Kingston Hospital offers two types of fetal monitoring: intermittent auscultation (IA) and cardiotocography (CTG).
These monitoring methods are described in detail below.
We encourage you to discuss monitoring options with your midwife or obstetrician during your antenatal appointments. They can offer personalised advice, based on your medical history and preferences.
Choosing the right type of fetal monitoring is a personal decision. Remember that you and your baby may need more detailed monitoring as your labour progresses.
Intermittent auscultation (IA)
About IA
IA involves listening to your baby’s heartbeat at regular intervals, using either a handheld Doppler device or a pinard stethoscope.
Your midwife will place the Doppler or stethoscope onto your abdomen and listen to your baby’s heartbeat until the baby is born. They will do this at these intervals:
- for 1 minute every 15 minutes during the first stage of labour
- every 5 minutes in the second stage of labour.
When we recommend it
We typically recommend it for pregnancies without complexities.
Where it is available
It is available in every birthing area at Kingston Hospital: at a homebirth or at the Birth Centre. It is one of the monitoring options in our Delivery Suite.
Benefits
The benefits are as follows.
- It allows you more mobility while you are in labour.
- It reduces the likelihood of an assisted birth, such as forceps or a ventouse (vacuum cup), or a caesarean birth.
Risks
There is a small chance that your pulse could be picked up, instead of your baby's heartbeat. Your midwife will feel your pulse at the same time to avoid this happening.
What to consider
- To make this type of monitoring most effective, your midwife will need to listen immediately after a contraction has finished. To do this, they may need to feel your tummy to assess when the contraction has ended.
- If your baby's heartbeat is giving us concerns, we will recommend that we continue monitoring your baby using cardiotocography (CTG). See below for more information.
- IA is the least invasive form of fetal monitoring on offer at Kingston Hospital.
Cardiotocography (CTG)
About CTG
A CTG is a piece of electronic equipment that we use to continuously monitor:
- your baby’s heartbeat
- your contractions throughout labour.
We do this until your baby is born.
We place two transducers on your abdomen. (The transducer is a small plastic device with an electrode attached).
One monitors your baby’s heartbeat and the other (known as a TOCO) monitors your contractions.
These transducers generate a pattern which your midwife will interpret, using strict guidelines. If your midwife has concerns about your baby’s heartbeat, they will discuss these with you and your doctors.
When we recommend it
We typically recommend it for more complex pregnancies or if complexities arise during labour.
Where it is available
It is available in our Delivery Suite only.
Benefits
It generates continuous data on your baby’s heart rate. This helps us to quickly identify any concerns.
Risks
Using this type of monitoring increases the likelihood of an assisted birth (such as forceps or ventouse (vacuum cup), or a caesarean birth. (If you are monitored with IA, you are less likely to have an assisted or caesarean birth).
There is a small chance that your pulse could be picked up, instead of your baby's heartbeat. Your midwife will feel your pulse at the same time to avoid this happening.
What to consider
- You will need to wear belts around your abdomen to hold the transducers/TOCOS in place.
- Your midwife might need to adjust these belts/transducers/TOCOS regularly, to maintain good contact with your baby’s heartbeat.
- There may be reasons why we recommend this form of monitoring for you and your baby (instead of IA).
Different types of CTG monitoring
Kingston Hospital offers four types of CTG monitoring.
Wired CTG monitoring
This is a type of continuous CTG monitoring that uses wired technology to transmit data. We attach two transducers to your tummy, connected to the CTG machine with wires.
This type of monitoring is available in every room of our Delivery Suite.
Wireless telemetry CTG monitoring
This is a type of continuous CTG monitoring that uses wireless technology to transmit data. It gives you greater mobility than wired CTG monitoring (you can move around and walk during labour).
We attach two transducers to your tummy, which connect wirelessly to the CTG machine.
This type of monitoring is available in every room of our Delivery Suite. One of our Delivery Suite rooms has a wireless CTG which you can use in the pool.
