How Your Baby Is Being Monitored During Childbirth

Fetal Monitoring (February 2019).


Why does your baby need to be monitored?

Birth pains are not only stressful for mothers, they can also be stressful for babies. During a woe, the child is squeezed tightly in the uterus and the blood supply through the placenta may be diminished. Most babies are very good with it, but not all of them: Especially for children who have not grown enough during pregnancy, it can be difficult, and also for those whose mothers suffer from preeclampsia.

Since your midwife / doctor is controlling the baby's heart sound, he / she can estimate how well your baby is doing during labor. If your baby seems to be endangered by birth, you may be advised to have a caesarean section.

Intermittent or Intermittent Surveillance

During pregnancy, your doctor or midwife listens to your baby's heart sounds at each screening appointment. He or she probably uses a handheld Doppler (also Sonicaid ) or an auditory tube ( Pinard Stethoscope ). Doppler lets you hear the heartbeat of your child. And that sounds very fast: almost like a horse at full gallop!

Even while you're in labor, Doppler and Pinard Stethoscope can be used without you feeling impaired. You just have to keep still for a few moments while the midwife listens. Then you can move right back. However, a 30-minute recording CTG is usually written at the onset of labor, which is then repeated every 30 minutes to 2 hours. This is called interval monitoring or intermittent auscultation .

Continuous electronic monitoring using CTG (labor pens

In addition to interval monitoring, there is also the option of continuous monitoring via CTG.The German Society of Gynecology and Obstetrics recommends the following in its guidelines for risk-free pregnancies: Monitoring in the opening phase by means of interval monitoring CTG is an abbreviation for cardiotocography and is also often called cardiac and postoperative.For high-risk pregnancies, continuous monitoring by CTG may be necessary even in the early opening phase. Doctor and midwife but this is handled differently strict: Advantages and disadvantages of the CTG are controversial, not always a continuous CTG is written.

Continuing electronic monitoring by a labor reviewer is likely to be recommended if:

  • you are suffering from pre-eclampsia
  • you have diabetes
  • you are suffering from heart disease
  • you are taking one during pregnancy
  • you decide to have epidural anesthesia for pain relief
  • you had bleeding just before birth
  • your labor pains were instituted or were speeded up by oxytocin drip
  • you twins expect
  • your previous child
  • your baby is born too small
  • your baby is too small
  • you are overdue for more than two weeks

Even if your pregnancy and childbirth are considered low-risk Of course, you may want continuous monitoring, if that gives you more security.

A labor reviewer uses two electronic sensors, one on your stomach and one placed over your child's heart. Both sensors are attached with elastic straps that can feel very tight around your stomach. If it gets too uncomfortable for you, ask if the straps can be loosened a bit. The first sensor measures your contractions, the second measures your baby's heartbeat. Both are connected by cables to a machine that records the heartbeats of your child. The heart rate varies from beat to beat, so the display might look something like this:

140 142 139 141 144 140

In addition, the CTG prints a continuous graph paper with two lines: one showing your baby's heartbeat, the other The pattern of your contractions and both together let midwives and doctors see how your baby copes with labor.

Sometimes an electrode is attached directly to the child's head which registers the heart sounds (instead of the sensor on your stomach) - this so-called internal cardiotocography can provide more accurate data. If you do not understand why the doctor recommends internal cardiotocography, ask!

How accurate is fetal monitoring?

Even for highly trained clinicians, it is sometimes difficult to interpret CTG data. If anything goes wrong, your doctor will probably ask you if he / she can take a blood sample from your child's head. For this, after a short sting into your baby's scalp, a small amount of blood is obtained with a thin tube. This procedure is called fetal blood sampling . Although it may be very uncomfortable to lie on your back while taking blood, the procedure should not normally be painful for the mother. By determining the level of oxygen in the blood sample, the doctor can better estimate how the baby is doing during the birth process.If there is enough oxygen in the blood sample, you will be told that everything is fine. If the sample contains too little oxygen, your doctor will probably want to take another sample after a short time or even advise you to have a caesarean section for the benefit of your child.

How uncomfortable are CTG or Sonicaid for the mother?

If your child's heartbeat is monitored by sonicaid or auditory tube, your midwife must come to the right place on your abdomen. This usually works very well in lying, sitting or standing. The same applies to monitoring by CTG.

Birth Pool Surveillance

If you give birth to your baby in a birth pool, your baby's heartbeat can be monitored with a special waterproof Sonicaid or a waterproof CTG. If the midwife can not properly assess your baby's heartbeat in the water, she will ask you to get out of the pelvis. The monitoring then takes place for a short time with electronic sensors via CTG. And if all is well, you can sink back into the birth basin.

Monitoring Your Baby During Homebirth

In a home birth, your midwife listens to your baby's heartbeat by Doppler, Earpiece, or Portable CTG. If your baby's heart sounds are conspicuous, the midwife can quickly detect it and act immediately. However, the possibilities of action are very limited - internal CTG, blood collection from the child to determine the oxygen level in the blood or even surgical deliveries are not possible at home, so that - if there is a suspicion that your baby is not feeling well - always relocation a clinic becomes necessary.

The choice is yours!

Midwives and physicians are now expected to discuss with you why they advise which method of listening to your child's heartbeat. Remember: the choice is yours!


Afors K, Chandraharan E. 2011. Use of continuous electronic fetal monitoring in a preterm fetus: clinical dilemmas and recommendations for practice.

J Pregnancy 2011: 848794. Alfirevic Z, Devane D, Gyte GML. 2013. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labor.

Cochrane Database of Systematic Reviews (5): CD006066. CMACE / RCOG. 2010.

Management of women with obesity in pregnancy. Center for Maternal and Child Inquiries and Royal College of Obstetricians and Gynecologists Joint Guideline. DGGG, AWMF. 2013. 015/036 - S1 guideline:

Application of the CTG during pregnancy and childbirth. NCCWCH. 2008a.

Antenatal care: Routine care for the healthy pregnant woman. National Collaborating Center for Women's and Children's Health. London: NICE. NCCWCH. 2008b.

Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Revised reprint July 2008, National Collaborating Center for Women's and Children's Health, Clinical Guideline. London: RCOG Press. NCCWCH. 2011.

Caesarean section. National Collaborating Center for Women's and Children's Health, NICE Clinical Guideline. London: RCOG Press. NCCWCH. 2014.

Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Center for Women's and Children's Health, Clinical Guideline, 190. Neilson JP. 2013. Fetal electrocardiogram (ECG) for fetal monitoring during labor.

Cochrane Database of Systematic Reviews (5): CD000116. RCM. 2012. Intermittent auscultation (IA).

Evidence based guidelines for midwifery-led care in labor. Royal College of Midwives Trust. RCOG. 2007.

Birth after previous caesarean birth. Royal College of Obstetricians and Gynecologists, Green-top Guideline no. 45. RCOG. 2012.

Information for you: pre-eclampsia. Royal College of Obstetricians and Gynecologists. RCOG. 2013.

The investigation and management of the small-for-gestational-age fetus. 2nd edition, minor revisions January 2014. Royal College of Obstetricians and Gynecologists, Green-top Guideline no. 31. Redshaw M, Heikkila K., 2010.

Delivered with care: a national survey of women's experience of maternity care 2010 . National Perinatal Epidemiology Unit. Oxford: NPEU. Stampalija T, Signaroldi M, Mastroianni C, et al. 2012. Fetal and maternal heart rate confusion during intra-partum monitoring: comparision of trans-abdominal fetal electrocardiogram and Doppler telemetry.

J Matern Fetal Neonatal Med 25 (8): 1517-20 Show sources Hide sources

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