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Fetal Heart Monitoring | Johns Hopkins Medicine

What is fetal heart monitoring?

Fetal heart rate monitoring measures the heart rate and rhythm of your baby (fetus). This lets your healthcare provider see how your baby is doing.

Your healthcare provider may do fetal heart monitoring during late pregnancy and labor. The average fetal heart rate is between 110 and 160 beats per minute. It can vary by 5 to 25 beats per minute. The fetal heart rate may change as your baby responds to conditions in your uterus. An abnormal fetal heart rate may mean that your baby is not getting enough oxygen or that there are other problems.

There are 2 ways to do fetal heart monitoring, external and internal:

External fetal heart monitoring

This method uses a device to listen to and record your baby’s heartbeat through your belly (abdomen). One type of monitor is a Doppler ultrasound device. It’s often used during prenatal visits to count the baby’s heart rate. It may also be used to check the fetal heart rate during labor. The healthcare provider may also check your baby’s heart rate continuously during labor and birth. To do this, the ultrasound probe (transducer) is fastened to your belly. It sends the sounds of your baby’s heart to a computer. The rate and pattern of your baby’s heart rate are shown on a screen and printed on paper.

Internal fetal heart monitoring

This method uses a thin wire (electrode) put on your baby’s scalp. The wire runs from the baby through your cervix. It is connected to the monitor. This method gives better readings because things like movement don’t affect it. But it can only be done if the fluid-filled sac that surrounds the baby during pregnancy (amniotic sac) has broken and the cervix is opened. Your provider may use internal monitoring when external monitoring is not giving a good reading. Or your provider may use this method to watch your baby more closely during labor.

During labor, your healthcare provider will watch your uterine contractions and your baby’s heart rate. Your provider will note how often you are having contractions and how long each lasts. Because the fetal heart rate and contractions are recorded at the same time, these results can be looked at together and compared.

Your provider may check the pressure inside your uterus while doing internal fetal heart monitoring. To do this, he or she will put a thin tube (catheter) through your cervix and into your uterus. The catheter will send uterine pressure readings to a monitor.

Why might I need fetal heart monitoring?

Fetal heart rate monitoring is especially helpful if you have a high-risk pregnancy. Your pregnancy is high risk if you have diabetes or high blood pressure. It is also high risk if your baby is not developing or growing as it should.

Fetal heart rate monitoring may be used to check how preterm labor medicines are affecting your baby. These are medicines are used to help keep labor from starting too early.

Fetal heart rate monitoring may be used in other tests, including:

  • Nonstress test. This measures the fetal heart rate as your baby moves.
  • Contraction stress test. This measures fetal heart rate along with uterine contractions. Contractions are started with medicine or other methods.
  • A biophysical profile (BPP). This test combines a nonstress test with ultrasound.

Things that may affect the fetal heart rate during labor:

  • Uterine contractions
  • Pain medicines or anesthesia given to you during labor
  • Tests done during labor
  • Pushing during the second stage of labor

Your healthcare provider may have other reasons to use fetal heart rate monitoring.

What are the risks of fetal heart monitoring?

Radiation is not used for this test. The transducer usually causes no discomfort.

You may find the elastic belts that hold the transducers in place slightly uncomfortable. These can be readjusted as needed.

You must lie still during some types of fetal heart rate monitoring. You may need to stay in bed during labor.

With internal monitoring, you may have some slight discomfort when the electrode is put in your uterus.

Risks of internal monitoring include infection and bruising of your baby’s scalp or other body part.

Note: You should not have internal fetal heart rate monitoring if you are HIV positive. This is because you may pass the infection on to your baby.

You may have other risks depending on your specific health condition. Be sure to talk with your provider about any concerns you have before the procedure.

Certain things may make the results of fetal heart rate monitoring less accurate. These include:

  • Obesity of the mother
  • Position of the baby or mother
  • Too much amniotic fluid (polyhydramnios)
  • Cervix is not dilated or the amniotic sac is not broken. Both of these need to happen to do internal monitoring

How do I get ready for fetal heart monitoring?

