CONTINUOUS ELECTRONIC OR INTERMITTENT MONITORING – WHAT IS BEST?

Written by: Caroline Meyer

It is important for carers to know how your baby is doing during labour and birth. By listening to your baby’s heart, they can get an idea of how well your baby is tolerating the blood flow changes that happen during contractions.  There are 2 methods that are usually used to monitor baby’s heart rate. The first is periodic or intermittent assessments known as intermittent auscultation (IA). The second type is when a foetal monitor is used for continuous assessment (EFM).  

Intermittent assessments are done used a Doppler device which is a handheld device known as a fetoscope which is similar to a stethoscope.  Intermittent assessment may also be done using one part of an electronic foetal heart monitor. Continuous assessment is done via two transducers (electronic disks) that are strapped on to your abdomen with wide, stretchy bands. One of the bands tracks your contractions while the other measures your baby’s heartbeat. Neither methods are painful. Some women do complain of discomfort from the transducers especially if they do not want to be confined to a bed. EFM can be done using an internal monitoring system as well. 

For most women, continuous EFM is unnecessary. If there are no issues with the pregnancy and the mother is healthy, intermittent monitoring should be all that is needed.  There are a few aspects that may require you to undergo continuous monitoring. Your doctor will discuss the best system to use during your labour and birth. There is no evidence that low-risk pregnancies benefit at all from continuous monitoring.  

As a comparative, in low risk pregnancies there was no significant change to risk of cerebral palsy, infant mortality or admission to the ICU of women monitored via EFM as opposed to IA. When it came to Apgar scores, there was also no measurable difference. There was a lower risk of non-harmful seizures in newborns monitored via EMF, but this was also minimal. One of the main issues with EMF is that the mum to be is attached to a machine which monitors and records the information received. This restricts movement and comfort.  

With IA you are still able to more around freely. This can result in faster labour and less risk of having to undergo a caesarean. It is also notable that women who can walk around require less pain relief. Women monitored via EFM on a continuous basis are more likely to undergo a caesarean due to readings on the machines appearing atypical. A caesarean results in a longer recovery than natural birth, there is risk of infection and there is a lot more pain. Caesareans can also cause risks for future pregnancies. There may be injury to the baby during the surgery and higher risk of respiratory issues. Constant monitoring can also lead to a higher risk of forceps and vacuum assisted deliveries. This can also cause injury to the baby as well as increase the chance of vaginal tears. Continuous monitoring is also a lot more expensive than intermittent monitoring. 

When should continuous monitoring be used? 

EFM on a continuous basis is recommended in pregnancies where there are risk factors that may result in complications during the labour and childbirth. It would also be used if your baby demonstrates an abnormal heartbeat when being assessed intermittently during labour. If you have been given medication to start labour such as oxytocin, you will also be monitored continuously. If you have had a caesarean in the past and are attempting vaginal birth, you may also need to be monitored closely. If you have had an epidural, EFM would also be in order. If you are showing bleeding or have developed a fever during labour, your doctor will also recommend continuous monitoring.  You may start with intermittent monitoring and certain factors may present themselves during the labour which would then result in continuous EFM to try and improve the outcome for you and your baby. 

If you are in doubt, always discuss with your doctor. He or she can discuss the option with you and inform you should the requirements change during your labour. This type of monitoring is designed to help improve the outcome for your baby and reduce the risk of baby mortality during childbirth.