One of the important questions for doctors and midwives is whether to monitor intermittently or continuously mindful of the goal, which of course is to have a healthy, happy baby.
In making the decision for intermittent or continuous monitoring, caregivers must first determine and weigh the risks. The mother’s birth history, findings on physical exam as well as known fetal and maternal risk factors play into this.
For example, has the mother had a baby in the past and did she deliver vaginally or is this her first time and will her pelvis accommodate a vaginal birth? We are concerned about how large the baby is and will it fit through the mom’s pelvis? Is the uterus going to work properly to push the baby down the birth canal? And then, what’s the baby’s position? Is it breech, which is unfavorable for vaginal birth or is it vertex, which is head down and favorable?
There are fetal factors – gestational age for instance. Is this baby premature or postdates, both which trigger the need for more careful monitoring. What’s the status of the amniotic fluid? And very importantly, is there any evidence for meconium, which is a substance that babies may pass through their intestines when stressed or distressed.
Then there are maternal factors. There’s diabetes. Does the mom have high blood pressure? Is she obese? What’s her past obstetrical history? Does she currently have fever; is there any vaginal bleeding? Does she desire a trial of labor after a cesarean section also known as vaginal birth after cesarean section?
And what are the possible issues around any medications that she’s taking or any street drugs that she’s been using.
Then there’s the physical examination – doing the maneuvers to determine how big we think the baby is; whether or not the baby is breech or vertex (head first). Is there any vaginal bleeding or passage meconium? Is the bag of waters intact? And of course, observing the mom’s vital signs from moment to moment.
Lastly, how is the uterus contracting during the early part of labor, which is the subject of my next segment – segment 2, with focus on uterine contractions.
The full-length YouTube video on the entire first segment: Fetal Monitoring: Continuous or Intermittent? can be found at: https://www.youtube.com/watch?v=WjcQAk36r2s&feature=youtu.be