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Fetal Monitor Description Reasons For Fetal Monitoring Fetal Monitor Risk Factors Fetal Monitoring Procedure Description Fetal Monitoring Expected Outcome Fetal Monitoring Complications Fetal Monitoring Post Procedure Care Medication Activity Recommendations & Restrictions Diet & Nutrition Notify Your Health Care Provider
FETAL MONITOR DESCRIPTION
The machine that goes "ping"... Monty Python
"One cannot help an involuntary process. The point is not to disturb it." So renowned French physician Michel Odent articulated the philosophy that has been the cornerstone of birth assistance worldwide since human birth began.
Under this philosophy of childbirth, the modern medical model borders on absurdity. Monty Python's The Meaning of Life shows obstetricians preparing to deliver a baby shouting, "More apparatus! Get the machine that goes ping!" Assistants scurry to bring in the equipment, and the most expensive machine soon serves its sole purpose when the hospital administrator stops in to visit and is clearly impressed. "Ah, I see you have the machine that goes ping! Carry on!" Meanwhile they have literally lost the laboring mother behind all the large equipment. They fetch her, deliver her and leave her behind, dazed, as they run out with the baby ... and the machine.
Real-life hospital birth today is not so different from this comic scenario.
MONITORING FETAL WELL-BEING
Monitoring of fetal well-being during pregnancy and labor. Sophisticated electronic monitors are often used in hospital, clinical and birth center facilities. These monitors are used for some prenatal examinations and during labor. Studies have shown that these high-tech approaches to monitoring the fetus's well-being are not a reliable approach. At best, than are not as accurate or more capable of catching a fetus "in distress" than less intrusive, simpler methods. At worse, they are a major contributor to highly dangerous interventions and increased rates of unnecessary cesareans deliveries.
A simple form of monitoring is the use of a special fetal stethoscope (fetoscope) by the midwife or health care provider to listen to the baby's heart beat. This is the most often used, non-intrusive method, preferred by midwives. This simple method has been found to be just as effective, if not better than, the electronic methods, without the potential for complications.
VARIOUS TYPES OF AVAILABLE FETAL MONITORING DEVICES
Fetoscope: This is a special type of stethoscope used for listening to a baby. There are many types of fetoscopes available, and a regular stethoscope works as well. This can usually be used after about 18 weeks.
Doppler: This is a handheld ultrasound device that transmits the sounds of the baby's heart rate either through a speaker or into ear pieces that are attached. This can generally pick up heart tones after 12 weeks gestation.
Electronic Fetal Monitoring: This is an ultrasound device used during labor and birth, or during certain testing (non-stress test, contraction stress test, etc.) to record the baby's heart rate, and sometimes mother's contractions. It can be used intermittently or continuously.
Internal Fetal Monitoring: It is an internal monitoring with an electrode attached to the baby's head to record heart tones, and a pressure catheter to record contractions. This is also used during labor and birth, however, it is not used intermittently.
Telemetry Monitoring: It is a lot like the regular Electronic Fetal Monitoring, however, one can maintain mobility.
BENEFITS & RISKS OF THE VARIOUS TYPES OF FETAL MONITORS
Fetoscope: This method is non-invasive, simple to use, and has a live person on the other end. This can prevent some of the errors that are mechanical. This gives mother the mobility to deal with her labor, shower, and so forth. It does require that the person using it be trained, although it is a standard procedure taught in every medical and nursing type institution. In the case of high risk, induced, or with certain medications, it cannot provide the round the clock monitoring that may be necessary. Many homebirth midwives carry a fetoscope as a standard form of prenatal equipment. It is one of the least expensive fetal monitoring devices available and requires no batteries or special equipment to use. It uses no ultrasound echo devices and is safe for the baby and the mother.
Doppler: This method is also used intermittently, requires little training to use, has a live person on the other end, and allows mother to maintain her mobility. It may also be easier to use during a contraction. This device does use ultrasound and does not provide the continuous monitoring needed for high risk labors. Many homebirth midwives carry a doppler in their prenatal bag along with the fetoscope. It is helpful for finding a baby's fetal heart sounds when the fetus is in a odd position, the mother is obese, or the mother is in a laboring position that the midwife does not want to disturb. Some dopplers can be adapted for underwater use while the mother is laboring in a birthing tub. Concerns have been raised over the years about just how safe an ultrasound fetal monitoring device is on a developing fetus, but there have been few long-term organized studies about this matter. Some midwives only use it when they are unable to get a good fetal heart tone monitoring with the fetoscope.
