Monitoring labour

Labour monitoring

Checking baby's wellbeing

During your labour we will recommend that you have either intermittent or continuous monitoring of your baby. It is your choice whether or not to accept this. We will recommend continuous monitoring in some situations, and for this you will need to be in a consultant-led unit.

Intermittent monitoring is where your midwife will listen to your baby’s heartbeat either using a special stethoscope or using a handheld device. This is available in all birth settings.

An illustration of the intermittent monitoring hand held device - on the left is the monitoring screen and buttons, on the right is the stethoscope attached through a wire that loops below

Continuous monitoring is where we monitor your baby constantly during your labour, this is called a CTG.

Cardiotocography (CTG) is a way of monitoring baby’s heartbeat and your contractions at the same time. An elastic strap is placed over your abdomen and there are two round flat parts. One of these is looking at baby’s heartbeat and the other is monitoring your contractions.

An illustration of a CTG machine. The machine sits with a black monitoring screen at the top with a piece of paper being printed out underneath. The round flat parts that will attach to the abdomen sit beside the main device, attached through wire.An illustration of a machine next to a pregnant person's belly. There are pads placed on the belly. These pads give readings to the machine through wires.

The outcomes for both of these types of monitoring are similar. The rates of cerebral palsy in babies are also the same with intermittent monitoring and CTG. Continuous monitoring is also associated with more caesarean and instrumental births. However, seizures in babies are less common when CTG is used to monitor baby’s heartbeat.

We can also continuously monitor your baby using a fetal scalp electrode. This is clip attached to baby’s head during your birth. This is a way of monitoring baby if we are unable to pick up their heartbeat through your tummy reliably. In some hospitals, the fetal scalp electrode is used routinely as part of their fetal monitoring system called ‘STAN’.

An illustration of the fetal scalp electrode - it is a cable with a protective covering wrap around it. At the end is a white tip with a small yellow spiral clip.An illustration of a cross-section of a baby in a womb with a small clip (fetal scalp electrode) attached to their head with a wire extending out of the vagina and it strapped to a leg to measure baby's heart rate. A flat probe is placed on the pregnant belly with a wire attached to it to measure contractions.

When the baby heart trace is normal, we can be sure that the baby is getting enough oxygen. When it is not normal, it is not always the case that your baby is distressed. To try to work this out we can examine you and tickle the baby’s head. If your baby responds, we can be somewhat reassured that the baby is coping. In some circumstances, a fetal blood sample can be taken to see if your baby is getting enough oxygen. This will require you to remain still whilst a doctor takes this sample from your baby’s head. If this result is normal, it is reassuring, if it is not, we would recommend an urgent instrumental or caesarean birth.

Vaginal examinations

https://www.nice.org.uk/guidance/ng235/chapter/Recommendations#planning-place-of-birth

During your labour, a midwife or doctor may ask to perform a vaginal examination. A vaginal examination is done for many reasons, e.g. to see if your waters are intact or broken and how open your cervix is. This involves them putting their fingers into your vagina and up to your cervix. This will only ever be done with your consent. A cervical sweep may be offered to help start your labour and this would also involve a midwife putting their fingers into your vagina and moving their finger around the cervix in a ‘sweeping’ motion.

If an examination like this could trigger trauma for you, please let your carer know so they can help ensure their care helps you in a way that suits you. If you would like a chaperone, you are free to request one at any time. There are other methods to assess progress in labour and if you opt for a vaginal examination this can be stopped at any time.

A vaginal examination is usually offered every 4 hours in your first stage of labour to see how dilated your cervix is. Sometimes, this may be offered sooner if we have intervened, for example by breaking your waters, or of there is concern for you or your baby.

During the second stage of your labour, you may be offered more frequent vaginal examinations to see where your baby’s head is, how far down it is, and the shape of the baby’s head. After you have given birth to your baby, your placenta will come out. If your placenta doesn’t come out by itself, you will be offered an examination.

The number of vaginal examinations will vary from person to person and from labour to labour. Not all labours progress the same and not everyone has the same circumstances and therefore the number you will be offered may be different. To perform any of these, your consent will be needed and you can always choose to say no. Your midwives and doctors will try not to do too many examinations as they are an infection risk.

Baby's wellbeing references:

  1. Intrapartum care. NICE guidelines Published September 29, 2023. Accessed October 18, 2023. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations#planning-place-of-birth 

  2. Fetal monitoring in labour. NICE guidelines. Published December 14, 2022. Accessed October 20, 2023. https://www.nice.org.uk/guidance/ng229 

  3. Alfirevic Z, Devane D, Gyte GML, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD006066. DOI: 10.1002/14651858.CD006066.pub3 


Vaginal examination references:

  1. Intrapartum care. NICE guidelines Published September 29, 2023. Accessed October 18, 2023. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations#planning-place-of-birth 

  2. Fetal monitoring in labour. NICE guidelines. Published December 14, 2022. Accessed October 20, 2023 

  3. Signs that labour has begun. nhs.uk. Published December 1, 2020. Accessed November 20, 2023. https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/signs-that-labour-has-begun/ 

  4. Preterm labour and birth | Guidance | NICE. Published November 20, 2015. Accessed November 24, 2023. https://www.nice.org.uk/guidance/ng25