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Fetal Monitoring Segment 1: Continuous or Intermittent?

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.

Hi, Dr. Jim here. I’ve  decided to take off on a new track. I’m going to do five-part series on something that is near and dear to me – the care of moms and babies during labor and delivery. I’ve been delivering babies for over 30 years and I still love it, but I must say it’s always great when the baby turns out meeting our goal, which is of course a healthy, happy baby.

The focus in this five part series is really is going to be on fetal monitoring. I know for many pregnant families that monitoring is kind of a mystery. You  go into the hospital, we strap you down with those electronic devices and when we go in there – I mean back into the laboring room – it seems we are focusing on the monitor strips. Sometimes, I think moms and dads must wonder if we care more about the monitor than about the patient lying in the labor bed.

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. That’s the reason we use fetal monitoring – doing everything possible to ensure that goal.

First, we must determine the mother’s and baby’s risks when making decisions whether or not to monitor. Said another way, does the mom need continuous fetal monitoring, or can we monitor intermittently?

Several factors play into this.

First , has the mother had a baby before 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 the baby fit through the mom’s pelvis? So that’s an issue. 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 or is it vertex, which is head down and favorable?

There are fetal factors  – gestational age – is this baby premature or postdates? How has the baby grown and how big is the baby? What’s the status of the amniotic fluid? Is the baby breech? And very importantly, is there any evidence of 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 or a 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 and the like. So these are all really important factors determining whether or not a mom should be continuously monitored or intermittently monitored.

Finally, there’s the examination – doing the maneuvers to determine how big we think the baby is; whether or not the baby is breech or head down or vertex. There’s the issue of observing the mom’s vital signs at the moment. Is there any vaginal bleeding or passage meconium? Is the bag of waters intact?

Lastly, how does the uterus seem to be contracting and behaving during the early part of labor?

That’s the subject of my next segment – segment 2, during which I will focus on uterine contractions.

In the meantime, remember that the goal of fetal monitoring is a healthy, happy baby, and my goal is a healthy, happy you!  This is Dr. Jim. Power your path to happiness!