In labor, continuous monitoring increases the risks of many interventions, including pitocin, epidurals, and cesarean birth, without improving birth outcomes for mother or baby. Asking a woman in labor to be still (and often in bed) so the monitor can do its job is not a benign request since it can result in a longer labor and more painful contractions. The American College of Obstetricians and Gynecologists (ACOG) doesn’t recommend routine continuous monitoring in labor.
It is sometimes possible to be monitored near the bed (sitting on a birth ball, standing and swaying, leaning on the bed, etc.) rather than in bed, to increase comfort and encourage the labor to continue to progress. When mothers or babies need to be continually monitored, it is sometimes possible to get a telemetry monitor, which can be worn and allows the mom to walk the halls during labor.
Babies are expected to have periods of sleep and wakefulness during labor. They will usually have a flat (steady) heartbeat during sleep and a baseline variablity during the times they are awake. Only the variable heartbeat is considered reassuring, so more monitoring is often done when a baby is initially asleep.
Cold and sweet foods make babies move. Eating something cold and sweet prior to monitoring will help ensure a variable heartbeat and a shorter period of monitoring.
Normal fetal heart rate is 110 to 160 beats per minute. A heart rate that is below 110, above 160, or flat for long periods of time is considered non-reassuring. The old term is fetal distress, but the wording was changed to acknowledge that no one can say for sure that a baby is in distress based on heart tones alone.
Monitors can distract support people’s attention away from the laboring mom, and some families choose to turn the audio off and cover the monitor. Electronic fetal monitoring will show the length and frequency of contractions, but not their relative strength.
Women birthing in hospitals can expect a period of monitoring of about twenty minutes when they are admitted in labor. Those birthing in free standing birth centers and at home will not have to meet this requirement.
Interventions such as pitocin (used to induce or augment labor) or epidurals, and conditions such a premature labor, require continuous monitoring because of the increased risk.
There are alternatives to electronic fetal monitoring. Fetoscopes can pick up the babies heart rate without exposing mother and baby to ultrasound. Since dopplers are handheld they are usually not used for more than a few minutes at a time, and thus are usually more comfortable than electronic fetal monitors which are held on with belts. If you are on the electronic fetal monitor, consider asking the nurse how long you’ll be on, and buzzing her after that amount of time if she’s not with you in order to be taken off the monitor.
Internal monitors are both more accurate and more invasive than electronic fetal monitors. They are often accompanied by a fetal scalp blood sample, which gives additional information about the state of the baby. They require the bag of waters to be ruptured if it hasn’t released on its own, and once placed are usually used for the remainder of the labor. They are used when there is a concern about the baby’s heart rate, or when it is difficult to get the heart rate. Because they are less likely to produce a false positive reading, they can help to avoid an unnecessary intervention.