Claire Dawson
There are two main types of contraction monitors used in hospitals: continuous and intermittent. Continuous monitors provide real-time data on both the mother’s contractions and the baby’s heart rate, while intermittent monitors involve checking contractions periodically using handheld devices such as a Doppler or stethoscope. The TOCO monitor is the most widely used contraction monitor in hospitals. It is placed on the mother’s abdomen and measures pressure changes caused by uterine contractions, displaying this information as graphs and numbers. On a TOCO monitor, contractions appear as wave-like peaks, with the intensity of contractions reflected in the TOCO number. During true labour, the TOCO number will be higher, ranging from 40-60 mmHg in the beginning of the active phase to 50-80 mmHg during the second stage of labour.
| Characteristics | Values |
|---|---|
| Type of contraction monitor | Continuous, Intermittent (Auscultation) |
| Continuous monitor type | TOCO monitor, Electronic contraction monitor |
| Intermittent monitor type | Doppler, Stethoscope, Fetoscope, Doppler transducer |
| Continuous monitor placement | Beside the hospital bed |
| Continuous monitor display | Two stacked graphs |
| Continuous monitor graph details | Top graph: Baby's heartbeat (BPM), Bottom graph: Mother's contractions |
| Intermittent monitor interpretation | Interpreted by a doctor |
| TOCO monitor placement | Mother's abdomen, secured with an elastic belt |
| TOCO monitor position | Over the uterine fundus |
| TOCO monitor data | Graphical and numerical |
| TOCO number | mmHg (millimeters of mercury) |
| TOCO number during true labour | 40-60 mmHg in the beginning, can reach 50-80 mmHg in the second stage |
| TOCO number during false labour | Braxton Hicks contractions are unpredictable, sporadic and non-rhythmical |
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What You'll Learn
Continuous vs. Intermittent Monitors
There are two main types of contraction monitors used in hospitals: continuous and intermittent. While both have their place in childbirth, they serve different purposes depending on the circumstances.
Continuous Monitors
Continuous monitors provide ongoing, real-time data on both the mother's contractions and the baby's heart rate. They are often used in hospital settings, particularly for high-risk pregnancies, when labour is induced, or when an epidural is administered. An example of a continuous external monitor is the TOCO monitor, which tracks contractions throughout labour. It is usually placed on the mother's abdomen, secured with an elastic belt, and positioned over the uterine fundus, where contractions are strongest. The TOCO number, reflecting the intensity of the contractions, is displayed on the monitor, helping healthcare providers determine the effectiveness of each contraction and monitor the overall progress of labour.
Intermittent Monitors (Auscultation)
Intermittent monitoring, on the other hand, involves checking contractions periodically using handheld devices such as a Doppler or stethoscope. This method is more likely to be used during check-ups throughout low-risk pregnancies. It allows for the periodic monitoring of the fetus's heart rate and contractions. Intermittent monitoring is generally considered just as effective as continuous monitoring for low-risk pregnancies, and it may be preferred to avoid the discomfort and limitations on movement associated with continuous monitoring.
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Understanding TOCO Monitors
TOCO monitors, or tocodynamometers, are devices that measure uterine contractions externally. They are the most widely used type of contraction monitor in hospitals. TOCO monitors provide a non-invasive way to measure the strength and frequency of contractions, making them a popular choice for routine labour monitoring.
The monitor is usually placed on the mother's abdomen, secured with an elastic belt, and positioned over the uterine fundus, where contractions are strongest. It detects pressure changes in the abdomen caused by uterine contractions and translates these changes into graphical and numerical data. The TOCO number, displayed on the monitor, reflects the intensity of the contractions, helping healthcare providers determine the effectiveness of each contraction and monitor the overall progress of labour.
TOCO monitors are an example of continuous external monitors, which provide ongoing, real-time data on both the mother's contractions and the baby's heart rate. Continuous monitoring is often used in hospital settings, particularly for high-risk pregnancies, when labour is induced, or when an epidural is administered. The monitor displays two charts: one depicting contractions and the other depicting the baby's heart rate. The X-axis on both charts indicates time in minutes, while the Y-axis on the contraction chart indicates contraction intensity and the Y-axis on the heart rate chart indicates the baby's BPM (beats per minute).
On the screen, the baby's heartbeat is usually displayed on the top graph, with the mother's contractions shown on the bottom graph. The lines on the graphs move from right to left, with the most recent information on the right. This allows healthcare providers to see the baby's heart rate in relation to the contractions occurring at the same time.
TOCO numbers are measured in mmHg (millimetres of mercury), a unit of pressure. During true labour, the TOCO number will be higher, typically ranging from 40-60 mmHg in the beginning phases to 50-80 mmHg during the second stage of labour when the cervix is fully dilated. However, it's important to note that not all contractions mean you are going into labour, and Braxton Hicks contractions, for example, are considered false labour.
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Reading the Graphs
There are two main types of contraction monitors: continuous and intermittent. Continuous monitors provide real-time data on both the mother’s contractions and the baby’s heart rate. Intermittent monitors, on the other hand, involve checking contractions periodically using handheld devices such as a Doppler or stethoscope. The TOCO monitor is an example of a continuous monitor. It measures the response of the fetus’s heart rate to contractions of the uterus and displays the results continuously on a screen.
An electronic contraction monitor, such as the TOCO monitor, displays two charts: one depicting your contractions and another depicting your baby's heart rate. The X-axis on both charts indicates time in minutes. On your chart, the Y-axis indicates contraction intensity, usually in mmHg, which stands for millimeters of mercury. On the fetal heart rate chart, the Y-axis indicates the baby's BPM (beats per minute). The lines on the graphs move from right to left, with the most recent data on the right.
