Tessa Quinn
During childbirth, hospital contraction monitors are used to measure the strength, duration, and frequency of contractions, as well as the baby's heart rate. There are two main types of fetal monitors: external and internal. External fetal heart rate monitoring is the most common, with two straps placed on the belly to measure uterine activity. One strap has a sensor to read the baby's heartbeat, while the other measures the strength and frequency of contractions. The monitor displays two charts, with the X-axis indicating time in minutes, and the Y-axis indicating contraction intensity and the baby's BPM (beats per minute). The lines on the graphs move from right to left, with the most recent information on the right. In addition to monitoring the baby's heart rate, doctors may also monitor heart rate, movement, and contractions to ensure the baby has an ample oxygen supply. While the doctors and nurses can interpret the graphs, it is beneficial for the mother to also understand how to read the monitor.
| Characteristics | Values |
|---|---|
| Purpose | To monitor the fetus's heart rate and the strength, duration, and frequency of contractions |
| Types | Intermittent/auscultation, continuous/electronic, external, internal |
| Intermittent contraction monitoring | Periodic monitoring of the fetus using a special stethoscope (fetoscope) or a Doppler transducer |
| Continuous contraction monitoring | Constant monitoring of the fetus's heart rate and contractions, displayed continuously on a screen |
| External fetal heart rate monitoring | Most common tool with two straps placed on the belly to measure uterine activity |
| Internal fetal heart rate monitoring | Less common, used to monitor the fetus's heart rate |
| Uterine contraction monitoring | Quantitation of uterine activity (strength of contractions) and contraction patterns (frequency of contractions) |
| Fetal Non-Stress Test (NST) | Monitoring of fetal heart rate, movement, and contractions to ensure ample oxygen supply |
| Early deceleration | Lowest point of deceleration and peak of contraction occurring simultaneously, considered healthy |
| Late deceleration | Lowest point of deceleration occurs after the peak of traction, considered abnormal |
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What You'll Learn
Continuous vs. intermittent monitoring
Continuous fetal monitoring provides ongoing, real-time data on the fetus's heart rate and uterine activity throughout the entire birthing process. It is often used in high-risk pregnancies and when labour is induced or augmented with medication. It is also used when a reliable, direct line to the fetus is needed. However, it can be uncomfortable for the mother, restricting her movement and ability to carry out activities that may bring comfort before or during labour.
Intermittent monitoring, on the other hand, is done periodically, rather than constantly. It is typically used in low-risk pregnancies, during check-ups, and when labour occurs spontaneously. It can be done with an electronic fetal monitor, a handheld Doppler device, a fetoscope, or a transducer. Intermittent monitoring is generally considered just as effective as continuous monitoring for low-risk pregnancies, although continuous monitoring may be marginally safer for the baby.
A continuous contraction monitor, or an electronic contraction monitor, is the most common type of monitor. It measures the response of the fetus’s heart rate to contractions of the uterus, and displays the results continuously on a screen as you experience them. The top graph on the screen usually shows the baby’s heartbeat, measured in BPM, and the bottom one shows your contractions. The X-axis on both charts indicates the time in minutes, and on the contraction chart, the Y-axis indicates contraction intensity.
If you are using an intermittent contraction monitor, your doctor will likely be there to interpret your chart, but when using a continuous monitor, you may be alone for a portion of the time.
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Understanding the monitor's graphs
The monitor's screen will display two graphs, one stacked on top of the other. The top graph will show the baby's heartbeat, measured in BPM (beats per minute). The bottom graph will show your contractions. The X-axis on both charts indicates time in minutes, with the most recent information on the right. The Y-axis on the bottom graph indicates the intensity or strength of your contractions. Each small block represents 10 seconds, and each bold line represents one minute. The duration of a contraction can be measured by counting the number of small blocks from the beginning to the end of the contraction. For example, a contraction that spans seven small blocks lasted 70 seconds.
In the early stages of labour, contractions are shorter and spaced further apart. As labour progresses, they increase in duration and become closer together. Higher peaks indicate greater cervical change, or dilation. If your contractions are peaking regularly near 75, this is a sign that labour is progressing. If you are on Pitocin, expect higher intensity contractions as the dosage increases.
In addition to monitoring the baby's heart rate, the monitor will also show information about the effects of labour on the baby by observing the pattern of contractions. This includes the strength of the contractions and how often they are occurring. This information can be used to determine the potential effects of the contraction rate and force on the baby.
