Fetal Monitoring: Teaching the Options

Fetal monitoring is a routine part of labor for most women, making it an essential topic to cover when preparing expectant parents for childbirth. By understanding what to expect, the available options, and the advantages and disadvantages of different approaches, parents can feel more informed and confident. Additionally, they should be equipped to communicate their preferences, express concerns, and ask questions with their healthcare providers, empowering them to advocate effectively for their needs during labor and birth.

Here, we’ll review the basic principles behind fetal monitoring, what the various options are, what the research says, and how to teach and empower your clients about fetal monitoring options.

What is Fetal Monitoring?

Simply put, fetal monitoring refers to methods for checking the fetal heart rate during labor and birth. When the fetal heart rate remains reassuring, labor can continue without concern. If alarming changes in the heart rate are detected that do not resolve, interventions may become necessary to protect baby's health.

Monitoring may be continuous or intermittent (occasional) during labor and when to use continuous monitoring is a bit controversial. The American College of Obstetricians and Gynecologists (ACOG) recommends continuous monitoring for high-risk pregnancies, including pregnancies impacted by preeclampsia, type I diabetes or intrauterine growth restriction. But many providers routinely use continuous fetal monitoring for all labors regardless of risk levels. Research has found that continuous monitoring for low-risk labors can lead to unnecessary interventions during labor and increase the risk of Cesarean delivery. In addition, intermittent monitoring has been found to be effective at catching complications for healthy labors, without the added risks of continuous.

What are Options for Fetal Monitoring?

There are two primary ways to monitor a baby’s heart rate during labor:

Auscultation

A hand-held device like a fetoscope or Doppler is used intermittently to listen to the fetal heart rate. For low-risk pregnancies, it’s usually recommended that a health care provider listen to the fetal heart rate either after each contraction, or in 30-minute intervals during the first stage of labor and in 15-minute intervals during the second stage of labor.

Electronic Fetal Monitoring (EFM)

EFM involves keeping a monitor against the mother's abdomen (external EFM), often with adhesive or a strap, or attaching an electrode to the fetal scalp (internal EFM). External EFM can be done continuously or intermittently. Internal EFM is continuous and typically used only when there are problems with external monitoring or when careful monitoring is needed. 

Monitoring in General

Fetal heart rate monitoring in general has both risks and benefits, and each type of fetal monitoring carries its own risks and benefits as well. Some birthing facilities use a combination of different approaches.

As The National Library of Medicine outlines, here’s what the overall research says on fetal heart rate monitoring in general:

• Fetal heart rate monitoring is linked with an increase in C-sections as well as operative vaginal deliveries, both without notable improvements in outcomes.
• The research is unclear when it comes to the impact of fetal heart rate monitoring on newborn deaths, but there is a small reduction in newborn seizures.
• There is no evidence of fetal heart rate monitoring improving Apgar scores, cerebral palsy rates, NICU admission, or developmental delays.
• Fetal heart rate monitoring may have a role to play when it comes to evaluating for conditions like placental abruption, differentiating between true labor and false labor, and monitoring high risk pregnancies.

Intermittent vs. Continuous Monitoring

The type of fetal monitoring that has been researched most extensively is continuous electronic fetal monitoring. This type of fetal monitoring is more invasive than auscultation or intermittent EFM. Continuous monitoring can restrict movement, increases the risk of unnecessary interventions, and according to the Merck Manual, does not reduce mortality rates in large clinical trials. Moreover, the practice is known to increase C-section rates. Often, the abnormalities these electronic fetal monitors detect are false positives.

Teaching Your Clients about Fetal Monitoring Options

When it comes to teaching about the different options for fetal monitoring, a picture is worth a thousand words. Showing your clients photos of the different options, or videos of how they work, can go a long way in preparing them for what to expect. You can take questions or break your class into small groups to discuss the pros and cons of each method. It is also helpful to practice positions and movements that clients can use even when being monitored. Encourage clients to research monitoring options at their birth place and practice positive communication with their health care team about monitoring as labor unfolds. 

The Preparing for Birth book includes practical, clear information and visuals on fetal monitoring that parents can use to better understand their options. This book also has communication tools and a labor preferences sheet, so parents can advocate for the birth experience they desire. 

Communicating with their healthcare providers about options, before and during labor is key for a healthy and satisfying birth experience. Of course, all labors and deliveries are different, and one can’t always plan for what interventions may be needed. But it’s helpful to empower clients by offering them guiding questions to ask their providers, and to make it clear that they have a voice when it comes to what fetal monitoring options may be employed during their labors.

Questions your clients may want to bring to their appointments with their provider include:

• Do you routinely use continuous fetal monitoring during labor?
• Do you have options for which kind of fetal monitoring is used?
• Are these choices different based on my risk factors?
• What are the pros and cons of each method?

The Bottom Line

The topic of fetal monitoring can be controversial at times, because different providers have different ways of handling fetal monitoring. That’s why it’s important for clients to be well versed on the ins and outs of fetal monitoring, and understand that in most cases, there are different options available to them. Encourage your clients to follow up with their providers if they continue to have questions and concerns about fetal monitoring options. 

Wendy Wisner, Freelance Writer and Lactation Consultant (IBCLC)

Sources

American College of Obstetricians and Gynecologists. Fetal Heart Rate Monitoring During Labor.

Merck Manual Professional Version. Fetal Monitoring During Labor and Delivery.

National Library of Medicine. Fetal Monitoring.

Evidence Based Birth. The Evidence on: Fetal Monitoring

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