Category: 41 Weeks

***Key Points***

You may be offered CTG monitoring during the latter part of pregnancy if there is a concern about your baby. Continuous CTG monitoring is often done in labour where there are risks to your baby such as induction of labour or you have an epidural [there are many other reasons when CTG monitoring might be recommended]. Many studies that explored the use of CTG during labour were done a long time ago, they showed benefits and problems with its use. Make sure you understand why it is being recommended to you.

***Key Points***

***CTG Monitoring***

If you are pregnant your midwife or doctor may suggest you have some CTG monitoring if they are concerned about your baby’s heart rate, or if you have reported a change in your baby’s movement pattern. This will usually be done only when you are more than 28 weeks pregnant. Often you will attend a pregnancy day stay or fetal monitoring unit where you will have the CTG monitor on for a period of time until it shows that the baby is well. That may be 30 minutes or it may be longer depending on the trace and how busy the unit is. Make sure you understand why they are recommending the monitoring.

***CTG Monitoring***

***Continuous CTG Monitoring***

Having continuous CTG monitoring during labour can restrict your ability to move around and you will not be able to use water immersion for pain relief. This may affect some women’s ability to cope with the challenges of labour. Studies showed that CTG monitoring increased the chances of interventions such as instrumental birth and caesarean section. It is known that CTGs are relatively reliable in showing a baby is well but they are not so reliable when it comes to showing a baby is unwell.

There are a number of reasons why you might need continuous CTG monitoring including but not limited to: having an induction of labour; having an epidural; an abnormal heart rate heard using a hand held Doppler; meconium [baby poo] or blood in the amniotic fluid; pre-term labour; a long first stage or long second stage of labour; or you have a high temperature.

***Continuous CTG Monitoring***

***CTG monitoring – the experience for you***

The process of having a CTG involves: you giving informed consent to the monitoring [this means you understand why you are having it]; you are on the bed in a semi-recumbent position not lying flat [you should empty your bladder first]; the midwife will complete an abdominal palpation to confirm the position of the baby [the heart sounds are picked up over the shoulder of the baby]; the ultrasound is placed in a position on your lower abdomen and held in place by a thick elastic belt; the device that monitors your uterine contractions is placed higher up on your abdomen at the top of your uterus.

***CTG monitoring – the experience for you***

The normal rate for a baby’s heart is between 110 and 160 beats per minute. The heart rate will vary with movement, or if there is pressure on the cord either by uterine contractions or your position. Most often the monitors are connected to the machine via cords that are a couple of metres long. Occasionally, the hospital may have cordless ones available called telemetry. Sometimes telemetry can improve your mobility, as long as they can still monitor the baby’s heart rate.

If you are having continuous CTG monitoring in labour and there are problems with obtaining a good heart rate reading, the medical team may want to use a fetal scalp electrode. That involves a placement of a small metal clip into the skin of your baby’s scalp via your vagina. That clip is then attached to the CTG monitor and shows the baby’s heart rate. You may be able to move around more freely if you have this type of monitoring. The clip is removed after the baby is born.

***CTG monitoring – the experience for you***

***CTG in Labour – The research***

Research has shown that there was low quality evidence showing no better outcome for babies using continuous CTG compared to using a hand held Doppler to listen to the baby’s heart rate intermittently. However, rates of instrumental birth and birth by caesarean section increased where continuous CTG was used. There has been no new research since 2016.

For women and babies considered low risk, listening to the baby’s heart rate intermittently with a hand held Doppler is as effective as continuous CTG monitoring during labour.

***CTG in Labour – The research***

References

Cochrane – continuous cardiotocography [CTG] as a form of electronic fetal monitoring [EFM] for fetal assessment during labour

RANZCOG – monitoring the baby’s heart rate in labour

Queensland Health – fetal monitoring in labour

The Women’s – CTG interpretation and response

Regular antenatal care is a key component of a healthy pregnancy and provides an opportunity to receive advice, information and support, while engaging in shared decision making about your  pregnancy that is designed to suit your individual pregnancy needs.

KEY POINTS

Antenatal care should be woman centred acknowledging pregnancy is a normal life event for most.

Antenatal care improves pregnancy outcomes for both mother and baby by recognising potential problems in pregnancy early.

The range of routine antenatal care visits range from 7 – 12 throughout the course of pregnancy with the average being around 10 visits.

During each visit your midwife or doctor will discuss screening test and arrange these as required.

It’s good if your partner, a friend or a family member can go with you to antenatal appointments.