  • Your healthcare provider will explain the procedure to you. Ask him or her any questions you have about the procedure.
  • You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
  • The consent form for fetal heart monitoring may be included as part of the general consent for labor and birth.
  • Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthesia.
  • If fetal heart rate monitoring is done along with another monitoring test, you may be asked to eat a meal before the test. This can help make your baby more active.
  • The amniotic sac must be broken and your cervix must be dilated several centimeters before the internal device can be put in place.
  • Follow any other instructions your provider gives you to get ready.

What happens during fetal heart monitoring?

You may have fetal heart rate monitoring in your healthcare provider's office or as part of a hospital stay. The way the test is done may vary depending on your condition and your healthcare provider's practices.

Generally, fetal heart rate monitoring follows this process:

External fetal heart monitoring

  1. Depending on the type of procedure, you may be asked to undress from the waist down. Or you may need to remove all of your clothes and wear a hospital gown.
  2. You will lie on your back on an exam table.
  3. The healthcare provider will put a clear gel on your abdomen.
  4. The provider will press the transducer against your skin. The provider will move it around until he or she finds the fetal heartbeat. You will be able to hear the sound of the fetal heart rate with Doppler or an electronic monitor.
  5. During labor, the provider may check the fetal heart rate at intervals or nonstop, based on your condition and the condition of your baby.
  6. For continuous electronic monitoring, the provider will connect the transducer to the monitor with a cable. A wide elastic belt will be put around you to hold the transducer in place.
  7. The provider will record the fetal heart rate. With continuous monitoring, the fetal heart pattern will be displayed on a computer screen and printed on paper.
  8. You may not be able to get out of bed with nonstop external fetal heart rate monitoring.
  9. Once the procedure is done, the provider will wipe off the gel.

Internal fetal heart monitoring

  1. You will be asked to remove your clothes and put on a hospital gown.
  2. You will lie on a labor bed. Your feet and legs will be supported as for a pelvic exam.
  3. Your healthcare provider will do a vaginal exam with a gloved hand to see how far you are dilated. This may be slightly uncomfortable.
  4. If the amniotic sac is still intact, your healthcare provider may break open the membranes with a tool. You will feel warm fluid coming out of your vagina.
  5. Your healthcare provider will feel the part of the baby at the cervical opening with gloved fingers. This is usually the baby’s head.
  6. The provider will put a thin tube (catheter) into your vagina. He or she will put a small wire at the end of the catheter on the baby’s scalp. He or she will gently turn it on the baby’s skin.
  7. The provider will remove the catheter and leave the wire in place on the baby’s scalp.
  8. The provider will connect the wire to a monitor cable. He or she will keep it in place with a band around your thigh.
  9. You may not be able to get out of bed with nonstop internal fetal heart rate monitoring.
  10. Once the baby is born, the provider will remove the wire.

What happens after fetal heart rate monitoring?

You do not need any special care after external fetal heart monitoring. You may go back to your normal diet and activity unless your healthcare provider tells you otherwise.

After internal fetal heart rate monitoring, your healthcare provider will check your baby’s scalp for infection, bruising, or a cut. The provider will clean the site with an antiseptic.

Your healthcare provider may give you other instructions, based on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Electronic Fetal Heart Rate Monitoring Test: Procedure & Results

Written by Lisa Fields

In this Article

  • What Is Fetal Heart Rate Monitoring?
  • Reasons for Fetal Heart Rate Monitoring
  • Types of Fetal Heart Rate Monitoring
  • Fetal Heart Rate Monitoring Risks
  • Fetal Heart Rate Monitoring Procedure
  • Fetal Heart Rate Monitoring Results
  • Abnormal Fetal Heart Rate Treatments

What Is Fetal Heart Rate Monitoring?

Fetal heart rate monitoring is a process that lets your doctor see how fast your baby’s heart is beating. If you’re pregnant, your doctor will want to make sure your baby is healthy and growing as they should. One of the ways they do that is to check the rate and rhythm of your baby’s heartbeat.

The doctor is most likely to do this later in your pregnancy and when you’re in labor. They may combine it with other tests for a closer look if you have diabetes, high blood pressure, or any condition that could cause problems for you and your baby.

Reasons for Fetal Heart Rate Monitoring

The doctor is more likely to use fetal heart rate monitoring when your pregnancy is high-risk. You may need fetal heart rate monitoring when:

  • You have diabetes.
  • You have high blood pressure.
  • You’re taking medicine for preterm labor.
  • Your baby isn’t growing or developing normally.

