Monitoring During Labor
Your baby's heart rate is an indication of how well your baby is dealing with labor and it is monitored at regular intervals, called intermittent monitoring. If a problem is found or you have a high-risk pregnancy, then you may be advised to have fetal electronic monitoring, in which your baby's heart rate and your contractions are monitored continuously by a electronic fetal heart monitor (see External fetal monitoring). All the information about your labor is recorded on a chart, called a labor graph (see External fetal monitoring).
This is done using a handheld battery-operated device known as a Doppler sonicaid, which is held against your abdomen to listen to your baby's heartbeat. When you are pushing in the second stage of labor, the fetal heart needs to be monitored more frequently.
In this type of fetal monitoring, two devices monitor your baby's heart rate and the strength and frequency of your contractions. Your baby's heart rate is monitored with a circular ultrasound-like device. If you want, you can hear the heartbeat, or ask that the volume be turned down if this is distracting. Your contractions are monitored with a small plastic circular device. One or two elastic belts are placed around your abdomen to secure the monitors. You should be able to stand, sit, or squat with the monitors in place, and some hospitals have monitors that allow you to walk around and be monitored by radio signal.
If your baby's heart-rate reading indicates the baby is distressed or the signal from an electronic monitor is poor, the doctor may suggest internal fetal monitoring. In this technique, a small electrode is attached to the baby's scalp and detects the electrical impulses of his heart. A wire from the electrode comes out via the cervix and attaches to the EFM machine (see External fetal monitoring). You still wear a strap around your abdomen, which holds the device for detecting the rate and strength of your contractions.
The electrode is placed during a vaginal examination and is no more uncomfortable than this. Placing a scalp electrode may be mildly uncomfortable for your baby and there is a small risk that your baby could get a scalp infection, which can be treated with antibiotics. Even though these risks are small, a scalp electrode should not be placed routinely. Your doctor should discuss how it works before it is placed, and you should understand why it's being done. Electrodes should also be avoided if you have a viral disease that can be transmitted to your baby during labor, such as hepatitis B or C, or HIV. Once a scalp electrode has been placed, you can't move far from the monitor, although you may be able to change position.
If a EFM reading from the scalp electrode indicates that your baby is distressed, a blood sample may be taken from the scalp to check acidity levels. If these are high, a cesarean or assisted delivery may be suggested.
A labor graph is a large chart that contains several graphs which provide information on your labor, allowing the doctor to monitor the progress of your labor. One of the most useful tools in this chart is a graph showing your labor curve. This plots cervical change and the position of your baby's head in relation to your pelvis over time. The graph enables the doctor to establish when your labor became active. Also recorded with your baby's heart-rate monitoring are your blood pressure, pulse, temperature, and the rate of your contractions, as well as your pain levels.