Considerations
Wired and wireless CTG monitoring both require you to wear abdominal straps to hold the necessary devices in place.
Using wireless CTG monitoring may require us to touch your tummy and adjust the transducers more often than with a wired CTG monitor.
Wireless CTG monitoring is battery operated. If the battery runs out, your midwife will need to change to wired electrodes to hear your baby’s heartbeat.
CTG via fetal spiral electrode (FSE)
A fetal spiral electrode (FSE) is a small spiral electrode which we place under the skin of your baby’s head. We do this while we examine you to assess how dilated (open) your cervix (the entrance to your womb) is.
During labour, your cervix dilates so that your baby can pass through. We can usually feel your baby’s head once your cervix is dilated, and this is when we can apply the electrode. The electrode stays in place for your whole labour and we remove it as soon as your baby is born.
When we recommend FSE
We recommend it when we need more accurate data. For example when wired or wireless GTG is giving us inadequate or inconclusive data.
Who it is suitable for
- Mothers and and babies for whom we recommend continuous heart rate monitoring in labour.
- Babies over 34 weeks gestation.
- Babies who are head down (cephalic) or bottom down (breech) in labour.
- Mothers who have chosen or accepted a recommendation to give birth on a labour ward.
- Mothers who choose this type of monitoring.
When FSE is unsuitable
FSE is not suitable if you have any of the following:
- HIV (human immunodeficiency virus)
- Hepatitis B or C (infection of the liver)
- Thrombocytopenia (a blood platelet count of less than 80).
Benefits of FSE
- FSE offers us more precise information on your baby’s wellbeing, compared to a wireless or wired CTG (which uses data generated by abdominal monitoring).
- It allows us to monitor your baby’s heart rate directly.
Risks
- It will cause a small scratch on your baby’s scalp.
- There is a small chance (about 1 in 100) of a larger cut or injury to your baby's scalp.
- We may need to try more than once to apply the electrode to your baby's scalp.
Considerations
- We do not typically use FSE in situations where the baby does not require continuous heart rate monitoring.
- After applying the electrode, we can remove the abdominal heart rate monitor from your abdomen. (We will still recommend that you keep wearing the abdominal contraction monitor (TOCO).
- You can walk around more freely during labour without affecting our ability to monitor your baby’s heartbeat.
- You cannot use FSE if you have chosen the pool for labour and/or birth. If this is the case, we will recommend CTG or IA.
FSE with STAN monitoring
STAN (ST analysis) monitoring is an advanced fetal monitoring setting that we can activate. It assesses your baby's electrocardiogram (ECG) alongside standard CTG heart rate monitoring. An ECG records the electrical activity, rhythm and rate of your baby's heart.
This type of monitoring gives us detailed information about your baby’s heart function by analysing a particular segment (the ST segment) of the ECG. We can only use this technology when we are monitoring your baby using an FSE.
Your baby's FSE will need to stay in place on their scalp for your whole labour. We remove it as soon as your baby is born.
When we recommend it
We often recommend it in complex situations, or when we have concerns about a baby’s heart rate patterns during labour.
Benefits
- It gives us additional information about your baby’s oxygenation (how they receive oxygen) and wellbeing. This can help us make more informed clinical decisions.
- It reduces the likelihood of earlier interventions (actions to manage, accelerate or assist in labour and delivery).
- Compared to CTG monitoring alone, it reduces the likelihood of you needing an assisted birth (such as forceps or ventouse/vacuum cup, or a caesarean birth).
Considerations
- We can only activate STAN analysis when we apply an FSE to your baby's scalp. The risks of FSE are as follows:
- It will cause a small scratch on your baby’s scalp.
- There is a small chance (about 1 in 100) of a larger cut or injury to your baby's scalp.
- We may need to try more than once to apply the electrode to your baby's scalp.
- This type of monitoring is only suitable for babies over 36 weeks gestation
- You will need to have a leg strap and electrode placed on your inner thigh for STAN analysis to work correctly.
Contact information
Maternity Helpline
Telephone: