لماذا يحتاج طفلي إلى المراقبة والمتابعة؟ قد يكون المخاض مرهقاً لطفلك، كذلك بالنسبة لك. أثناء الانقباضات، ينحشر طفلك بإحكام في الرحم
Why does my baby need monitoring and follow-up?
Labour can be exhausting for your baby, as well as for you. During contractions, your baby is squeezed tightly in the uterus, which stops the flow of blood from the placenta.
The good news is that this is completely normal and your baby is likely to cope well. But some babies find it difficult to cope. The strength and intensity of labour can affect your baby, for example, if your baby did not grow well during pregnancy, or if you have had pre-eclampsia. But there are ways to monitor your baby to make sure they stay well as they make their way into the world.
During labour, a midwife listens to your baby's heartbeat. This way she knows if your baby is coping well with labour, or if they have become distressed. If your baby has severe fetal distress, you may be advised to have a caesarean section.
What is intermittent monitoring?
During pregnancy, the midwife listens to your baby's heartbeat at antenatal follow-up appointments. She uses a handheld Doppler ultrasound device (Sonicaid) or a Pinard stethoscope, also called a fetal stethoscope. If the midwife uses a Sonicaid, you can then listen to your baby's heartbeat very quickly. It may sound like a galloping horse.
Listening to your baby's heartbeat during labour using a Sonicaid or fetal stethoscope is an essential part of your care. But it will not interfere much with your comfort. You will only need to stay still for a minute or so while the midwife listens, and then you can move again.
The midwife will monitor your baby every 15 minutes after a contraction when you are in the established phase of labour. She then does this every five minutes when you are in the pushing phase. This is called intermittent auscultation.
If you are healthy and your pregnancy has had no complications, you will only be monitored during labour with intermittent auscultation.
What if I need continuous monitoring?
If you have health concerns during pregnancy, your labour will be monitored at all times. This is called continuous CTG monitoring, or continuous electronic fetal monitoring (EFM).
Research is being conducted on the pros and cons of continuous electronic fetal monitoring due to a possible link between this type of monitoring and an increased rate of interventions in labour, especially caesarean births.
About 45 percent of women agree to undergo continuous fetal monitoring during part or all of their labour.
You are likely to undergo continuous electronic fetal monitoring if you have complications in labour. This type of monitoring may be recommended if you have a high-risk health condition.
Continuous electronic fetal monitoring (EFM) is usually performed if:
• You have pre-eclampsia.
• Your waters broke more than 24 hours before labour began.
• You have diabetes.
• You have had a caesarean section previously.
• Your baby's size is smaller than expected.
• Your baby was born before 37 weeks of pregnancy.
• Your baby was born after 42 weeks of pregnancy.
• You are pregnant with twins, especially if they share the same placenta.
• Your body mass index is 40 or higher.
Events can sometimes take a different course when labour begins. Continuous electronic fetal monitoring during labour may be advised if:
• Your waters contain any amount of meconium (your baby's first stool).
• Your doctor detects problems with your baby's heart rate during labour.
• You develop a fever.
• Labour is taking too long to progress.
• You have new vaginal bleeding during labour.
• Your labour has been accelerated using a synthetic oxytocin drip.
If you have an epidural during labour, your baby will be monitored continuously for at least 30 minutes after the epidural is administered. Then monitoring resumes each time you receive an additional dose of the epidural.
Even if your labour is uncomplicated, you can choose continuous monitoring if it makes you feel safer. However, this option is only available in consultant-led units, not in midwife-led units.
What happens during continuous monitoring?
During continuous electronic fetal monitoring, an electronic transducer is placed on your abdomen to measure contractions. Another is then placed on your baby's heart to measure their heartbeat. Each transducer is connected to a wire, and this wire connects to the main machine and to elastic belts that hold the transducers in place.
You may feel that the belts are too tight on your abdomen, so ask for them to be loosened if you are uncomfortable.
The machine will give a digital reading of your baby's heartbeat. The heart rate varies from beat to beat, and the readings will look approximately like this:
140 142 139 141 144 140
The monitoring machine provides a printed graph with two lines: one line shows your baby's heartbeat and the other indicates the pattern of your uterine contractions. By studying the relationship between these two lines, your doctor or midwife will know how your baby is coping with labour.
Some hospitals have wireless monitoring devices called telemetry monitors. These devices allow you greater freedom of movement, as long as you stay within a certain range.
Sometimes a small clip or electrode is placed on your baby's head to monitor their heartbeat. This can only be done once your waters have broken. This clip is called a fetal scalp electrode, and it gives a more accurate reading of your baby's heartbeat compared to the transducer placed on your abdomen. It also allows you to move more easily.
If you are unsure why your doctor or midwife is recommending the use of a fetal scalp electrode, do not hesitate to ask.
How accurate is continuous monitoring?
Even highly trained health professionals sometimes find it difficult to interpret electronic machine readings accurately and conclusively.
If this applies to you, your doctor or midwife may suggest gently touching your baby's scalp to get a response in their heart rate. Or they may take a blood sample from your baby's scalp to test oxygen levels ("fetal blood sampling").
Fetal blood sampling
To take a fetal blood sample, the doctor passes a long instrument with a small blade through your vagina. She then takes a tiny amount of blood from your baby's head. Your baby's head is sprayed with a local anaesthetic, and this procedure is usually not painful for you or your baby. However, lying on your back during the procedure may be slightly uncomfortable.
By analysing the amount of oxygen in the blood sample, your doctor can assess how well your baby is coping with labour. If the oxygen level in the sample is good, she will tell you that everything is fine. If the amount of oxygen in the sample is below the required level, your doctor may take another sample later.
You may be advised to have a caesarean section if it is in the best interest of you and your baby.
How will monitoring interfere with my labour?
If your baby's heartbeat is being tracked via a Sonicaid or fetal stethoscope, the midwife will only need to find the right part of your abdomen. She will be able to do this easily, whether you are kneeling, sitting, or standing.
Continuous monitoring using electronic transducers may make moving around difficult for you, unless the hospital you go to uses telemetry monitors.
Ask if you can sit on a chair, as this position is more comfortable than lying on the bed for hours. You can stand up from time to time and try different positions. Monitoring does not mean you need to spend your labour on the bed. You can still stand, kneel, sit, or use a birth ball.
Do I have a choice in monitoring and following up labour?
Try not to worry. Your doctor or midwife will talk to you and explain why they believe a specific method of monitoring suits you. In some cases, such as early labour, there is no conclusive evidence about the best method of monitoring.
It may be difficult to make a firm decision, but discussing the options with your doctor or midwife will help. And remember that the final choice is in your hands.