When viewed on a TOCO monitor, contractions appear as wave-like peaks or bell-shaped curves, starting low, rising slowly, and then returning to baseline. The TOCO number, which reflects the intensity of the contractions, is displayed on the monitor, helping healthcare providers determine the effectiveness of each contraction and monitor the overall progress of labour. During true labour, the intensity of a contraction is between 40-60 mmHg in the beginning of the active phase and can reach 50-80 mmHg during the second stage of labour, when the cervix is fully dilated and you are ready for childbirth.
It is important to note that not all contractions mean you are going into labour, and your TOCO number will read differently based on the type of contractions you are having. Braxton Hicks contractions, for example, are considered false labour and are usually unpredictable, sporadic, and non-rhythmical.
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Interpreting the Data
There are two main types of contraction monitors: continuous and intermittent. Continuous monitors provide ongoing, real-time data on both the mother’s contractions and the baby’s heart rate. They are often used in hospital settings, particularly for high-risk pregnancies, induced labour, or when an epidural is administered. Intermittent monitors, on the other hand, involve checking contractions periodically using handheld devices such as a Doppler or stethoscope. This method is more likely to be used during check-ups for low-risk pregnancies.
TOCO (short for tocodynamometer) monitors are the most widely used type of contraction monitor in hospitals. They measure uterine contractions externally and are placed on the mother’s abdomen, secured with an elastic belt, and positioned over the uterine fundus, where contractions are strongest. The TOCO number, which reflects the intensity of the contractions, is displayed on the monitor, helping healthcare providers determine the effectiveness of each contraction and monitor the overall progress of labour. When viewed on a TOCO monitor, contractions appear as wave-like peaks or bell-shaped curves, starting low, rising slowly, and then returning to baseline.
An electronic contraction monitor displays two charts: one depicting contractions and the other depicting the baby's heart rate. The X-axis on both charts indicates time in minutes, while the Y-axis on the contraction chart indicates contraction intensity and the Y-axis on the fetal heart rate chart indicates BPM (beats per minute). The monitor's graphs show how the baby's BPM corresponds to the mother's contractions. During true labour, the intensity of a contraction is between 40-60 mmHg in the beginning of the active phase, which occurs when the cervix dilates from 6 to 10 centimetres. The TOCO number can reach 50-80 mmHg during the second stage of labour, when the cervix is fully dilated and the mother is ready for childbirth. At this stage, contraction strength can reach 80 to 100 mmHg.
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When to Go to the Hospital
First, it is important to differentiate between true labour contractions and Braxton Hicks contractions, also known as false labour. True labour contractions usually occur after 37 weeks or near the due date, at regular intervals, and get closer together as time progresses. They last about 30 to 70 seconds and occur around five to ten minutes apart. Braxton Hicks contractions, on the other hand, can occur earlier and are unpredictable, sporadic, and non-rhythmic. They do not indicate actual labour as they do not cause cervical changes.
Monitoring contractions can help determine when to go to the hospital. This can be done through external uterine monitoring, where a belt is wrapped around the waist and attached to a machine like a tocodynamometer, which records the frequency and length of contractions. Internal monitoring involves inserting a special tube called an intrauterine pressure catheter through the vagina into the uterus, but this is only done after the amniotic sac membranes rupture. Home monitoring may be recommended in certain cases, especially for those living far from the hospital, but it is not always effective, and professional advice should be sought.
The TOCO number, measured in mmHg, is an important indicator. During true labour, the TOCO number is higher, ranging from 40-60 mmHg in the beginning phases and reaching 50-80 mmHg when the cervix is fully dilated and childbirth is imminent. Monitoring this number can help assess the intensity and progression of labour.
Additionally, fetal heart rate monitoring is crucial. Electronic fetal monitoring uses equipment to measure the fetus's heart rate response to contractions. Abnormal heart rate patterns do not always indicate a problem, but they may prompt further tests and interventions to ensure the fetus receives enough oxygen. Continuous monitoring is often used in high-risk pregnancies, labour, and induced labour, providing real-time data on both the mother's contractions and the baby's heart rate.
In summary, the decision to go to the hospital depends on various factors, including the timing and intensity of contractions, cervical changes, and the fetus's heart rate. Monitoring these parameters can help expectant mothers and their healthcare teams make informed decisions about when hospitalisation is necessary.
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Frequently asked questions
A contraction monitor measures the response of the foetus’s heart rate to contractions of the uterus. It displays the results continuously on a screen as you experience them.
An electronic contraction monitor displays two charts: one depicting contractions, and another depicting the baby's heart rate. The X-axis on both charts indicates time in minutes. On your chart, the Y-axis indicates contraction intensity, and on the fetal heart rate chart, the Y-axis indicates the baby's BPM (beats per minute).
A TOCO monitor, or tocodynamometer, is a device that measures uterine contractions externally. It is usually placed on the mother’s abdomen, secured with an elastic belt, and positioned over the uterine fundus, where contractions are strongest.
There are two main types of contraction monitors: continuous and intermittent. Continuous monitors provide ongoing, real-time data on both the mother’s contractions and the baby’s heart rate. Intermittent monitors, also called auscultation, refer to periodic monitoring of the fetus. Intermittent monitoring is done with either a special stethoscope called a fetoscope or a device known as a Doppler transducer.
TOCO numbers are displayed in mmHg (millimeters of mercury), a unit of pressure. During true labour, the intensity of a contraction is between 40-60 mmHg in the beginning of the active phase, and can reach 50-80 mmHg during the second stage of labour, when the cervix is fully dilated.