Electronic Fetal Monitoring: This method provides beat to beat view of the baby's heart tones, in relationship to mother's contractions. This may be used either continuously or intermittently. This is a benefit for the high risk mother, but of questionable benefit to the low risk mother. This method does use ultrasound; leaves room for mechanical error, which may cause incorrect interpretation, unnecessary interventions etc.; loss of maternal mobility (when in use), which may slow labor; and may switch attention from the mother to the machine. This is a standard fetal monitoring device often seen and used in clinics, health care offices, hospital maternity wards and birth centers.
Internal Monitoring: This is more accurate than the electronic monitoring, does not use ultrasound, and can provide continuous monitoring for the high risk mother. This method requires that your water be broken (An amniotomy [breaking the bag of waters] will be performed if your bag of water [amniotic sac] is still intact), and that you be 2-3 centimeters dilated. Amniotomy adds risks of its own. However, the risks and benefits of each procedure must be weighed. This type of monitoring is almost exclusively used in high-risk situations or when more accurate types of monitoring may prevent other unnecessary interventions. This type of monitoring also has been associated with fetal injury (from the electrode), infection for mother or baby, etc.
Telemetry Monitoring: This is the "newest" type of monitoring available. It uses radio waves, connected to a transmitter on your thigh, to transmit the baby's heart tones to the nurses station. You maintain your mobility, and have constant monitoring, but again, continuous monitoring for the low risk mother is very questionable in benefit.
There is no one right way for every woman. Depending on your choices of birth places, labor management, your monitoring will be tailored to your specific situation. You should discuss with your midwife or your care provider before labor about your options and what procedures you want to avoid. If you are in a hospital setting, high risk, are induced, or choose epidural anesthesia you will be more likely to have continuous monitoring. Think about your labor choices and how you plan to cope with labor. Research the different types of monitoring and talk to your midwife or health care provider and become aware of what is going on with the standards of monitoring in your community.
FETAL HEART RATE MONITORS AT HOME DURING PREGNANCY
When you are pregnant, there is nothing you want more than to know what is going on with the little person growing inside of you. If you have experienced complications or miscarriages in previous pregnancies, you may be even more anxious to know that your baby is healthy and happy inside of you. Having to wait between prenatal appointments to hear your child's heartbeat can make you uneasy. Thankfully, it is now possible to check on your baby with your own fetal heart monitor right at home.
HOW FETAL MONITORS WORK
At your prenatal appointments, you have likely been thrilled to hear your baby's heart beating. In order for you to hear your child's heartbeat, your health care provider or midwife uses a device known as a fetal heart rate monitor or doppler. This device uses a probe to detect high frequency sound waves that are produced by your baby's heart.
Because these sound waves are not easily heard under normal conditions, a gel, oil or water solution is spread onto your belly. The probe is then moved around this area until your child's heartbeat is detected. Once the sound waves are found, they are then sent from the probe to the doppler fetal heartbeat monitor, which amplifies the sound for you to hear.
USING A FETAL MONITOR AT HOME
Starting as early as eight weeks, it is possible to hear your baby's heartbeat. Although your child's heart rate is checked at every prenatal appointment, if you have experienced numerous miscarriages or serious pregnancy complications in previous pregnancies, you may be a bit apprehensive about having to wait so long to know that your baby is healthy. This is why many companies have begun to offer fetal heart rate monitors for home use.
The fetal heartbeat sounds like the hoof beats of a galloping horse. A rushing wind-like sound is audible from the placenta. The fetal heart rate usually ranges between 120 to 160 beats per minute, approximately twice the maternal rate. The mother's heart rate can be checked by taking the pulse. /b>
Using a fetal monitor at home can provide parents with comfort and reassurance that their pregnancy is progressing as it should. A fetal monitor can also offer peace of mind to those couples who are currently experiencing complications in their pregnancy as the device can help to alert you when there is a serious problem with your baby. Couples that must often go to the emergency room due to problems in the pregnancy may find that a home fetal baby heart monitor helps to reduce the number of trips they make.
Fetal doppler monitors are handheld devices that are generally easy to use. At home models usually run on batteries. If you are using one of these devices, you can start trying to detect your baby's heartbeat as early as eight weeks although most parents will not be able to find the heartbeat until the 10th to 12th week of pregnancy. Additionally, many at home models allow you to record the sound of your child's heartbeat, which you can easily download onto your computer as a special keepsake of your pregnancy.
Because these devices are meant to be used at home, using and reading a fetal monitor is fairly simple. To find your child's heartbeat, place the special gel or lotion on your belly just above the pubic bone and then slowly move the probe around, tilting it at different angles. Digital fetal monitors will automatically display the number of heartbeats per minute on their screen. If your fetal monitor is not digital, then count the number of heartbeats you hear over the course of ten seconds and multiply this by six to get the beats per minute (or 15 seconds and times by 4).
