That first magical sound – that most of us actually not only see, but also hear our baby. From early pregnancy, listening to our baby’s heartbeat becomes an accepted and normal part of pregnancy care.
When we go into labour, no matter where we give birth; at home, in a midwife led unit or in hospital, whether we have a midwife or doctor at our birth, we will usually be offered monitoring of our baby’s heartbeat. Normally this is offered in one of two ways – intermittent (available at home or in midwifery led birthing units) or continuous (available in hospital and some birth centres, but not home) – and of course what you decide to accept is entirely up to you.
Intermittent monitoring can be done using either a pinard or a doppler. A pinard is a wooden stethoscope which looks a little bit like a wooden tube with flanges like a trumpet at each end. The pinard is placed on the woman’s belly, and the midwife listens in to the baby with her ear on the other side of it. Using the pinard, only the midwife can hear the baby. The doppler is a probe attached to a machine. The probe is placed on the mother’s belly and the machine recognises the heart beat and creates the sound that we hear as the baby. Dopplers use ultrasound, and women who prefer not to have their babies exposed to ultrasound may prefer their midwife to use a pinard. Whether the pinard or doppler is used, it’s offered intermittently, so it may be used for a short period of time (say a minute) and then taken off. Intermittent monitoring tends to be offered to women who are classed as “low risk”, but it’s up to you whether you have it or not, and you can have it if you’re “high risk”, too, although recommend you discuss this with your doctor.
A continuous monitor has two probes which are secured to the woman’s belly with straps to hold them in place. The probes are just flat plastic disks and they shouldn’t dig in or hurt at all, although the straps can be uncomfortable if they’re too tight – ask for them to be loosened a little if you need to. The monitor picks up the baby’s heart rate as well as other data such as contractions and displays this on a screen and prints it to paper. It also creates the sound of the heartbeat so this can be listened to by the medical staff. The continuous monitor is left on either for a period of time, or for the whole labour. Continuous monitoring is often advised for women who are classed as “high risk”, but you can ask why your specific reason for this classification means that continuous monitoring is suggested before making your decision. If you don’t want it, you can always change your mind, and if you are being continuously monitored and want to switch to intermittent or no monitoring, that’s your choice, too.
Intermittent monitoring may be better for women who want to be mobile and active in labour, as the monitoring can easily be done with the woman in any position – kneeling, standing and leaning, sitting on a ball or squatting, for instance. It is easy to use in the birth pool, too, it just needs a waterproof cover which should be standard equipment at home or in hospital.
It’s still possible to be mobile and active if you choose to accept continuous monitoring, however women are often asked to lie on the bed as otherwise the probes can move too much. This can make labour harder to cope with and may increase your chance of an instrumental birth or caesarean because, when you’re trying to keep still, your body isn’t moving to help your baby to be born. Having said that, you don’t need to be on the bed to have continuous monitoring, and it’s always worth trying to see how well the probes work while you stand up and move around. Sometimes it’s possible to have someone (say a birth partner) hold the probes in place (still in the straps) if a woman wants to move around.
Continuous monitoring can be done in the pool, but this needs a specific type of monitor called a telemetry system. This has the same belly probes and straps, but the data that they pick up is sent wirelessly to the device which displays it.
So what’s the purpose of all this? Why are we listening to the heart? During labour, listening to your baby’s heart may help the midwife or doctor to judge how well your baby is coping with labour. Surprisingly, the evidence for this is poor, and despite nearly every woman having some kind of monitoring in labour, there’s no evidence that continuous monitoring improves outcomes for women and babies – and continuous monitoring is shown to increase the number of babies born by caesarean, when compared to intermittent monitoring, without any improvements to babies’ health.
Despite this, monitoring is entrenched in our maternity care and is unlikely to go away anytime soon. The important thing for women to know is that they have options, and it is they who decide what’s right for them.