If you are giving birth in a hospital, your doctor will likely use continuous fetal monitoring to show your contractions on a monitor. However, this is not always necessary, and intermittent monitoring may be used during check-ups for low-risk pregnancies.
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The vertical axis measures intensity
The vertical axis, or Y-axis, of a hospital contraction monitor measures the intensity of contractions. This tells you the length of each contraction, or how long your contraction lasts. The higher the peaks, the greater the cervical change (dilation). For example, if your contractions are peaking regularly near 75, your labour is progressing. In most normal spontaneous labours, contractions occur with a frequency of 2-5 minutes, and they may last between 30-60 seconds. As labour progresses, contractions increase in duration and intensity.
If you are at high risk of having a preterm delivery, your doctor may recommend more frequent contraction monitoring. Intermittent contraction monitoring, also called auscultation, refers to periodic, rather than constant, monitoring of the fetus. This is done with either a special stethoscope called a fetoscope or a device known as a Doppler transducer. External fetal heart rate monitoring is the most common tool used for monitoring fetal heart rate and your contractions. It has two straps that are placed on the belly to measure uterine activity: one has a sensor to read the baby’s heartbeat, and the other measures how strong and frequent your contractions are.
Internal fetal heart rate monitoring is less common. With this method, a tiny electrode is inserted into your vagina and placed on your baby’s scalp to monitor their heartbeat. This is known as electronic fetal monitoring, where a sensor is placed on your belly that sends a signal to a computer monitor.
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The horizontal axis measures time
Hospital contraction monitors display two charts: one showing contractions, and the other showing the baby's heart rate. The horizontal axis on both charts indicates time in minutes. The monitor's graphs show the baby's BPM and your contractions.
Each small, individual block on the contraction monitor graph represents 10 seconds. Each bold line represents one minute. The vertical axis measures the intensity of contractions, telling you the length of each contraction, or how long your contraction lasts. To measure the duration, count the small blocks from the beginning to the end of a contraction. For example, if a contraction spans seven small blocks, it lasted 70 seconds. In early labour, contractions are shorter and spaced further apart. As labour progresses, they increase in duration and become closer together.
If you have an epidural, it's important to watch the monitor. It's easy to take a nap and wake up ready to push. If you have any questions, ask your nurse. Most are happy to explain.
If you're using an intermittent contraction monitor, your doctor will likely be there to interpret your chart. With a continuous monitor, you may be alone for a portion of the time.
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How to spot early/late deceleration
Early decelerations and late decelerations are two of several recognised fetal heart rate patterns. They are classified into three tiers, which usually correlate with the acid-base status of the fetus.
Early Decelerations
Early decelerations are caused by fetal head compression during a uterine contraction, resulting in vagal stimulation and a slowing of the heart rate. They are characterised by a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction. They are not associated with fetal distress and are therefore considered reassuring. Early decelerations may be present or absent in a normal pattern.
Late Decelerations
Late decelerations are associated with uteroplacental insufficiency and are provoked by uterine contractions. Any decrease in uterine blood flow or placental dysfunction can cause late decelerations. Maternal hypotension and uterine hyperstimulation may decrease uterine blood flow, as can post-date gestation, preeclampsia, chronic hypertension, and diabetes mellitus, among other conditions. Late decelerations are characterised by a symmetric fall in the fetal heart rate, beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction has ended. The descent and return are gradual and smooth. Regardless of the depth of the deceleration, all late decelerations are considered potentially ominous. A pattern of persistent late decelerations is nonreassuring, and further evaluation of the fetal pH is indicated.
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Frequently asked questions
A contraction monitor will have two graphs, one stacked on top of the other. The top graph will show the baby's heartbeat, and the bottom one will show your contractions. The lines on the graphs move from right to left, with the most recent information on the right.
In most normal spontaneous labours, contractions occur with a frequency of 2-5 minutes and last between 30-60 seconds. As labour progresses, contractions will become stronger and more frequent.
Intermittent contraction monitoring, also called auscultation, refers to periodic monitoring of the fetus. It is done with a special stethoscope called a fetoscope or a device called a Doppler transducer, which is placed against the abdomen to hear the fetus's heartbeat.
A fetal non-stress test (NST) is performed to ensure the baby has an ample oxygen supply. Accelerations and decelerations are monitored to determine whether the test is reactive or non-reactive. Early deceleration, where the lowest point of the deceleration and the peak of the contraction occur simultaneously, is considered healthy.
