Monitoring your baby in labour

As well as checking on you throughout labour, your midwife will check how your baby is doing. They will do this by monitoring your baby’s heart rate. This can help to check your baby’s health and strength during labour and birth, and pick up any problems early on. 

Your midwife should explain how and why they are monitoring your baby’s heart rate, and they will support any choices you make about how your baby is monitored. They will also let you know if they think they need to change how they monitor your baby during labour. 

Here are some ways in which your midwife or doctor will check how your baby is doing. 

Listening to your baby

If you have a low risk of complications the midwife will listen to your baby's heart rate using a Sonicaid or a Pinard stethoscope. 

• A Sonicaid is a small hand-held device, sometimes called a doppler. It picks up your baby’s heartbeat, so your midwife can listen to it.
• A Pinard stethoscope is a trumpet-shaped device that your midwife will put on your bump. It helps them to hear and count your baby’s heartbeat.

Using a Sonicaid or Pinard stethoscope to check your baby’s heart rate is a safe and effective way to make sure they are doing well during labour and birth. 

Your midwife will aim to listen to your baby’s heart every 15 minutes in the first stage of labour and at least every 5 minutes in the second stage. 

Having your baby checked in this way means you are free to move around during labour. Waterproof Sonicaids can be used in baths and birthing pools. 

Electronic fetal monitoring (EFM)

Electronic fetal monitoring involves your midwife strapping 2 plastic pads to your bump using elastic straps. These are attached to a monitor that shows your baby's heartbeat and your contractions. 

This is also called continuous monitoring. Your midwife might offer it to you if you have any complications during pregnancy or labour. These include:

• gestational diabetes,
• high blood pressure
• your baby being small for their dates. 

They will also suggest it if you have had a caesarean birth in the past.

But you can ask for EFM even if there are no complications. It is worth being aware that having continuous monitoring can increase your chance of having further interventions in labour. Your midwife should explain all of this to you.

Your midwife or doctor will suggest EFM during the course of labour if:

• you have an epidural 
• you have an oxytocin drip to speed up labour
• there is baby poo (meconium) in the amniotic fluid around your baby
• you develop high blood pressure, a high pulse rate or a high temperature
• you start bleeding in labour
• your labour does not seem to be progressing
• there are concerns about your baby's heartbeat, position, or movements.

It is up to you whether you have EFM or not. If you are recommended to have it, your midwife should explain why it is needed, and what it may show.  

If your midwife or doctor suggests EFM because of worries about your baby’s heart rate, and it turns out your baby’s heartbeat is normal, they may suggest removing it and returning to using a Sonicaid or Pinard stethoscope. But if you would prefer to keep it on, that is fine too.  

If you are having a home birth, and your midwife thinks your baby needs EFM, they will suggest you transfer to hospital. Once electronic monitoring is started, your midwife will:

• stay with you at all times
• ask you how you are feeling
• ask you about your baby’s movements
• check the monitor often
• carry out any other tests that are needed.

Your midwife should tell you what is going on at every stage of EFM. If you have concerns or questions, you can ask them what is happening and why.

EFM can sometimes make it harder for you to move around. It may make changing positions and staying mobile during labour tricky.

Some hospital units now have wireless monitors (telemetry), which you could ask for instead. These make it easier to move around. They are often waterproof, so can even be used in a birthing pool. 

Sometimes, a special clip called a fetal scalp electrode can be attached to your baby's head instead, or to their bottom if they are breech. This can give a better reading of your baby's heart rate.,  It will not harm your baby, but you might see a small graze on their head or bottom after birth.

This should heal quickly, but carries a small risk of infection. A fetal scalp electrode clip will stay on until just after your baby is born. 

Fetal blood sampling (FBS)

If your midwife or doctor is worried about your baby's heart rate they may sometimes ask to do fetal blood sampling (FBS). This means they will take one or 2 drops of blood by making a small scratch on your baby’s scalp. 

They will do this through your vagina and cervix, using an instrument similar to what a nurse uses during a cervical screening. They then test the blood, to help them see how your baby is coping with labour, and measure the level of oxygen in your baby’s blood. 

After the FBS, your midwife or doctor will explain the results and talk to you about what might happen next. Your options may include:

• carrying on with labour as normal (with electronic monitoring)
• taking a second sample from your baby
• having an assisted birth or a caesarean section.  

Some people do find FBS a difficult, painful or upsetting experience. There is also not enough evidence about how useful it is for you and your baby, so you may be offered it as part of a research study. You should not feel any pressure to have FBS if you are not sure you want it.