***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
RANZCOG – monitoring the baby’s heart rate in labour
