Prenatal heartbeat monitors

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

Types, safety, accuracy, and alternatives

Fetal heart monitors measure the rate and rhythm of a fetus’s heart. Doctors may recommend fetal heart rate monitoring during late pregnancy or labor to monitor the fetus’s health. The monitors that doctors use can measure heart rate, heart rate variability, accelerations, and decelerations.

This gives doctors important information about a fetus’s health.

It is possible to buy handheld heart monitoring devices for use at home, too. However, these are different from the monitors that doctors use. Unlike professional monitors, at-home devices can only measure heart rate.

The Food and Drug Admiration (FDA) strongly advises against using at-home heart monitoring devices because they are not a reliable way to determine whether or not a fetus is healthy.

Read on to learn more about fetal heart monitors, including the types that doctors use, at-home devices, and safe alternatives that allow people to track fetal health.

Doctors use fetal heart monitors to get an indication of a fetus’s health. They may use one in the following situations:

• During routine prenatal appointments: Healthcare professionals can use an ultrasound device to briefly monitor the fetus’s heart rate during routine checkups.
• To monitor for specific concerns: If someone is experiencing troubling symptoms during pregnancy, such as bleeding, a doctor may recommend heart monitoring to assess the well-being of the fetus. They can also use fetal heart monitoring to determine if preterm labor medications are affecting the fetus. These medications stop labor from beginning too early.
• During high risk pregnancies: If a person is at high risk of health or birth complications during pregnancy, a doctor may use a fetal heart monitor to detect signs of distress as early as possible.
• During labor: Once labor begins, a doctor can use a heart monitor to make sure the fetus is doing well during birth.

Several factors can increase the likelihood of a person having a high risk pregnancy. These include:

• having a health condition such as high blood pressure, diabetes, or HIV
• having overweight or obesity, which can increase the risk of several health conditions during pregnancy
• having multiple births, such as twins or triplets, which can make preterm birth or premature labor more likely
• being very young or older than 35 years of age, as these groups are more likely to experience preeclampsia and gestational high blood pressure

It is important to note that not everyone with these risk factors will go on to have a high risk pregnancy, and not all medical practices will recommend fetal monitoring based on a person’s age or body weight alone.

Doctors can use two types of fetal heart monitors: external or internal. The following sections will look at these in more detail.

External devices

A Doppler ultrasound device is an external monitor that uses sound waves to detect a fetus’s heartbeat. To check the heartbeat, a doctor places an ultrasound probe against a person’s abdomen.

If a doctor wants to monitor the fetal heart rate continuously during labor, they can strap the probe to the person’s abdomen. This will record the fetus’s heartbeat pattern and alert the doctor to any changes that could indicate distress.

People can also use handheld versions of Doppler ultrasound devices at home. However, these devices only measure the speed of the fetal heart rate. The FDA recommends only seeking heart monitoring from qualified healthcare professionals when there is a medical need.

Internal devices

Doctors can fit an internal heart monitor once the amniotic sac breaks. This can happen naturally at the beginning of labor or artificially through a procedure that a healthcare professional carries out. As a result, doctors tend to use this type of monitor when a person is already in labor and if an external monitor is not providing a clear reading.

To fit the monitor, a healthcare professional will insert a catheter containing a thin wire through the cervix and place an electrode on the fetus’s head. If the doctor also wants to measure the pressure within the uterus, they may also insert a catheter that measures uterine pressure.

The fetus’s movements do not affect this type of monitor. This makes internal monitor readings more accurate.

Both the FDA and the National Health Service (NHS) advise against using at-home Doppler machines. This is for several reasons, including the following:

• Health effects: Ultrasound devices can heat tissues and create tiny air bubbles inside them. Scientists do not know if this has any long-term impact on health.
• Inaccuracy: Doppler ultrasound machines require training to operate and interpret correctly. People using at-home devices may get inaccurate results, which could pose a risk to their pregnancy. Additionally, a normal fetal heart rate does not always mean that a fetus is healthy.
• Stress: If a person uses an at-home device and cannot hear a heartbeat, they may worry unnecessarily about the health of the fetus. This can cause avoidable stress and anxiety.

Receiving heart monitoring from a healthcare professional can prevent any risk of inaccuracy and worry. If a person is considering trying an at-home fetal heart monitor, it is important that they speak with a doctor first.

People who still wish to use an at-home monitor should be aware of the following:

• It is very difficult to listen to a baby’s heartbeat before 14–16 weeks into pregnancy.
• Any heartbeat a person hears could be from their own heart or the pulse of an artery.
• The placenta also has a pulse, which can create a sound that is similar to that of two heartbeats.

Although mobile apps might seem like a safer alternative to at-home Doppler devices, they come with their own risks.

Mobile apps have very little regulation from health authorities. Many are also inaccurate. In fact, one 2019 study found that 30 free apps on the Apple iTunes store all gave inaccurate fetal heart rate readings.

Some of the apps did provide a disclaimer that said that they were inaccurate. However, some did not, which could lead to people incorrectly believing that their fetus is healthy. This may mean they do not seek help from a doctor or midwife, which could put their pregnancy at risk.

People should not use or rely on fetal heart rate monitoring apps for an accurate insight into their fetus’s health. Only a healthcare professional can provide this.

There are some safer ways for people to get an insight into their fetus’s health at home. These include the following.

Fetal movement counting

Movement is a good indicator of a fetus’s well-being. During the early weeks of pregnancy, a person may feel swirling or fluttering movements. As time goes on, they will notice more pronounced kicks and jerky movements.

Fetal movement counting, or kick counting, involves setting aside time each day to monitor the rhythm of these movements. Most people can feel a fetus’s movements after 20 weeks. These movements should continue throughout the pregnancy until giving birth.

To try fetal movement counting, speak with a doctor for advice first. Then, follow these tips:

1. Choose a time each day to monitor the fetus’s movements. During the evenings or after a meal is often a good time.
2. Write down the number of times the fetus moves or kicks within 1 hour.
3. After several days, people will typically notice that the fetus moves roughly the same number of times within that hour. This is the baseline number of movements.
4. Keep monitoring the movements each day. If there are changes to the number of movements, or if the fetus takes longer to move, call a doctor immediately.

Fetoscope

If a person does not want to use a Doppler machine, they can use a fetoscope instead. A fetoscope is similar to a stethoscope, but it is a slightly different shape. It can detect a baby’s heartbeat at 20 weeks.

One benefit of using a fetoscope over a Doppler machine is that it is not an ultrasonic device, so it does not carry the same potential risks. However, like with a Doppler machine, a person should not panic if they do not hear a heartbeat, as long as they feel the baby moving.

A person should speak to a doctor if they notice any of the following changes:

• The fetus is moving less than usual.
• There is no movement at all.
• The fetus has a different movement pattern.

If someone is worried, they should contact a doctor immediately rather than trying to assess the fetus’s health using an at-home Doppler device. This is not a reliable way to determine whether or not the fetus is in distress.

Fetal heart monitors measure a fetus’s heart rate and rhythm. Healthcare professionals may use them later in a person’s pregnancy or during labor. They can also use them in high risk pregnancies or to check fetal health in people experiencing specific symptoms, such as bleeding.

At-home devices are available, but people should not use them without discussing this with a doctor or midwife first. Interpreting sounds from a Doppler device is complicated, and only a trained healthcare professional can do this accurately. A false reading could be risky, as people may mistake their own heartbeat for the fetus’s.

Instead, people can track a fetus’s movements or use a fetoscope to get insights into their health. If a person notices a change in the fetus’s usual movements, they should contact a doctor or midwife right away.

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