Antenatal appointments keep track of your health and your baby’s health and are a great time to ask questions, discuss concerns and get health and lifestyle support throughout your pregnancy.  All antenatal visits require a directed clinical assessment at each visit, with a focus on general wellbeing and early diagnosis of pregnancy complications.

The clinical assessment should include a –

• blood pressure check
• urine dip stick, usually you do this yourself
• weight and how you can achieve a healthy weight gain
• measure your tummy, otherwise called a symphysis-fundal height (SFH) measurement
• listen to your baby’s heartbeat using a handheld doppler, this is always lovely to hear
• and ask about your baby’s movements from approximately 20 weeks of pregnancy onwards.

The midwife or doctor may also

• recommend blood tests, screening tests and other tests when appropriate and talk about test results.
• discuss healthy eating options and foods that aren’t recommended in pregnancy.
• ask about your lifestyle and help you get support for lifestyle changes like quitting smoking, or giving up alcohol or other drugs
• ask about your work and home environment and your family situation and support throughout your pregnancy.

Many women attend antenatal visits every 4-6 weeks until 28 weeks of pregnancy, then every 2-3 weeks until 36 weeks of pregnancy. After this, you’ll probably have weekly or fortnightly visits until birth.  The number and timing of pregnancy appointments could be more or less than this, depending on your health and your baby’s health. For example, if you have a high-risk pregnancy you might have more pregnancy appointments. Your midwife or doctor will talk with you about the appointments you need and why.

Having access to maternity care that is culturally appropriate and personally acceptable is important throughout antenatal care. Your midwife or doctor will ideally provide informed choice, and where possible include you in both the planning and monitoring of your pregnancy care.

Choice in pregnancy care is important and your midwife or doctor will provide access to appropriate information about the benefits and potential risks of each and every option of your pregnancy care as it applies to yours and your baby’s individual needs at each antenatal visit appointment. Be sure to ask questions at each visit too.

Most babies are born between 37 and 42 weeks of pregnancy, often referred to as ‘term’.

Your body will go through some changes to let you know that labour might be starting.

***Key Points***

If your labour is starting before 37 weeks that means your baby might be born prematurely.

Take some time each day to feel what is happening in your body and connect with your baby so you will know when your body is starting to show signs of going into labour.

***Key Points***

***Signs of early labour***

Some of the changes in your body that may indicate the start of labour include:

• Increasing pressure in your pelvic area
• A mucousy discharge called a show or the mucous plug that has been released from the cervix, there might be some streaks of blood in it
• You might be experiencing cramping like period cramps
• your water might release – take note of the colour, odour, amount and time (use the acronym COAT) and put a pad on.
• you might feel nauseous or have some diarrhoea; you might feel emotional, grumpy, short tempered or excited.

When your body is getting ready for labour these are the signs that things are starting to happen. Your cervix is starting to soften and get ready to start opening, the baby will move into position and the hormones of labour will be produced and increase slowly.

This early phase of labour may take a few days before strong, regular, rhythmic contractions begin and active labour starts. There might be times where you are having some regular contractions, which might be a bit like strong period pain, then they will space out again.

***Signs of early labour***

***What can I do?***

If you can, stay home as long as possible during this early phase of labour. You can do things to distract yourself like preparing food, listening to music, taking a bath or shower, reading a book or watching a movie. If it is night time, try resting or sleeping if you can.

If you have other children that will be taken care of by other people you can start to make those arrangements. You can call the hospital to let them know what is happening if you need to.

If you do go into the hospital and they find that everything is okay, be prepared for them to send you home. If you feel more comfortable or safe with someone around, ask them to be with you.

While your body is preparing to go into labour it is important to

• rest as much as you can.
• Try not to expend any energy on this early stage.
• Eat and drink as normal or try frequent nutritious snacks.
• Go to the toilet as needed, open your bowels if you feel the need.
• Try gentle, rocking movement if during the day, or
• try to sleep if it night time, use lots of pillows to help you get in a comfortable position.
• Try to stay home as long as you can.

***What can I do?***

***When to call your midwife or doctor***

Call your care provider if

• your water breaks (put a pad on so the Midwife can check the fluid)
• you have any bleeding (put a pad on so the Midwife can check the fluid)
• your baby isn’t moving as normal

Make sure you put a pad on so the midwife can check the fluid or blood coming from your vagina. If you feel that your baby’s movements aren’t the normal pattern you should also call your midwife or hospital.

When your contractions are strong and regular lasting about one minute and come every 5 minutes and have been coming in that pattern for a couple of hours, active labour may have started. Call your care provider for advice.

***When to call your midwife or doctor***

Resources

Pregnancy Birth Baby – stages and signs of labour

Better Health Channel – labour

Raising Children Network – labour and birth what to expect