Fetal monitoring cannot prevent a problem from occurring. However, it can alert your doctor or nurse to warning signs and allow them to take steps to help the baby.

This pamphlet explains:

Types of fetal heart rate monitoring What the patterns may mean What risks may be involved

Fetal heart rate monitoring is one way to check the well-being of your baby during labor.

Types of Monitoring

There are two methods of fetal heart rate monitoring in labor. Auscultation is a method of listening to the fetal heartbeat. Electronic fetal monitoring is a procedure in which instruments are used to record the heartbeat of the fetus and the contractions of the mother's uterus during labor.

Either method can be done at set times during labor or nonstop throughout labor. Sometimes auscultation and electronic fetal monitoring are used together. Either method is a good way to measure how well your baby is doing during labor and delivery.

The choice of which method is used depends on how your labor is going and your risk of problems. It also depends on the hospital where you deliver.

Auscultation

Auscultation involves listening to your baby's heartbeat at set times. There are two ways of listening to the baby's heartbeat with auscultation:

1. A Doppler device is a small device that is pressed against your abdomen. This device uses a form of ultrasound to convert sound waves into signals of your baby's heart you can hear.
2. A special device like a stethoscope—called a fetoscope—is placed in the ears of your doctor or nurse. The open end is pressed on your abdomen. The fetoscope allows your baby's heartbeat to be heard clearly. It is used less often than Doppler.

The heart rate of the baby will be monitored before, during, and just after a contraction or nonstop during labor. This is done to tell how the baby reacts to the contraction. If abnormal patterns are found with auscultation, electronic monitoring may be done.

Electronic Fetal Monitoring

Electronic fetal monitoring uses special equipment to measure the response of the baby's heart rate to contractions of the uterus. It provides an ongoing record that can be read by the doctor or nurse.

Electronic fetal monitoring can be external (outside), internal (inside), or both. You may need to stay in bed during both types of electronic monitoring, but you can move around and find a comfortable position.

External monitoring. With this method, a pair of belts is wrapped around the mother's abdomen. One device uses Doppler to detect the fetal heart rate. The other device measures the length of uterine contractions and the time between them.

Internal monitoring. For internal monitoring, a small device called an electrode is inserted through the vagina and placed on the baby's scalp. This device records the heart rate. Uterine contractions also may be monitored with internal monitoring.

A thin tube called a catheter also may be inserted through the vagina into your uterus. The tube measures the strength of contractions. You may feel some discomfort when the devices are put in place (about the same as for a pelvic exam). Internal monitoring can be used only after the membranes of the amniotic sac have ruptured (that is, after "your water breaks" or is broken).

What Do Fetal Heart Rate Patterns Mean?

It is normal for a fetal heart rate to vary between 110 and 160 beats a minute. This is much faster than your own heart rate, which is about 60–100 beats per minute. A heart rate in your baby that doesn't vary or is too low or too high may signal a problem.

Changes in the fetal heart rate that occur along with contractions form a pattern. Certain changes in this pattern may suggest a problem.

If there is an abnormal fetal heart rate pattern, to help the baby you may be:

• Asked to change positions
• Given oxygen through a mask
• Given intravenous (IV) fluids
• Given medication to weaken contractions and relax the uterus

Abnormal fetal heart rate patterns do not always mean there is a serious problem. Other tests may be needed to get a better idea of what is going on with your baby.

If test results suggest your baby has a problem, your doctor may decide to deliver the baby right away. In this case, the delivery of the baby is more likely to be by cesarean birth or with a special device (such as forceps or vacuum extraction).

Finally...

Fetal heart rate monitoring is one way to check the well-being of your baby during labor. As you prepare for the birth of your baby, discuss your questions about fetal monitoring with your doctor.

Glossary

Amniotic Sac: Fluid-filled sac in the mother's uterus in which the fetus develops.

Cesarean Birth: Delivery of a baby through an incision made in the mother's abdomen and uterus.

Doppler: A form of ultrasound that reflects motion—such as the fetal heartbeat—in the form of signals that can be heard.

Forceps: Special instruments placed around the baby's head to help guide it out of the birth canal during delivery.

Vacuum Extraction: The use of a special instrument attached to the baby's head to help guide it out of the birth canal during delivery.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © March 2001 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISSN 1074-8601

Requests for authorization to make photocopies should be directed to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923.

To reorder Patient Education Pamphlets in packs of 50, please call 800-762-2264, ext 830, or order online at sales.acog.com.

The American College of Obstetricians and Gynecologists
409 12th Street, SW
PO Box 96920
Washington, DC 20090-6920

12345/54321