If electronic monitoring is needed

Why might electronic monitoring be needed?

Having electronic monitoring involves being attached to a monitor that continuously monitors your baby's heartbeat and your contractions. Continuous electronic monitoring is not needed if labour is going well. But sometimes it will be advised – for example if:

  • you have an epidural

  • you have an oxytocin drip to speed up labour

  • thick or lumpy meconium is present

  • you have high blood pressure, a high pulse rate or develop a temperature

  • you start bleeding in labour

  • there is a delay in labour

  • there are concerns about your baby's heartbeat.

If you are advised to have electronic monitoring, your midwife should explain why, the advantages and disadvantages, and what it might show. If you have electronic monitoring you will need to be transferred to an obstetric unit if you are not already there.

You should be offered a monitor that allows you to move around, and be encouraged to move and to change position as often as you want. The midwife should stay with you at all times and ask you how you are feeling and about your baby's movements, as well as checking the monitor and carrying out other tests as needed.

If electronic monitoring is started because of possible concerns about your baby's heartbeat but it is found to be normal, the monitor should be taken off after 20 minutes (unless you ask to keep it on).

How might electronic monitoring affect my care?

Your care team should take into account a range of factors, including your wishes, when suggesting any changes to your care – not only the results of the electronic monitoring. You should be kept fully informed about what is happening at every stage. You should be seen by an obstetrician or a senior midwife (or both) if the monitoring raises any concerns.

If the electronic monitoring suggests that your baby might not be coping well with labour, you will be encouraged to move around or shift your position, as this can help. You should be offered extra fluids (either drinks or a drip). If you are on an oxytocin drip to speed up labour, this may be reduced or stopped. You may be offered a drug to slow down your contractions.

Fetal scalp stimulation

If the monitor trace still shows that there might be a problem, your midwife may suggest that you have a vaginal examination in which they rub your baby's head with a finger – this is called 'fetal scalp stimulation'. This may make your baby's heartbeat speed up, which is a reassuring sign. Your midwife should explain what it involves.

Fetal blood sampling

Fetal blood sampling may be advised if electronic monitoring raises concerns about your baby's heartbeat, and things don't improve after changes to your care and fetal scalp stimulation.

It is a test to see how the baby is coping with labour, and measures the level of oxygen in the baby's blood. It can help to reduce the need for emergency procedures, such as a caesarean.

Your midwife or doctor should explain why they are advising fetal blood sampling, what will happen and what it may show. They should also tell you about other options that are open to you, including the advantages and disadvantages of each.

Fetal blood sampling involves having a vaginal examination using a device similar to a speculum. A scratch is made on your baby's scalp to take a small amount of blood for testing. The scratch will heal quickly after birth, but there is a small risk of infection.

After the fetal blood sampling, your midwife or doctor should explain what the results show. They will talk to you about what they advise should happen next. Depending on the results, this could be:

  • carrying on with labour as normal (with electronic monitoring) or

  • having a second fetal blood sample taken after a while if there is still uncertainty or

  • having a forceps, ventouse or caesarean birth as soon as possible.

Sometimes a fetal blood sample can't be obtained. This makes an instrumental birth (forceps or ventouse) or a caesarean more likely, because it isn't possible to be reassured about how well the baby is coping. But the process of trying to get a blood sample can sometimes improve a baby's heartbeat – if this happens, it might mean that your labour can continue as normal.

Questions about electronic monitoring of the baby's heartbeat and fetal blood sampling

  • Why do you think I should have electronic monitoring?

  • What will this involve?

  • What might it show?

  • Can I move around?

  • What are the advantages and disadvantages of electronic monitoring?

  • What are the alternatives to electronic monitoring?

  • Will I be able come off the monitor after a while?

  • If the monitoring suggests a problem, what will happen next?

  • What might rubbing my baby's head (fetal scalp stimulation) show?

  • Why do you want to take a blood sample from my baby? What will this involve? What are the advantages and disadvantages?

  • What alternatives are there to taking a fetal blood sample?

  • How soon will you have results from the fetal blood sampling? What might they show? What will happen next?

  • Information Standard