When you’re having a baby—whether you’re at the hospital, in a birth center, or at home—your care provider will monitor your baby, specifically their heart rate, in some way. When they monitor the frequency and duration of your contractions simultaneously, they can check in on how baby is coping with labor. You have a few options for monitoring, and here we’ll discuss what you get with each type.
Intermittent Auscultation
Intermittent auscultation is when your doctor, midwife, or nurse checks in on the baby’s heart rate in a hands-on way for regular, short periods during active labor. Usually the care provider uses something like a Doppler device for this type of monitoring, which is a portable ultrasound machine that uses high frequency sound waves to detect blood moving through vessels and provide a readout that care providers can hear. A Doppler device is usually handheld, battery-powered, and can be used wherever you’re laboring—even in the water.
Another tool that was used historically but is less commonly used today for intermittent auscultation is called a fetoscope or fetal stethoscope. There are several types, but each of them is some variation on a bell-shaped hollow tube that when placed on the belly can amplify fetal heart tones so that your care provider can hear them through earpieces. These tools are generally used in birth centers or at home, and much less commonly in hospitals.
Electronic Fetal Monitoring
Electronic fetal monitoring is just what it sounds like: electronically monitoring baby’s heartrate. Usually electronic fetal monitoring relies on monitors worn over the belly, called external fetal monitoring, or inserted under the top layer of skin of baby’s scalp, known as internal fetal monitoring. Electronic fetal monitoring is typically continuous, meaning that belted monitors—one to track baby’s heart tones and one for contractions—are worn on the pregnant person’s abdomen throughout labor. It’s also possible to experience intermittent fetal monitoring, where you might wear a monitor for some portion of every hour, for instance.
When continuous, electronic fetal monitoring typically means that you can’t move far based on wires that connect the monitor to the receiver. Occasionally hospitals have wireless electronic monitors that allow you to move around and try water and different positions for pain relief during labor, but most commonly if you’re giving birth in a hospital, you’ll be offered continuous electronic fetal monitoring.
What does the evidence say about fetal monitoring?
Studies have shown that continuous fetal monitoring can lead to an increased risk of Cesarean section—a major surgery in which the baby is born through an incision in the abdomen rather than via the vagina—and births where a care provider uses forceps or vacuum without a corresponding increase in safety or outcomes for the baby. For that reason and because it allows pregnant people to move around, which can facilitate labor progress, intermittent auscultation is recommended by the National Institute of Health and Care Excellence in the United Kingdom, Society of Obstetricians and Gynecologists of Canada, the American College of Nurse-Midwives, and the American Academy of Family Physicians. The American Congress of Obstetricians and Gynecologists has identified intermittent auscultation as an approach that can limit intervention during labor and birth.
Despite the evidence, electronic fetal monitoring remains very popular. According to Rebecca Dekker, a doctorally prepared nurse and founder of the website Evidence Based Birth, about 9 in 10 people will experience electronic fetal monitoring during labor. Dekker explains in her signature article on fetal monitoring that there are legal and personnel training reasons that electronic fetal monitoring is so common. Because electronic fetal monitoring provides an automatic, continuous record of fetal heart tones, many providers believe that will protect them from lawsuits if babies are injured during birth. Plus, many nurses and doctors are not trained to use intermittent auscultation, which means it’s not always offered to laboring people.
If intermittent auscultation is something that you would like to try during your labor, ask your care provider whether it is an option at the place where you’ll have your baby. If your care provider doesn’t offer it, it might be worth it to look into a different care provider or speak to your current doctor or midwife about why they have the policies in place that they have.
