Fetal Monitoring: Understanding Your Options

Types of Fetal Monitoring
When you're in labor, one of the ways care providers assess how your baby is doing is through fetal monitoring. There are different types and devices used, and understanding these options can help you make informed choices about what’s best for you and your baby.

Intermittent Monitoring
Fetal monitoring falls into two main categories: intermittent and continuous. Intermittent monitoring means your baby's heart rate is checked at regular intervals rather than constantly. This is often done with a handheld Doppler or a fetoscope, which is a special stethoscope for listening to fetal heart tones. This type of monitoring allows more freedom of movement, reduces unnecessary interventions, and can be a good option for low-risk pregnancies. The downside is that it may not pick up on subtle changes in the baby’s heart rate. Some hospitals also have strict policies on when and how often intermittent monitoring is done, which may not always align with your preferences.

Continuous Monitoring
Continuous monitoring, on the other hand, involves tracking the baby's heart rate and contractions throughout labor. This is the standard in many hospitals, especially if you are being induced, have an epidural, or are considered high risk. It can help detect potential problems early, but it also comes with drawbacks. Being hooked up to a monitor can limit movement, which can make coping with contractions more difficult. It can also lead to unnecessary interventions if providers react to minor heart rate changes that might not actually indicate distress.

Electronic Fetal Monitoring (EFM)
There are several types of devices used for external monitoring. The most common is the electronic fetal monitor, which uses two belts around the abdomen. One belt holds an ultrasound transducer that tracks the baby's heart rate. The other has a toco transducer that measures contractions. It’s important to know that while this monitor tracks how often contractions happen and how long they last, it does not measure their actual strength.

Wireless Fetal Monitors
Wireless fetal monitors, like the Monica Novii, work the same way as traditional EFMs but use Bluetooth technology to send data to the monitor. These allow for more mobility and are sometimes an option for people who want continuous monitoring without being stuck in bed.

Handheld Dopplers
Handheld Dopplers are another tool used for monitoring, especially in out-of-hospital births or for intermittent monitoring. These small devices use ultrasound to pick up the baby's heartbeat. They are quick and easy to use but don’t provide continuous data, which means they might not catch certain heart rate variations.

Internal Fetal Monitoring
Sometimes, external monitoring doesn’t provide enough information, or continuous monitoring is difficult due to movement. In these cases, providers may recommend internal monitoring. Internal monitoring requires breaking the amniotic sac if it hasn’t already ruptured, which makes it more invasive.

Fetal Scalp Electrode (FSE)
A fetal scalp electrode (FSE) is a small wire attached to the baby's scalp that provides a more accurate heart rate reading. While it can be helpful when external monitors aren’t picking up a clear signal, it does leave a small mark on the baby’s head and carries a slight risk of infection.

Intrauterine Pressure Catheter (IUPC)
Another internal monitoring tool is the intrauterine pressure catheter (IUPC), a thin tube inserted into the uterus to measure contraction strength. Unlike an external monitor, an IUPC does measure contraction intensity, but it also comes with risks like infection or, in rare cases, uterine perforation.

Fetoscope
A fetoscope is a specialized stethoscope designed to listen to a baby’s heartbeat during pregnancy and labor. Unlike Dopplers or electronic monitors, a fetoscope does not use ultrasound. Instead, it amplifies sound through direct contact with the pregnant belly. This makes it a great option for those who want to avoid ultrasound exposure or prefer a more hands-off approach to monitoring. Fetoscopes are commonly used in home births and midwifery care, especially for intermittent monitoring. While they require more skill to use and may not pick up heart tones as early as a Doppler, they provide a simple and non-invasive way to check on the baby’s well-being.

Informed Decision-Making
Fetal monitoring can be useful, but it’s not always necessary for every birth. Many hospitals default to continuous monitoring, even when evidence shows that intermittent monitoring is just as safe for low-risk pregnancies. It’s important to understand your options and know that you have a say in how your labor is monitored. If you are planning a hospital birth, ask about their monitoring policies ahead of time. Find out if intermittent monitoring is allowed and whether wireless monitors are available. Ask under what circumstances internal monitoring would be recommended and whether you can decline it if it’s not medically necessary.

Being informed about fetal monitoring helps you make decisions that support both your baby's safety and your ability to labor in the way that feels right for you. Monitoring should be a tool for reassurance, not a restriction that limits your movement or choices. Knowing the pros and cons of each method gives you the confidence to ask questions, advocate for yourself, and have a birth experience that aligns with your needs and preferences.