The doctor might also use fetal heart rate monitoring to make sure your baby is OK when you’re in labor or if there are other reasons to check your baby’s heart rate.

Types of Fetal Heart Rate Monitoring

The doctor can monitor your baby’s heartbeat in a couple of ways. They can listen for or electronically record the beats from outside your belly. Or once your water has broken and you’re in labor, they can thread a thin wire through your cervix and attach it to your baby’s head.

External monitoring (auscultation): If your pregnancy is going normally, the doctor likely will check your baby’s heart rate from time to time with a special stethoscope or a hand-held device called a Doppler ultrasound. Doctors sometimes call this type of fetal heart rate monitoring auscultation.

If you need it, the doctor might do a special test called a nonstress test, usually starting around week 32 of your pregnancy. It counts the number of times your baby’s heart speeds up during a 20-minute period.

For the test, you'll lie down with an electronic sensor belt around your belly that continuously records the baby's heartbeat.

The doctor also may wrap an electronic sensor belt around you to measure the baby’s heart rate during labor and delivery. This lets them know if the contractions are stressing your baby. If so, you might have to have your baby as soon as possible.

Internal monitoring: Once your water breaks and your cervix opens to prepare for birth, the doctor can run a wire called an electrode through it and into your womb. The wire attaches to your baby’s head and connects to a monitor. This gives a better reading than listening to your baby’s heartbeat from the outside.

Fetal Heart Rate Monitoring Risks

External monitoring isn’t risky. It doesn’t hurt or use radiation. If your doctor uses a belt, it might be a little uncomfortable. It also might mean you have to stay in bed during labor.

Internal monitoring risks include:

  • Slight discomfort
  • Infection
  • Bruising or scratching your baby’s scalp

If you’re HIV-positive, you shouldn’t have internal fetal heart rate monitoring. That’s because there’s a risk of passing the infection to your baby. If you have other health conditions, ask your doctor if there are any special risks.

Fetal Heart Rate Monitoring Procedure

Fetal heart rate monitoring could happen in your doctor’s office or at the hospital. The procedure will depend on what type of monitoring you’ll have.

External fetal heart rate monitoring procedure

  • Your doctor will ask you to undress and lie down on an exam table or labor bed.
  • You’ll get clear gel on your belly.
  • Your doctor will press a gadget called Doppler transducer to your belly and move it around.
  • You’ll hear the sound of your baby’s heartbeat.
  • If your doctor wants to measure the heartbeat continuously, they’ll use a wide belt to hold the transducer in place.
  • Your doctor will record the fetal heart rate. You may see it on a computer screen.

Internal fetal heart rate monitoring procedure

  • You’ll be asked to undress and lie down.
  • You’ll put your feet and legs in supports, like you’re getting a vaginal exam.
  • The doctor will check to see if your cervix is dilated.
  • If your water hasn’t broken, the doctor may break it.
  • The doctor will feel for your baby’s head.
  • The doctor will put a thin tube (catheter) with a small wire at the end into your vagina.
  • The doctor will put the wire on your baby’s scalp and remove the catheter.
  • Once it’s connected to a cable, the wire will record your baby’s heartbeat until a doctor removes it or your baby is born.

Fetal Heart Rate Monitoring Results

A healthy baby’s heart usually beats 110-160 times a minute in the womb. It speeds up when the baby moves. Signs of possible problems include:

  • Heart beats slower than 110 beats a minute
  • Heart beats faster than 160 beats a minute
  • A heartbeat pattern that isn’t normal
  • The heartbeat doesn’t go up when the baby moves or during contractions

Lack of a normal heartbeat doesn’t always mean something is wrong with your baby. But it can be a sign that the baby isn’t getting enough oxygen.

Your results also may be less accurate if:

  • You’re obese.
  • You or your baby is in the wrong position.
  • You have too much amniotic fluid.

Abnormal Fetal Heart Rate Treatments

If your baby’s heart rate isn't what it should be, the doctor may try:

  • Changing your positions to move the baby
  • Giving you fluids through an IV
  • Having you breathe extra oxygen
  • Relaxing your uterus with medicine to slow contractions
  • Giving you other drugs

If these steps don’t return your baby’s heart rate to normal, you may need to deliver them right away. If your cervix is completely open, the doctor may use a tool called forceps or a special vacuum to help you push the baby out. Otherwise, you’ll have the baby by emergency cesarean section.

