Amy Peterson, CD-DONA, CLC of Hound Hill Doula
Most moms are familiar with the small hand held doppler used to listen to your baby’s heart beat at prenatal appointments. But once you are at the hospital there are other options for fetal heart monitoring. Which is best, when and where, is not the topic for today. We will specifically be looking at Internal Fetal Monitoring.
Typically, external fetal monitoring is used to check on your baby’s well being during labor. This may be done by the nurse with the familiar hand held doppler from your prenatal visits, or with the more common external electronic fetal monitor that consists of a fetal heart monitor and a contraction monitor placed against your belly and held snug with adjustable elastic belts. Sometimes these are wired directly to a bedside machine, but more and more hospitals are offering wireless monitors that can be worn in the tub and even walking the hall during labor. You will find the nurses must readjust the monitors often as they slip and as your baby moves down in your body.
Internal fetal monitors are a direct monitor of your
baby’s heart rate. A small coiled clip at the end of a wire is inserted vaginally through a catheter, and slipped under your baby’s scalp.The clip is called a fetal scalp electrode (FSE). It goes no deeper than the top layer of skin, and the entrance hole no more than that of a vaccination. Your water must be broken for the monitor to be attached, so that the monitor can get inside of the bag around the baby. Your cervix must also be dilated enough to get the monitor catheter through. Often, but not always, your provider may also want to insert an internal contraction monitor. It is just a long catheter that measures the pressure between your baby and your uterine wall. The pressure catheter is not required in order to asses your baby’s heart rate, and is an intervention choice that you may make independently from your decision to use an internal fetal heart rate monitor.
Obviously an internal monitor is much more invasive than an external monitor. It brings with it a risk of infection to both mother and baby and if your water has not yet broken it will require artificially rupturing your membranes. It requires you to be tethered to a machine and limits your movement. This is an intervention that most people would choose to avoid simply based on the thought of the tiny wire piercing their perfect new baby’s scalp. So why is it worth considering?
An internal fetal monitor is currently the most accurate way to assess your
baby’s heart rate. External monitors are notoriously inaccurate, and the lower your baby gets in the pelvis the more difficult it becomes to locate the fetal heat beat externally. When should you consider internal fetal monitoring? Anytime that an intervention is being considered that is based on your baby’s heart rate. This might be a Cesarean being suggested for a baby with a low heart rate, or giving medication to reduce contractions when a baby “appear stressed” on the external monitor. Consider asking for an internal monitor before making any heart rate based decisions. It is not uncommon for external monitors to be reading the mother’s heart rate (or the sound of the placenta) and not the baby’s. While a heart rate of 86 in the fetus will have the hospital staff jumping, it is a relatively normal heart rate for a laboring mom. An internal monitor leaves no room for error.
When there is concern for your baby’s well being, decisions are made quickly and it can become very emotional. Try to remember to ask first if it is an imminent emergency. If the answer is no, take a deep breath and consider all of your options.
Hound Hill Doula provides full service doula care from a DONA certified birth doula, postpartum doula and Certified Lactation Counselor(CLC); including labor support, parenting and childbirth education, placenta encapsulation and breastfeeding support. Serving Seacoast MA, ME, and NH area families, in home, hospital and birth center settings.
