Monitoring Baby on the Hospital Birth Plan

By: Aunt Doula (10/12/2022)

Often seen as a mainstay of your labor process, monitoring of the baby's heart rate can be done multiple ways with varying levels of inconvenience. There are two types of monitoring, external (passive) and internal (invasive). We will be covering both with their subsets below.

Typically upon triage to determine if you will be admitted to the delivery floor you will be strapped around the belly with two bands - one will track the heart rate of the baby, the other will track your contraction pattern. This is typically measured for 30 minutes and you will be asked to remain in bed and not move significantly. This is the traditional choice of monitoring, can be made intermittent if you wish to keep moving around, and some facilities even have wireless, waterproof options!

External Monitoring

Assuming you are admitted it depends on your facility how often they will ask you to climb back in bed, get strapped up, and be still for 30 minutes. Some are every 2 hours, 4 hours, or if you are high risk they may want you to have continuous monitoring for your entire labor. I would ask if at all possible to have the wireless monitor for the combined ability to maintain mobility while also getting the data the doctors desire - best of both worlds.

So - in the realm of external electronic passive monitoring of the baby on your birth plan you can choose:

• Decline monitoring all together
• Allow intermittent monitoring of baby according to your facilities policy
• Allow monitoring on triage and at limited intervals of your choice
• Allow monitoring on triage and continuously in bed according to facility poljcy
• Allow monitoring on triage and if they wish for continuous monitoring, allow the wireless set up only

It is important to know that external monitoring of your infant has not been proven since their inception to improve fetal or maternal outcomes. It has been shown to increase anxiety in parents, hyperfocus parents and care teams to pay too much attention to the readings rather than other biological changes that can better indicate the health of the fetus, and it also has been shown to increase the application of interventions that are often unnecessary.

Internal Monitoring

In longer labors that have had difficult progression or that external monitoring has been unreliable due to a number of potential factors, doctors may suggest an Internal Fetal Monitor. This procedure comes with its own risks, has no proven benefits to maternal fetal outcomes and often is an intervention that leads to tunnel vision based on the readings alone instead of ll clinical signs being taken into account.

To achieve placement of an internal fetal monitor, the amniotic sac must be broken if it is still intact. A probe on the end of a long wire will then be inserted through the vagina and cervix to reach the top of the baby's head where it will be screwed into your baby's scalp with an electrode that passes data back to a machine you will be connected to. The data on internal monitoring is mixed at best, so I highly encourage that you learn about this procedure before you reach the hospital and know whether or not you want to approve or decline this procedure. The risk of exposing the mother to the baby's blood could sensitize her for her subsequent pregnancies, requiring a rhogram shot. This is definitely something to talk to your doctor about as a benefits/risks/alternatives discussion.

So, for internal monitoring you would choose on your birth plan:

• Internal Monitoring Approved
• Internal Monitoring is Declined

Monitoring of your baby is an extremely common practice in a hospital based birth. Many people don't know that they can decline the process all together, and some people who would benefit greatly from not having another beeping monitor or number to obsess over can be extremely freeing in the labor room. Others are completely unbothered by the process and don't mind participating in it. This is why a birth plan choice is so individual! Think about how these choices might limit the other choices you plan for your birth, and if knowing more numbers is a helpful or hurtful addition to the labor room.