Your baby's heartbeat
Hearing your baby’s heartbeat is a special part of pregnancy and labour. Midwives have an important role in listening to and recording your baby’s heart rate throughout your labour. This helps the midwives to observe how your baby is coping with labour, and to provide you, and the midwives, with reassurances that your baby is doing well.
The midwife caring for you during labour will check your baby’s heartbeat, which is usually between 110 and 160 beats per minute (about twice as fast as your own heart-rate), using one of two different methods. These methods are called ‘intermittent auscultation’ (listening in every now and then) and electronic fetal monitoring (recording the heartbeat all the time, with a machine).
Intermittent auscultation means listening to and counting your baby’s heartbeat for one full minute at set times during your labour, usually every 15 minutes during the early part of labour and more often (every 5 minutes) as you get nearer to giving birth to your baby. The two common ways of doing intermittent auscultation are using a Pinard stethoscope or a hand-held battery-operated tool called a Doppler or ‘sonicaid’.
A Pinard stethoscope is like a little trumpet. The midwife will place the open wide end of the Pinard onto your abdomen (tummy), while placing her/his ear against the flatter end of the Pinard. This allows the midwife to hear and count your baby’s heartbeat.
If the midwife uses a Doppler device, she/he will place the circular end of the device onto your abdomen. This picks up the sound of your baby’s heartbeat which can then be heard and counted – you will be able to hear it too.
Fig. 1: Pinard stethoscope (left) and doppler (right)
Electronic Fetal Monitoring
Electronic fetal monitoring involves the use of a machine called a cardiotocograph (or CTG for short), which listens to your baby’s heartbeat all of the time and records it on a paper printout (or sometimes directly to a computer in the office). This is also called continuous CTG monitoring.
Checking your baby’s heartbeat in this way involves having two flat round sensors placed on your abdomen and held in place by elastic belts which go around your tummy. One of the sensors is placed near the top of your abdomen where it can detect and record when you are having a contraction. The second sensor is placed at or near the position of your baby’s shoulder where it will find and record your baby’s heartbeat.
Fig 2. CTG machine
Which method should you choose?
Research shows that intermittent auscultation (listening in every now and then) is most suitable, safe and recommended for checking a baby’s heartbeat in a normal healthy pregnancy and uncomplicated labour. Research has also shown that fewer caesarean sections occur in low risk, healthy women, with normal pregnancy and labour, when intermittent auscultation is used during labour compared to using continuous CTG (Alfirevic et al. 2017). It also has the advantage of allowing you to move freely during your labour.
However, if you have had problems in your pregnancy, such as high blood pressure or diabetes, or if the midwife has some concerns about your baby’s wellbeing during labour, she/he may recommend the use of a CTG. Also, if the midwife thinks there may be a problem after listening to your baby’s heartbeat with a Pinard or Doppler during labour, she/he will recommend that you change to continuous monitoring or CTG. This may be for a short period of time only, such as 20 minutes, or it may need to be left on for the rest of your labour.
Talking to your midwife about the different methods of checking your baby’s heartbeat will help answer any questions you have, and will help you make a choice that is right for you.
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