Fetal heart rate monitoring

What is fetal heart rate monitoring?

Fetal heart rate monitoring checks your baby's heart rate at different stages of pregnancy and during labour.

Monitoring your baby's heart rate helps check your baby's wellbeing. Your doctor or midwife looks at whether your baby's heart rate is:

• too fast
• too slow
• responding as expected
• showing a pattern that is right for your baby's age

This information helps guide your pregnancy care and whether more tests may be needed.

How is fetal heart rate monitoring used during pregnancy?

Your doctor or midwife may ask to check your baby's heart rate at regular antenatal appointments.

To listen to your baby's heart rate through your abdomen (tummy), they may use:

• a handheld device called a fetal Doppler
• an ear trumpet, also called a Pinard horn or Pinard stethoscope

How is fetal heart rate monitoring used during labour?

Fetal heart rate monitoring checks how your baby is coping with the labour process. This is called intrapartum fetal heart monitoring.

Your doctor or midwife will talk with you about fetal heart rate monitoring:

• before labour, often in the third trimester
• when labour starts
• as labour progresses

They will talk with you about:

• the benefits
• the possible risks
• the different monitoring options available

Decisions are made together with your doctor or midwife, with your consent.

What are the different ways of monitoring my baby's heart rate?

There are different ways to monitor your baby's heart rate during pregnancy and labour.

Intermittent auscultation

At your antenatal visits, your doctor or midwife may listen to your baby's heart rate through your tummy. They will use a fetal Doppler or a Pinard horn.

During labour, listening is done at regular intervals to check that your baby is coping well with the labour process. This approach is commonly used when your pregnancy and labour are progressing without complications, and you are well.

If there are complications with you or your baby, another type of monitoring may be suggested.

Continuous external monitoring

A cardiotocograph (CTG) records your baby's heart rate and your contractions continuously. It is sometimes used to help check your baby's health during pregnancy.

During CTG monitoring, 2 round discs containing sensors are placed on your tummy and held in place with a soft belt. These sensors track your baby's heart rate and how it changes during contractions.

Some CTG machines use wires, which may limit how much you can move during labour. You can ask if wireless CTG is available. This may allow you to move around more freely.

Routine CTG monitoring is not recommended for uncomplicated (low-risk) pregnancies during labour. This is because it can sometimes lead to unplanned medical interventions. It is only recommended after other checks have been done and when it is clinically needed.

Your doctor and midwife are trained to read the CTG and check your baby's wellbeing during labour. If you feel unsure, uncomfortable or have questions, talk with your doctor or midwife.

Internal monitoring

Sometimes a clear heart rate reading is hard to get from external monitoring. Your doctor or midwife may suggest internal monitoring with a device called a fetal scalp electrode.

A fetal scalp electrode is a small wire placed on your baby's scalp during a vaginal examination.

Internal monitoring is only used when:

• your cervix is open enough to place the fetal scalp electrode on your baby's head (noting your waters will need to be broken if they are not already).
• there are no infection risks

What type of fetal heart rate monitoring may be suggested for my baby?

The type of monitoring used to check your baby's heart rate during labour depends on:

• how many weeks pregnant you are when you go into labour
• your health
• your baby's health
• the stage of labour
• how your labour is progressing
• whether labour complications are present or develop

If a suggested monitoring option doesn't feel right for you, talk with your doctor or midwife.

What happens if differences are found during fetal heart rate monitoring?

Changes in your baby's heart rate during labour may mean closer monitoring is needed. It can sometimes mean your baby needs to be born sooner. This may happen if your baby is not getting enough oxygen. When this happens, their heart rate may become too fast or too slow.

If more information is needed, fetal scalp blood sampling may be suggested.

• This is a test that takes a small drop of blood from your baby's scalp, similar to a pin prick.
• It is done during labour as part of a vaginal examination.
• This test gives quick information.
• It is usually only suggested when heart rate monitoring does not give enough information.
• The results can help your care team work out if your baby is coping well or needs to be born straight away.

Decisions are made with you and only with your consent. Read more about interventions during labour.

Questions to ask your doctor or midwife

It's a good idea to ask your doctor or midwife questions about fetal heart rate monitoring.

Here are some examples:

• What are the different types of fetal heart rate monitoring during labour?
• What are the benefits of fetal heart rate monitoring for me and my baby?
• What are the risks of fetal heart rate monitoring?
• What type of fetal heart rate monitoring would you recommend for my situation?
• Will I be able to move around with this type of monitoring?
• What are the next steps if the heart rate pattern is outside the usual range?
• How does fetal heart rate monitoring fit with my birth preferences or birth plan?

Read more about questions to ask your doctor about tests and scans.

Resources and support

Talk to your doctor, midwife or maternal child health nurse about baby heart rate monitoring during pregnancy and labour.

The Royal Women's Hospital Melbourne has information available on checking on your baby during labour.

Queensland Health has information on monitoring your baby during birth, including a comparison table between CTG and intermittent auscultation.

Languages other than English

The Royal Women's Hospital Melbourne has translated fact sheets on a range of topics about pregnancy and birth.

Government of Western Australia Child and Adolescent Health Service has translated child health fact sheets in languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

You can find out more about Aboriginal and/or Torres Strait Islander pregnancy health at Stronger Bubba Born.

The Koori Maternity Service (KMS) program provides access to holistic, culturally safe maternity care for Aboriginal and/or Torres Strait Islander peoples.