If you have your baby at a hospital, the nurse will want to check what is happening when you first arrive in the labour and delivery unit. If you are delivering at home, your midwife will do this instead. You will be asked questions about your pregnancy, and why you came to the hospital or called the midwife. Your cervix (through which the baby will pass into the birth canal) may be examined to see what stage of labour you are in. Once your cervix is thin and open (dilated) three to four centimetres, and your contractions are regular, you are in active labour. You may be asked to give a urine sample to check for sugar, protein and signs of infection. Sometimes it is necessary to do blood tests as well.
Once labour is active, your pulse, blood pressure and temperature will be taken at regular intervals. This helps check for signs of bleeding, dehydration, blood pressure problems of pregnancy, infection, and other stresses in labour. You will be encouraged to change your position throughout labour, and to empty your bladder often. You will also be checked to make sure your bladder does not get too full, as this is not healthy or helpful for your labour.
Of course, you will be asked about your comfort. Your caregivers can suggest ways to help you manage pain, nausea or any other symptoms you may be having.
It is important to know that the mother-to-be is in active labour before starting to monitor progress. If the cervix is only a centimetre or two dilated, this is still considered pre-labour. It is normal for progress to be much slower in this phase. In many cases, women who are not yet in active labour will be sent home for a while, as monitoring progress is not necessary at this stage. However, once a woman is in active labour, the cervix should be changing by about one centimetre every two hours. When you are in active labour, your cervix will be checked every couple of hours to make sure that you are dilating normally.
Each woman’s labour is different. As long as all is well and your labour progress falls within the normal range, your care providers will wait and allow things to move along at their own pace. However, women who labour for a very long time are at risk of tiring out, getting an infection, or bleeding heavily after delivery. This is why it is important to make sure the labour is not slowing down too much. Sometimes, there is a reason why labour is going slowly. Your care providers need to know why, so they can try to fix the problem.
If labour is not progressing, there are several possible reasons.
In some cases, the external monitor, or a device called an intrauterine pressure catheter (IUPC) is needed to measure this more accurately. If you need this type of monitoring, your caregivers will explain why they think you need it and what will be involved. If contractions are too weak or infrequent, breaking the water sac surrounding the baby may help make them stronger and more efficient. It may also be necessary to give the mother a medication called oxytocin (also called syntocin or pitocin) to strengthen contractions.
During labour, blood flow to the baby is reduced every time there is a contraction. This is normal, and healthy babies are able to tolerate this very well. However, sometimes blood flow is reduced too much. A baby who does not receive enough oxygen from the mother’s blood is at risk of damage to its organs – most importantly, the brain. While there is no way to directly monitor how the baby’s brain is doing, the heart can be monitored. The baby’s heart rate and pattern tell a lot about blood flow to the baby. They can be used to try to tell whether the brain is getting a good supply of oxygen.
The normal heart rate for an unborn baby is between 110 and 160 beats per minute. The rate often increases when the baby is active and moving, or being stimulated, as when somebody touches its head. This is called an acceleration, and is a sign of a healthy baby. When the baby is at rest, the heart rate still varies from beat to beat - another sign of a healthy baby.
Sometimes, the heart rate will drop below the normal rate for that baby. This is called a deceleration. Decelerations are common, but in some cases may signal that there is a problem with blood flow to the baby. If your baby has heart rate decelerations, your doctor or midwife will look carefully at the pattern of the decelerations for signs of trouble. They will want to see how low the heart rate goes, how long it stays low, and whether decelerations are before, during or after contractions. Some types of decelerations are considered fairly normal during labour, while others are very worrisome. Your doctor or midwife will tell you if your baby is having heart rate decelerations that are a concern.
There are two common ways to monitor the baby’s heartbeat in labour. One is just to listen to the heartbeat every so often, while the other is to listen to the heartbeat all the time during labour.
If you are healthy and have had a normal pregnancy and labour so far, it is recommended that your nurse or caregiver just listen to the baby’s heartbeat every 15 to 30 minutes during active labour. During the pushing stage of labour, the heart rate should be checked every five minutes.
Listening to the baby’s heart can be done with different instruments. A stethoscope or doppler (like the one used to check the heartbeat at your prenatal appointments) can be used to listen before a contraction and then immediately after a contraction to check that the heart rate is normal.
For low risk pregnancies with no sign of any problems, listening at intervals like these is preferred. This method is better than continuous monitoring for healthy women who have normal labour. First, it allows the mother to get up and move about freely, without having monitors and wires strapped to her belly. Second, listening to the heartbeat every so often is also less likely to pick up normal decelerations that happen during contractions (rather than before or after a contraction). Decelerations that occur during a contraction are due to normal drops in blood flow to the uterus, and are not a sign of problems. However, they can cause anxiety for mothers and their caregivers, so it is often best if they are not heard at all! They can cause worry when everything is actually fine. Sometimes people worry so much about these decelerations that they think a C-section or other drastic step is needed. Studies show that people who have continuous monitoring are more likely to get a C-section, and this may be why.
However, if there have been problems in the pregnancy or labour, it makes sense to monitor the baby’s heartbeat continuously rather than just listening every few minutes. This way, caregivers will be sure to notice if a real problem is developing. With the fetal monitor, an ultrasound device is strapped to the mother’s belly and the baby’s heart rate is recorded on a piece of graph paper. A second device is also strapped to the belly to pick up the timing of the contractions to compare them to the baby’s heartbeat. If decelerations occur, this helps to see whether they happen during contractions (not worrisome) or between contractions (which may signal a problem).
Occasionally, the heartbeat is difficult to pick up this way, or a more accurate recording is needed. At this point a scalp electrode is used. A small wire is attached to the skin on the baby’s head and the electronic signal of the heartbeat is sent to the machine.
These monitors are very safe and can be helpful to check on your baby. However, they are still only machines and can run into difficulties like any other machine. If the baby’s heartbeat drops or disappears suddenly, you may become worried. It may just be a problem with the signal reaching the machine. If you notice this happening, let your nurse know so the machine can be checked.
Monitoring in labour is done to be sure that everything is progressing normally and both mother and baby are healthy. The nurses, doctors and midwives will explain what they are doing as they monitor your labour. The information you receive can be very reassuring. Keep your labour normal by focusing on the things that help you feel well during your baby’s most important journey in life.