Understanding Fetal Monitoring

Fetal monitoring in labor is another area of modern obstetrics where evidence and practice don't meet. The rationale behind labor monitoring is to improve maternal and fetal outcomes by early detection of complications during labour.  


However, the research in this area tells us that higher levels of monitoring increases the risk of a c-section due to the high rate of false alarms from the technologies currently used.  


There is no research to support the practice of routine continuous electronic fetal monitoring.


In reality, your baby’s risk of having a problem in birthing is less than 2.5%, unless you choose medications.  Only 5% of all mothers will have any complications.  75% of all complications in birthing are maternal hemorrhage or a baby that does not breathe soon after birth.  


 Neither one of these complications can be detected by monitoring the baby.


Other complications of some types of labor monitoring include:

•    False readings that may cause panic or fear
•    Discomfort due to restricted positioning
•    Discomfort due to breaking of bag of waters
•    Discomfort of EFM band attached to abdomen


To truly understand monitoring during labor, you must be familiar with both the types and the tools used for each method:


Types of Monitoring

1. Continuous

This is monitoring for long periods of time.  It is usually medically-indicated when you  receive medications during labor or have high-risk conditions, such as pre-eclampsia,  diabetes,  heart problems, or other potentially life-threatening complications.

2.  Intermittent

This is monitoring on an intermittent schedule, such as every 15-30 minutes.  

3.  No Monitoring

This usually only occurs in the rare instance of an unassisted homebirth (although many families will secure a fetoscope for monitoring at home) or in the case of a precipitous birth where the baby is born en route to the chosen destination.


Tools for Fetal Monitoring

Fetoscope  

A Fetoscope is similar to a stethoscope and carries a number of benefits as a tools during labor.

Doptone
The Doptone is an ultrasound device that has the main benefit of being waterproof for use during waterbirth or if the mother uses the shower during labor.

Electronic Fetal-Monitor (EFM)
   
The EFM is the most commonly used method in hospitals, despite the evidence  that it is the least effective with the highest rates of false positives, adverse effects and its link to increasing the rate of c-sections without improving outcomes.

Telemetry

Telemetry is a form of EFM that allows for full mobility during labour.  However, it is not widely available.

Internal Fetal Monitor (IFM)

An internal fetal monitor is the most accurate way to determine fetal well-being.  However, it is the most invasive method and can start a cascade of interventions if not used judiciously.


Ultimately, you must choose what level of monitoring best fits your circumstances.  The more invasive options are medically indicated in some situations but not routinely.  Some women need to hear the sound of the baby’s heartbeat to relax while for others it causes undue stress and worry.  It is standard procedure in most hospitals to require continuous EFM for the first 15-20 minutes to develop a baseline.  After this you can take off the monitor and request intermittent monitoring.  Your choices will be limited by the equipment available at your chosen place of birth.  


However, the more aware you are of your options, the more comfortable you'll feel making informed decisions about your care during labor.   Make sure you ask your care provider about your options, including their routine practices.


If you are planning a hospital birth, you can also tour the hospital and ask for a copy of your doctor's standing orders to determine which interventions and procedures are his/her routine practice.  This will help you determine which issues need to be addressed before labor, including fetal monitoring.


References

Alfirevic Z, Devane D, Gyte GML. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD006066. DOI: 10.1002/14651858.CD006066.

Neilson JP. Fetal electrocardiogram (ECG) for fetal monitoring during labour. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD000116. DOI: 10.1002/14651858.CD000116.pub2.

Tan KH, Sabapathy A. Fetal manipulation for facilitating tests of fetal wellbeing. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003396. DOI: 10.1002/14651858.CD003396.
Mangesi L, Hofmeyr GJ. Fetal movement counting for assessment of fetal wellbeing. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004909. DOI: 10.1002/14651858.CD004909.pub2.

East CE, Smyth R, Leader LR, Henshall NE, Colditz PB, Tan KH. Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004664. DOI: 10.1002/14651858.CD004664.pub2.




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