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  • Writer's pictureNicole Ament

Fetal Monitoring During Labor

Updated: Mar 11, 2023

Routine fetal monitoring during labor has become the norm in our country. A tool that came about in 1958, developed for use in high risk pregnancies, External Fetal Monitoring (EFM) is now used on everyone who walks through labor and delivery to have a baby. However, one still has options!

A baby’s heart rate can vary during labor, typically ranging from 110-160 beats per minute and can help show how that baby is tolerating those labor contractions.

Done in a few ways, babies can be monitored by:

  • Doppler, a small device that’s handheld and when placed in the belly, transmits the heartbeat

  • Fetoscope or pinard, which looks similar to a stethoscope

  • Electronic Fetal Monitoring, external, done with two belts and two and two small monitoring devices that are put around the belly to measure heart rate and contractions; can be used continuously or intermittently

  • Electronic fetal monitoring, internal, uses an electronic transducer that’s screwed directly into the baby’s scalp, provides more accurate transmission of the fetal heart rate when the external one isn’t giving accurate details or closer watch of baby is needed.

  • Internal Intrauterine pressure monitoring is sometimes used with the internal EFM or alone, that gives information about the actual strength of a contraction, used mainly when they’re not seeing ‘strong enough’ contraction patterns with the external devices.

With continuous monitoring, one is hooked up to the machines non-stop. This can be done for no real reason at all, once a person has an epidural or other forms of interventions intended to progress labor or manage pain, or for other situations that can be deemed ‘higher risk.’

One can always ask to be intermittently monitored, which can look like being hooked up to the devices once an hour (or longer) for 20 minutes or so or to have a Doppler used on occasion.

Babies have different heart rates for different reasons throughout labor, and even though sometimes, the heart rate changing can seem scary, most things work themselves out with little intervention needed or merely a position change.

Heart rate accelerations are normal, of at least 15 beats per minute for up to 15 seconds or so and they happen during different stages of labor. They can indicate if the baby is getting enough oxygen or is handling labor well. Decelerations happen in labor as well, and there are three types of decelerations that they watch for:

  • Early decelerations, as baby’s head is compressed, often right before birth, when the baby is descending into the vagina, for example.

  • Late decelerations, which begin at the peak of a contraction or just after a contraction has ended. How a baby recovers from these can be a sign of how they’re tolerating labor.

  • Variable decelerations, happen at random times and are irregular dips that usually happen when the umbilical cord is being compressed. If it happens repeatedly, it can be a concern that baby’s oxygen and other important nutrients are being compromised from reaching the baby.

There are a few things that providers do to help babies cope better with their labors when decelerations occur, such as:

  • Making sure the laboring person is well hydrated

  • Changing positions

  • Making sure the laboring person has adequate oxygen

  • Emergency Cesarean

If things still don’t change with the heart rate of the baby after all of those measures have been taken, a provider may recommend the baby needing to be born more quickly. This can mean significantly more people in the birth space suddenly (NICU staff) and them urgently wanting to help get the baby out. If the birthing person isn’t yet in active labor, a c-section may be required to deliver the baby.

Just know that lots of things can happen during labor and delivery and not all seemingly-bad things stay bad for very long. Birth and babies have a way of working things out more often than not, and knowing what things are happening beforehand can help ease that fear and stress if and when they ever happen to you.


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