Baby monitor: luxury or necessity? | Motherhood

When our first child was born, we did not think about a baby monitor. Then, ten years ago, these devices were rare. A friend offered me an old foreign baby monitor, which worked intermittently and caught “foreign” waves, but, for lack of a better one, we were also happy with such a unit. To make it clear whether we are “in touch” with a sleeping child or not, we put a small ticking clock next to the device located in the baby’s room. As long as we heard their sound on our walkie-talkie, we were calm that “the waves were in place”, and we could go for tea to the neighbors without worrying that there was no one to leave the sleeping child with. nine0004

With our second child, the question of whether or not to buy a baby monitor did not even arise: we clearly understood that we would purchase this device along with such necessary things as a stroller and a crib.

Sometimes it's funny to watch the reaction of our guests when they hear the "strange sounds" of the walkie-talkie turning on, because. the child's voice does not come from the side of his bedroom, but from a device standing near us. Anyone who does not know about the included baby monitor is lost in the first minutes. And we feel very comfortable that we do not have to constantly look into the baby's room or listen, standing near his door, how is he there without us. nine0005

Why do we need a baby monitor

Why did we decide not to do without this device?

  • Having experienced the convenience of a baby monitor with our first child, we were convinced that we would miss it for our second baby. We are one of those parents who run to the baby "at the first peep", and without a special device, it is very often possible not to hear the child's anxiety, crying or coughing when he sleeps in a separate room with the door closed.
  • Our second child was born at 29weeks, and premature babies and children who have any health problems need more attention from their parents: constant control of breathing is important, it is necessary to ensure that the baby does not choke, etc. A baby monitor with a breath sensor is a good help for mom and dad in such cases.
  • Experts say that children who were not allowed to cry for a long time, to whose call their parents quickly came, have less pessimism in character, they are less inclined to grieve, in contrast to those children who often had to wait a long time for the arrival of adults and cry bitterly. It turns out that careful attention to the baby keeps stress hormones under control, preventing them from rising and causing anxiety and a sense of defenselessness in the child. Such children grow up more self-confident, their reactions to stress are adequate. nine0018
  • We often leave with my family to visit relatives. We are comfortable with any room that the hosts offer us, because with a baby monitor, we can always hear if everything is okay with our sleeping baby. We can also go out into the yard and be outside the house and not be afraid that the child will cry, but we will not hear.

How to find what you need

In today's market, you will find a very large selection of types and brands of all kinds of baby monitors. In order not to get confused and find exactly what you need, it is important for parents to decide on several basic parameters that the device must meet. Everyone will have their own list of requirements for a baby monitor. For example, in our case, we were guided by the following points:

1. The device must work efficiently without interruption. Having felt what it was like to have a baby monitor that didn't work well, for our second child we wanted to get a reliable device.

2. The baby monitor must have a breath sensor. Our child was born prematurely, so constant monitoring of lung function was important for him.

3. The baby monitor should be easy to use. This item is, of course, very relative, because At first, our device still seemed incomprehensible to us. At first, I was afraid that I would press the wrong button and not hear the baby cry. After a short time, our baby monitor became quite simple and understandable for us. nine0005

4. It is desirable that the device has additional functions , for example, a night light, a thermometer showing the air temperature in the baby's bedroom, a sensor showing that the baby is crying even if the sound on the device is turned off.

An invaluable role in choosing a baby monitor will be played by "advice from experienced" - those who have used the device of a particular company and can talk about its "pluses" and "minuses". If you do not have experienced acquaintances in this area, then on the Motherhood forum you can always find reviews about various models of baby monitors. nine0005

What baby monitors are like

If you call this device in one word, such a concept as a “walkie-talkie” is very suitable: one part of it is installed near the baby’s crib, the other is located with the parents.

Baby monitors include devices with one-way communication and two-way communication. One-way devices give you the ability to keep abreast of what's going on in your child's room. “Feedback” also works in two-way walkie-talkies - parents can talk to the child, for example, calm him down while they go to his room. But, if you can quickly respond to the crying of the baby and come to him, it will be more economical to purchase a device without feedback. nine0005

An even more "advanced" device is the baby monitor , which, in addition to the sound signal, transmits a video signal from the baby's room. This is quite convenient for those who live in a large house and may be at a considerable distance from the baby.

