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Family Health Magazine
CHILDBIRTH

Monitoring Your Labour
Keeping an eye on mom and baby

Monitoring in labour is often assumed to mean checking the baby’s heartbeat. Actually, monitoring helps ensure both mother and baby are well and the progress of labour is normal.

Monitoring Mother

When you first arrive at the labour and delivery unit of the hospital, the nurse who sees you will want to check what is happening. You will be asked questions about your pregnancy, and why you came to the hospital. As well, your cervix (through which the baby will pass into the birth canal) will probably be examined to see if you are in active labour. This is when the cervix is open three to four centimetres, thin and you are contracting regularly. You will usually be asked to give a urine sample just like in the doctor’s office to check for sugar, protein and signs of infection. Sometimes it is necessary to do some blood tests as well.

Once you are admitted to the hospital in active labour, your pulse, blood pressure and temperature will be taken at regular intervals. This helps check for signs of bleeding, dehydration, blood pressure problems of pregnancy, infection and other stresses in labour. You will be encouraged to change your position throughout labour and to empty your bladder often. The nurse may monitor the amount of fluid you take in and put out. You will also be checked to make sure your bladder does not get too full, as this is neither healthy for you nor helpful for your labour.

Monitoring Baby

During labour, the blood flow to baby is reduced every time there is a contraction. This is the way Mother Nature designed the system, and healthy babies are able to tolerate this very well.

A baby who does not receive enough oxygen from the mother’s blood is at risk of damaging the organs that need that oxygen - most importantly, the brain. There is no way to monitor directly how the brain is doing, but we can monitor the baby’s heart. The baby’s heart rate and pattern can show us that the brain is getting a good supply of oxygen.

The normal heart rate for baby is between 110 and 160 beats per minute. When the baby is active and moving, the heart rate will increase during the movement. This is called an acceleration, and is a sign of a healthy baby. When the baby is at rest, the heart rate will still vary from beat to beat and this is also a sign of a healthy baby.

Sometimes, the heart rate will drop to below the normal rate for that baby. This is called a deceleration. Some decelerations may occur right at the time of the contraction and they are not usually worrisome. Some decelerations may occur right after the contraction. If these late decelerations occur with every contraction, this may indicate the baby is having some problems with the blood supply. Some decelerations occur from time to time and are not related to the contractions. They are called variable decelerations.

To monitor the baby in labour, it is recommended that the baby’s heartbeat be recorded every 15 to 30 minutes in active labour. During the pushing stage of labour the heart rate should be checked every five minutes. Listening to the baby’s heart can be done with different instruments. A stethoscope or doptone can be used to listen before a contraction and then immediately after a contraction to check that the heart rate is normal. For low risk pregnancies with no sign of any problems, listening at intervals such as these is preferred because this allows the mother to get up and move about freely.

The fetal monitor is often used when there have been some problems in the pregnancy or labour. It may also be used after listening if there are some concerns that the pattern of the baby’s heartbeat may not be normal. If this is the case printed record of the heartbeat could be helpful. With the fetal monitor, an ultrasound device is strapped to the mother’s tummy and the baby’s heart rate is recorded on a piece of graph paper. Another device is also strapped to the tummy to pick up the timing of the contractions to compare them to the baby’s heartbeat. Occasionally, the heartbeat is difficult to pick up this way or a more accurate recording is needed. This is when a scalp electrode is used. A small wire is placed under the baby’s scalp and the electronic signal of the heartbeat is sent to the machine.

These monitors are very safe and can be helpful to check on your baby. They are still only machines and can run into difficulties like any other machine. If the baby’s heartbeat drops or disappears suddenly, you may become worried. It may just be a problem with the signal reaching the machine. If you notice this happening, you can let your nurse know so she can check it out for you.

If your doctor or midwife is concerned that the baby’s heart rate pattern is not reassuring, it may be decided that a fetal scalp sample is necessary. This is a test to check the oxygen and acid (pH) level in the baby’s blood. Since the baby’s scalp is all that can be reached, the blood sample is taken by pricking the skin of the baby’s scalp. If the baby’s pH is normal, then it is probably safe to continue on in labour.

A new technology still being tested is a fetal pulse oximeter. It checks the baby’s oxygen level through a monitor placed on the skin of the baby’s cheek. This is an exciting area that holds some promise to more directly monitor how well the baby is doing in managing the oxygen supply.

Monitoring Labour

Every woman’s labour is different and proceeds at its own pace. The normal variations of labour are known. We also know that women who labour for a very long time are at risk of tiring out, getting an infection or bleeding heavily after delivery. This is why it is important to make sure the labour is not slowing down too much, putting the baby and mother at risk.

It is important to know that the mother is in active labour before starting to monitor the progress. If the cervix is only a centimeter or two dilated, this is still considered prelabour and the progress may be much slower in this phase. Once in active labour, the cervix should be changing at least a centimeter an hour over a four-hour period. If it is not, it is important to know why.

Is the baby not fitting through the birth canal properly? Perhaps changing the mother’s position more will help rotate the baby into the proper position. Are the contractions strong enough to allow labour to progress? Breaking the water sac around the baby may help to make the contractions stronger and more efficient. It may also be necessary to give the mother a medication to make the contractions stronger.

The nurse monitoring the labour usually checks the strength and pattern of the contractions. The nurse will feel the mother’s tummy during a contraction, assess how tightly the uterus is contracting, and the length and frequency of the contractions. As well as heartbeat, a fetal monitor is used to time the contractions and their duration, but it will not pick up the strength of the contractions. An intrauterine pressure catheter (IUPC) can be used for this purpose. This is a soft device that is slipped up into the uterus past the baby’s head to accurately measure the force of the contractions from inside. If the contractions are strong enough and the labour is still not progressing, it will be necessary to perform a cesarean section to deliver the baby.

Monitoring in labour is done to be sure that everything is progressing normally and everyone is healthy. The nurses, doctors and midwives will explain what they are doing as they monitor your labour. The information you receive can be very reassuring. Keep your labour normal by focusing on the things that help you feel well during your baby’s most important journey in life.