BUY OR RENT A HOME FETAL MONITOR
If you are interested in getting a fetal monitor to use at home, you have the option of either renting or buying one. There are numerous companies that do one or the other or both. While purchasing a doppler can cost as much as $450, it saves you from having to rent a fetal monitor in future pregnancies. On the other hand, renting a fetal heart monitor can be surprisingly affordable, with prices ranging from $24 to $49 (US Currency) per month. If you only want a home monitor temporarily, this may be the more reasonable option.
Whether you buy or rent, one of the main things you should look for in your fetal monitor is FDA approval. When you purchase or rent a monitor with FDA approval, you can be assured that your fetal heart monitor is safe to use throughout your pregnancy.
HOME FETAL MONITOR PRODUCTS
Amazon: Fetal Monitoring Products
Amazon: Fetal Stethoscope Products
Amazon: Fetal Doppler Products
REASONS FOR FETAL MONITORING PROCEDURE
In pregnancy, monitoring is performed for reassurance of the parents. Extended monitoring is usually conducted in mothers who have any pregnancy complications.
During labor, the monitoring is performed to check for abnormalities in the fetal heart rate and detect fetal distress. A drop in the fetal heart rate can indicate that the fetus is not receiving adequate amounts of oxygen.
FETAL MONITORING RISK FACTORS
Conditions or situations that may normally be associated with pregnancy and delivery.
DESCRIPTION OF FETAL MONITORING PROCEDURE
An electronic fetal monitor attached externally or internally is used to make a continuous recording of the baby's heart beat. The heart beat is amplified and heard as a beeping noise or printed out as a paper trace.
With external monitoring, the monitor is placed on the mother's abdomen and held in place by adjustable bands.
With internal monitoring (done during early labor), a wire is inserted through the mother's vagina and attached by an electrode to the surface skin of the baby's head. There may be some mild discomfort felt during the placement of the internal monitor (no different than associated with a pelvic examination).
Electronic monitoring used during labor and delivery includes a pressure gauge that measures and records the mother's contractions.
Contractions can also be measured by an external gauge strapped to the mother's abdomen or by an internal plastic tube inserted through the vagina into the amniotic fluid.
FETAL MONITORING EXPECTED OUTCOME
Monitoring during pregnancy will help assess the health and well-being of the fetus. The simple method of testing using a fetoscope is non-invasive and no side effects are expected. The external electronic monitoring method, if used briefly, is considered non-invasive, as well. Extended use should be avoided which require the mother to lay on her back for an extended period of time.
Monitoring during labor is used to confirm fetal well-being. If the monitoring indicates the baby may be at risk, appropriate action can be taken immediately, such as additional tests and possibly, cesarean section delivery. If no fetal distress is detected, normal labor and delivery will proceed.
ACOG (American College of OB/GYNs) has the official policy statement that intermittent fetal monitoring is just as safe and effective as continuous. Their recommendations are a 20 minute baseline strip, then once every 30 minutes (for 60 to 120 seconds) in first stage, and every 15 minutes in second stage, as long as everything looks normal.
ACOG REFINES FETAL HEART RATE MONITORING GUIDELINES
www.acog.org - Press Release
June 22, 2009
Washington, DC -- Refinements of the definitions, classifications, and interpretations of fetal heart rate (FHR) monitoring methods were issued today in new guidelines released by The American College of Obstetricians and Gynecologists (ACOG). The objective of the guidelines is to reduce the inconsistent use of common terminology and the wide variability that sometimes occurs in FHR interpretations. ACOG's Practice Bulletin, published in the July 2009 issue of Obstetrics & Gynecology, supports the recommendations of the Eunice Kennedy Shriver National Institute of Child and Health Development workshop* on electronic fetal monitoring (EFM) held in April 2008.
The intent of FHR monitoring is to help keep an eye on the status of the fetus during labor and intervene if necessary. There are two main FHR monitoring methods. The most commonly used method is EFM, which detects the fetal heart rate and the length of uterine contractions and the time between them. EFM allows physicians and nurses to measure the response of the fetal heart rate to uterine contractions. A lesser-used method is manual auscultation, which employs either a small handheld Doppler device or a fetoscope (similar to a stethoscope). A normal fetal heart varies between 110 and 160 beats per minute. A heart rate that doesn't vary or is too low or too high may signal a potential problem with the fetus.
"Since 1980, the use of EFM has grown dramatically, from being used on 45 percent of pregnant women in labor to 85 percent in 2002," says George A. Macones, MD, who headed the development of the ACOG document. "Although EFM is the most common obstetric procedure today, unfortunately it has not reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions."
One notable update in the guidelines is the three-tier classification system for FHR tracings (print-outs of the fetal heart rate).
- Category 1 FHR tracings are considered normal and no specific action is required.
- Category 2 tracings are considered indeterminate. This category requires evaluation and surveillance and possibly other tests to ensure fetal well-being.
