WOMEN: PREGNANCY AND CHILDBIRTH. MONITORING LABOUR

During labour a close watch is kept on both mother and foetus so that any problems that arise can be attended to promptly. The mother’s pulse, temperature and blood pressure are measured hourly and any urine passed is tested.

Vaginal examinations are performed about every few hours to assess the progress of cervical dilatation.

Foetal monitoring

The foetus is monitored by listening to and measuring its heart rate. This is generally done by placing a foetal stethoscope or an amplifier on the mother’s abdomen, in the same way as the foetal heartbeat is checked during antenatal visits. Any amniotic fluid that escapes from the uterus is checked to make sure that it doesn’t contain meconium, the normal content of the foetal bowel. During labour the foetus only passes meconium if it becomes distressed.

In prolonged, or complicated, high-risk or trial labours, and when the foetus shows any signs of distress (too rapid or too slow heart rate and passage of meconium), the foetus’s condition may need to be monitored very carefully using electronic equipment.

External foetal monitoring is done by strapping two ultrasound discs to the mother’s abdomen – one to record the foetal heart rate and one to record uterine contractions. The discs are attached by leads to a monitoring screen so that the response of the foetal heart rate to each contraction can be observed.

Internal monitoring uses a small tube inserted into the mother’s uterus to record pressure changes, and an electrode attached to the foetal scalp to record its heart rate. If foetal heart rate becomes too rapid or slow, a sample of foetal blood may be taken from its scalp to measure oxygen content and acidity. If these measurements are not within normal range, it may necessary to deliver the baby quickly.

Many women are upset by foetal monitoring, mainly because it means that there’s doubt about how well the foetus is coping with labour. Also, for both internal and external monitoring you need to remain in bed, and the attachment of the leads to your abdomen external monitoring means that you move your position much. Many alarmed by the signals flashing on monitoring screen.

If your foetus needs monitoring, the reason and what the measurements mean should be explained to you. If you know that it’s done in the interests of safe delivery, you’ll find the procedure less upsetting.

If you need help

During your pregnancy you’ll hear a lot in favour of ‘natural’ birth and many negatives about medical intervention. Most women and obstetric staff would agree that vaginal delivery without the use of strong painkillers, episiotomy, forceps or electronic monitoring is desirable, but not always possible. As already mentioned, nature doesn’t always do the right thing. Some enthusiastic natural childbirth educators don’t prepare their pupils well enough for how they may feel if they need help during labour. Don’t feel too disappointed, guilty, or that you’ve let the side down if you need pain relief or any intervention to ensure safe delivery (and remember that this is the most important outcome). If you’ve done your best, you’re not a failure.

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