Fetal monitoring during labor is typically done through electronic fetal monitoring (CTG) or intermittent auscultation.
CTG involves continuous or periodic monitoring using ultrasound to track the baby’s heart rate and a pressure sensor to measure contractions. It’s widely used, with 90% of hospital births in the US involving CTG at some point.
Intermittent auscultation uses a fetal stethoscope or handheld Doppler to monitor the baby’s heart rate during labor while also assessing contractions manually. This method is more common in home births and birthing centers.
Evidence supporting fetal monitoring methods
According to Cochrane reviews covering over 37,000 births, there are no significant differences in neonatal outcomes between CTG and intermittent auscultation. Continuous CTG slightly reduces the risk of rare neonatal seizures but is associated with higher cesarean rates and increased use of forceps or vacuum.
Why is intermittent auscultation underutilized?
Despite being recommended by medical guidelines, intermittent auscultation is rarely implemented in hospitals. It requires hands-on care and continuous attention from healthcare staff, which is often deprioritized in busy hospital settings.
Pros and cons of each method
Intermittent auscultation:
This method supports natural birthing positions and reduces the likelihood of interventions like cesareans. However, it demands constant care from trained staff.
Electronic fetal monitoring (CTG):
While it reduces the risk of rare neonatal seizures, it increases the likelihood of cesareans and restricts maternal mobility during labor.
Conclusion
Intermittent auscultation offers evidence-based benefits for mother and baby but requires hospital systems to prioritize hands-on care for effective implementation.
Reference: https://evidencebasedbirth.com/fetal-monitoring-podcast/