Almost all baby monitors and baby monitors operate within a radius of 300 - 400 meters. In this case, you need to take into account everything that can interfere with the signal - interfere with radio waves - in this case, for some models, the radius can be noticeably reduced. nine0005

Digital or analogue?

There are analog and digital baby monitors. Their main difference is in the way the signal is transmitted.

The analog baby monitor emits a so-called “open” signal. Such a device is sensitive to various interferences that violate the purity of communication, because it does not have a signal encryption function. Nearby working vacuum cleaners, radios, phones will create problems for the quality work of an analog baby monitor. Thus, you can hear the sound of the baby monitor from the next apartment, and not the voice of your baby. Also, an analog device can be used as a means to eavesdrop on conversations: if you are talking near a baby monitor, an open signal with your voice can be “intercepted” by other walkie-talkies. nine0005

The advantage of the analog device is its price. An analog baby monitor is an order of magnitude cheaper than a digital one. If there is no open signal interference nearby, and you intend to save money on a baby monitor, if you do not need various additional features such as a thermometer, a silent signal display on the monitor, and the like, the analog option is fine for you.

It should be noted that analogue baby monitors are prohibited in some countries. They differ from conventional analog ones in the range of action, which reaches three kilometers. The existing ban applies specifically to baby monitors, since they operate at PMR 446 frequencies. In addition, doctors are not unambiguous about the impact on a child’s health if such a device works continuously. nine0005

The Digital Baby Monitor has an encrypted signal that cannot be "intercepted" by other similar devices in the vicinity. Thanks to this, no interference is created in its work: the sound is clear without impurities. A digital device usually has several dozen channels, which automatically switch from one to another in case of communication problems.

Additional options for baby monitors in a complete set are contained in digital devices. Along with a high-quality signal, you can get such amenities as: a thermometer, a night light with soft backlight, video communication, breathing control, air humidity monitoring, an alarm clock, music, a vibration signal when the sound is turned off, presence control in the radio zone. nine0005

Each additional item in the baby monitor, of course, increases its cost. Therefore, it is important to carefully consider what you really need and what features you can do without.

Criteria for choosing a baby monitor

So, when purchasing a baby monitor, pay attention to the following parameters:

  • What is the range of the device.

  • Whether this device is digital or analog.

  • Are there any additional features that are important to you and are there any that you can do without? nine0018
  • How durable is the material that the baby monitor is made of, how will it withstand falls, bumps.

  • Two way or one way communication.

  • What is the warranty period.

  • Can the device be operated with batteries?

  • What are the reviews of other parents about this model.

  • How does the baby monitor work during the control check in the store.

Photo - photo bank Lori

"Baby Monitor" . Mom's most important Russian book. Pregnancy. Childbirth. Early years

The main function of these devices is to inform you about what is happening in the child's room while you are in another room. For example, your baby fell asleep, and at that time you went to wash the dishes. Because of the noise of water pouring from the tap, you can not hear the crying of an awakened baby. The baby monitor captures all the sounds in the nursery and transmits to you, which means that you will certainly know that the baby has woken up. Of course, the device cannot replace a person, but it provides parents with real help. nine0005

What to look for when choosing a baby monitor:

• Communication between units of the machine can be one-way or two-way. In the first case, you will be able to hear the child, but you will not be able to answer him. If you are only going to monitor the baby’s sleep, while being at a distance from him, then this will be quite enough. In the second case, the electronic nanny works in the "intercom" mode: both mother and baby hear each other.

• The device works like a "radio" but without background noise. It is enough to connect one device to another, and parents will immediately be able to hear everything that happens in the baby's room. Depending on the technology used to transmit and receive information, baby monitors are analog and digital. nine0005

An analog signal is more susceptible to interference and easier to eavesdrop on by tuning a regular receiver to the desired frequency. Digital communication is characterized by a higher level of quality and security.

• The baby monitor must have a presence control function in range. Its task is to ensure that both blocks (parent and child) are within the radio coverage area, and signal a communication breakdown.

In this case, if you get carried away and move away from the child further than the set distance, the unit will give a signal.

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