally thought that monitoring the baby s heartbeat regularly during labour helps to reduce the number of babies who need help to breathe at birth. The best way of finding out if your baby is having difficulties is to listen to the heartbeat regularly throughout labour (fetal heart monitoring). What are they checking for? The Midwives and Doctors are checking the strength and frequency of your baby s heartbeat. The normal range for the baby s heart rate is between 110 and 160 beats per minute, although this can be a little higher or lower without meaning the baby is in difficulty. Before starting any monitoring the Midwife or Doctor will check your heart rate by counting your pulse as well as listening to your baby s heart rate to make sure they can tell them apart. What are the methods for fetal heart monitoring? Your baby s heartbeat can be monitored in a number of different ways which will be explained and include: Midwife s stethoscope (Pinnard s stethoscope) Handheld ultrasound machine (Doppler) Electronic fetal monitoring or EFM (cardiotocograph or CTG) Fetal heart monitoring can be intermittent auscultation with a Pinnard stethoscope or a handheld Doppler or continuous monitoring with an Electronic Fetal Heart Rate Monitor.

3 Page 3 of 7 Intermittent auscultation with a Pinnard s stethoscope or handheld Doppler You will have had your baby s heart rate listened to during your pregnancy by your Midwife or Doctor using the Midwife s stethoscope (Pinnard) or a small button operated handheld ultrasound machine (Doppler). Intermittent ausculation can be done either using the Pinnard stethoscope, which is a trumpetshaped stethoscope that enables the Midwife or Doctor to hear your baby s heartbeat through your abdomen (tummy). The Doppler is a small handheld device that looks like a microphone, when it is placed against your abdomen it allows you, your Midwife and your Doctor to listen to your baby s heartbeat using ultrasound. A special waterproof Doppler can be used to monitor your baby s heartbeat in labour if you are using the birthing pool or bath. If you are healthy and have had a trouble-free pregnancy, this is the recommended method of monitoring your baby s heartbeat during uncomplicated labour. This should happen for 1 minute, every fifteen minutes during labour (first stage of labour), increasing to after every contraction in the later stage, when you are giving birth (second stage of labour). With intermittent monitoring, your ability to move around will only be limited briefly when the baby s heartbeat is being listened to. You will be able to stand up, move around and change your position for comfort as often as you wish, or have a bath or shower. Current research evidence does not support the need for your baby s heartbeat to be monitored using an electronic fetal heart monitor when you arrive at the hospital. It is not the policy of the Women s Unit at Stepping Hill to offer an initial monitoring or admission CTG unless you are experiencing a problem with your pregnancy or the Midwife has concerns about your baby s heartbeat. Continuous Monitoring with an Electronic Fetal Heart Rate Monitor (EFM) If when listening to your baby with a Pinnard or a Doppler, the Midwife or Doctor thinks there may be a problem, they may recommend that you change to EFM. If you are in labour at home, in the Birthing Centre or at Corbar Maternity Unit they may suggest that you are transferred to a Consultant Unit in the Women s Unit at Stepping Hill Hospital. Sometimes your Midwife or Doctor may offer and recommend continuous monitoring. This may be for a number of reasons, for example if you have had problems during your pregnancy or there are concerns about how your baby will cope with labour. The reasons for using continuous monitoring should be explained and discussed with you and may include the following examples:

4 Page 4 of 7 Your Midwife or Doctor has already listened to your baby s heartbeat using a Pinnard or Doppler and thinks that your baby may not be coping well. You have health problems, such as Diabetes, infection, pre-eclampsia (high blood pressure), problems with your heart or kidneys. In your previous pregnancy you had a caesarean birth. In your current pregnancy: Your pregnancy has lasted more than 42 weeks. Your labour is induced (started artificially with prostaglandin and/or a drip (oxytocin). Your labour is progressing more slowly than expected. You have bleeding from your vagina before or during labour. You are having Epidural analgesia (pain relief injected into the back). Your baby is smaller than expected or premature. You have a twin/triplet pregnancy. Your baby is a breech presentation (going to be born bottom first). Continuous monitoring keeps track of your baby s heartbeat for the whole of your labour. This is done using a piece of equipment called an electronic fetal heart rate monitor, which records your baby s heartbeat. The monitor works by having two pads or sensors (transducers) against your tummy, which are held, in place with two elastic belts. One is placed at the top of your tummy to pick up the timing of your contractions; the other is positioned on your tummy where it can pick up the baby s heartbeat. The monitor records and prints the baby s heartbeat pattern on a strip of paper. This is sometimes called a cardiotocograph (CTG) or a trace. It will also record and print any contractions you are having. You can usually hear the baby s heart beating and see the heart rate on the monitor display. You may not hear the heartbeat straight away or the sound may disappear and occasionally the monitor stops showing the heartbeat on the graph or display. This happens because sometimes there is a loss of contact between the machine and the baby. It does not necessarily mean there is a problem. The Midwife or Doctor will read and interpret the trace to help to understand how well your baby is coping with labour. It is normal for there to be changes in the pattern of the heartbeat, for example when your baby is sleeping or moving around. You should speak to your Midwife or Doctor if you want the trace explained to you. Being attached to the monitor can limit your ability to move around. You will be able to stand up or sit down, use a birthing ball, beanbag or stool and move a little as the wires attaching you to the monitor are quite long. It will not be possible to have a bath or a shower whilst you are attached to the monitor or move from room to room. You can be easily disconnected from the monitor if you need to have a shower or a bath and use the toilet.

5 Page 5 of 7 If the Midwife or Doctor needs to monitor the baby s heartbeat so that the trace shows better contact, this can be done by using a fetal scalp electrode (FSE). This is sometimes called a clip. The electrode is a small clip on the end of a thin wire that is attached to the baby s scalp (or bottom if the baby is breech) during an internal examination through the vagina. The electrode picks up your baby s heartbeat directly. The electrode can be easily removed when your baby is born. The clip may leave a small mark that will heal within a few days of birth. In the past it was thought that Electronic Fetal Monitoring would make labour safer for the baby however, research has shown that where pregnancy and labour are uncomplicated, electronic monitoring does not improve the outcome for the baby. When labour is uncomplicated the Pinnard or Doppler is the appropriate method for monitoring the baby s heartbeat. What happens if a problem is suspected? The trace may make your Midwife or Doctor suspect that your baby is not coping well. If this happens you may be offered a test called fetal blood sampling. This means that a little blood (a few drops) is taken 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 up to twenty minutes to complete and is an accurate way of finding out if your baby is in difficulty. Occasionally the electronic fetal monitoring 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 find out if immediate delivery would be safest for your baby. It may also help to prevent you having an unnecessary caesarean. There may be reasons why fetal blood sampling is not appropriate for you, for example if you are not in established labour or you have certain infections. Your Midwife or Doctor should discuss this with you. Further information and making your choice The Midwives and Doctors of the Women s Unit at Stepping Hill Hospital want you to be fully informed and share in decisions about your care in labour. Your wishes and choices will be respected. There may be good reasons why your treatment is different from the information in this leaflet, depending on your individual circumstances and wishes. If you would like to know more about monitoring your baby s heartbeat in labour or would like more detailed information, please ask your Midwife or Doctor. They will be happy to talk to you about this or any other aspects of pregnancy or childbirth. Further information can be obtained from: NHS Direct Tel: NHS Direct Website - NICE Website RCOG Website MIDIRS informed choice The National Childbirth Trust

6 Page 6 of 7 Supervisors of Midwives Need extra information, support or advice? Contact a Supervisor of Midwives by ringing the main switchboard at Stepping Hill Hospital: A Supervisor of Midwives is available 24 hours a day. Supervisors are concerned with ensuring the safety and well-being of mother and baby and with the provision of high quality midwifery care. Contact us Maternity Triage Department

7 Page 7 of 7 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT09 Publication date June 2013 Review date June 2016 Department Maternity Location Stepping Hill Hospital

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