- Category 3 tracings are considered abnormal and require prompt evaluation, according to ACOG.
An abnormal FHR reading may require providing oxygen to the pregnant woman, changing the woman's position, discontinuing labor stimulation, or treating maternal hypotension, among other things. If the tracings do not return to normal, the fetus should be delivered.
"Our goal with the ACOG guidelines was to define existing terminology and narrow definitions and categories so that everyone is on the same page," says Dr. Macones. One of the problems with FHR tracings is the variability in how they're interpreted by different people. The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22 percent of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings.
A meta-analysis study shows that although EFM reduced the risk of neonatal seizures, there is still an unrealistic expectation that a nonreassuring FHR can predict the risk of a baby being born with cerebral palsy. The false-positive rate of EFM for predicting cerebral palsy is greater than 99 percent. This means that out of 1,000 fetuses with nonreassuring readings, only one or two will actually develop cerebral palsy. The guidelines state that women in labor who have high-risk conditions such as preeclampsia, type 1 diabetes, or suspected fetal growth restriction should be monitored continuously during labor.
Practice Bulletin #106, "Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles," is published in the July 2009 issue of Obstetrics & Gynecology. * In 2008, The Eunice Kennedy Shriver National Institute of Child Health and Human Development partnered with ACOG and the Society for Maternal-Fetal Medicine to sponsor a workshop focused on EFM.
RESEARCH ON FETAL MONITORING
The New England Journal of Medicine, March 7, 1996 Volume 334; #10 "Uncertain Value of Electronic Fetal Monitoring in Predicting Cerebral Palsy" Karin Nelson, MD; James Dambrosia, PhD, Tricia Ting, BS; and Judith Grether, PhD Editorial by Dermot MacDonald, MB, MAO (National Maternity Hospital - Dublin, Ireland) give an overview of the history of fetal monitoring and it's relationship to detecting intrapartum problems that could be possibly associated with cerebral palsy.
To quote, " ...the only clinically significant benefit from the routine use of EFM was in the reduction of neonatal seizures. The rates of intrapartum and neonatal death, short-term morbidity and long-term morbidity including cerebral palsy were similar whether the fetal heart rate had been monitored continuously or intermittently."
This gives rise to concluding that the fetal monitor has now been evaluated by 12 prospective, randomized, controlled trials involving more than 55,000 infants with the complete understanding now that there is no improvement in outcomes due to this technology.
MacDonald D., Grant A., Sheridan-Pereira M. et al. The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. AM J Obstet Gynecol 1995; 152:524-39.
Rosen MG and Dickinson JC. The paradox of electronic fetal monitoring: more data may not enable us to predict or prevent infant neurologic morbidity. Am J Obstet Gynecol 1993;168(3 Part I):745-751.
Shy KK. Larson EB, and Luthy DA. Evaluating a new technology: the effectiveness of electronic fetal monitoring in. Ann Rev Public Health 1987;8:165-190. Thacker SB. The efficacy of intrapartum electronic fetal monitoring. Am J Obstet Gynecol 1987;156(1):24-30. Prentice A and Lind T. Fetal heart rate monitoring during labor-too frequent intervention, too little benefit? Lancet 1987;2:1375-1377. Grant A. Epidemiological principles for evaluation of monitoring programs-the Dublin experience. Clin Invest Med 1993;16(2):149-158. Vintzileos AM et al. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. N Engl J Med 1990;322(9):588-593. Sandmire HF. Whither electronic fetal monitoring? Obstet Gynecol 1990;76(6):1130-1134. Steer PJ et al. Interrelationships among abnormal cardiotocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH and Apgar scores. Obstet Gynecol 1989;74(5):715-721. Sykes GS et al. Fetal Distress and condition of the newborn infants. Br Med J 1983;287:943-945. Curzen P et al. Reliability of cardiotocography in predicting baby's condition at birth. Br Med J 1984;289:1345-1347.
FETAL MONITORING POTENTIAL COMPLICATIONS
Over-diagnosis of fetal distress and unnecessary cesarean section delivery. Internal monitoring may increase the risk of infection during labor.
FETAL MONITORING POST PROCEDURE CARE
Follow-up measures will depend on the purpose and time of the fetal monitoring. If done during a prenatal examination, no special measures are necessary. If done during labor, follow-up measures will be determined by the method of delivery.
Medication is usually not necessary for the procedure itself.
ACTIVITY RECOMMENDATIONS & RESTRICTIONS
Restrictions as determined by method of childbirth.
DIET & NUTRITION
No special diet is associated with this procedure. However, it is important that every pregnant women follows a health balanced prenatal dietary plan for a strong and health body and a strong and healthy baby.
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NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER
If you or a family member has questions or concerns about the use of fetal monitoring.
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