Foetal Monitoring or Maternal Instinct is the best assessment of baby’s wellbeing? What are you options?
Doppler Monitoring
Also known as Intermittent Auscultation, is a method used during labour to listen to the baby's heartbeat. It involves placing a small handheld electronic device, called a Doppler ultrasound, on the mother's abdomen to detect the rhythmic sound of the baby's heart.
This helps healthcare professionals monitor the baby's well-being and adjust care offerings accordingly.
Continuous Monitoring
Cardiotocography (CTG), is a method used during labour to continuously monitor the baby's heart rate and the mother's uterine contractions. It involves placing two sensors on the mother's abdomen: one to measure the baby's heart rate and the other to detect uterine contractions. The data is displayed graphically on a monitor, allowing healthcare professionals to assess the baby's well-being and the progress of labour in real-time
(more on this in tomorrow’s post)
Let your midwife know what you want to be offered and how...
In the case of intermittent (doppler) monitoring
You could discuss on arrival (or note in your birth plan) how often you would like to be asked if you want baby listened to (if at all) and also how you would like to be asked.
(I would also suggest that you ask your BPIAB facilitator for latest info on NICE guidelines on motoring or find the guidelines linked in the resources pages)
We know that it is important not to wake the neocortex unnecessarily during labour (learn lots more about this in Hypnobirthing), when someone asks you verbally ‘can I listen in’ (as frequent as every 5 mins) a verbal response from you will wake your neocortex which is not good for birth physiology.
Instead, you could ask you midwife to come to you with a doppler, visually, and you can give her visual cues in response. ie. a head nod/shake, a hand wave or even a push away will suffice.
Alternatively, a hand written or prep-prepared sign, like the ones included in our pack of cards can be a great option.
Some evidence on the two types of monitoring from the Cochrane Library, continue reading below...
The evidence on Cardiotocography (CTG)
Continuous monitoring of babies’ heart rates and nervous systems is not and has never been an evidence based practice. However, it is here to stay as it would not be ethical to study it in its entirety (couldn’t select a proportion of women/birthing people and not offer them monitoring).
Let your midwife know what you want to be offered and how...
In the case of CTG (continuous) monitoring
It is a good idea to understand the circumstances when this may be offered to you, so do bring it up with your community midwife in advance.
Having a good understanding of what continuous monitoring is actually for and what the risks and benefits are in advance will be enormously helpful if you find that it is offered to you.
Ask your BPIAB facilitator to help you find some relevant resources or search the BPIAB website Resource Library for more information.
Birth Plan
Be clear with your preferences here on your written birth plan and make sure that your birth partner is prepped on this too and ready to speak up and advocate if needs be.
Decision making
Remember when making a decision about what is right for you, your experience of birth and your baby’s health that you have the following factors to consider, they will also influence the guidance you are given:
Guidelines
Evidence
Hospital Policy
Maternal Instinct
Keep reading for more on these four considerations and what they mean to you...
These are your Midwife/Doctor’s guidelines, applicable to them. They will often but not always be based on evidence.
They are guidelines for the healthcare professional not the service user (you).
Definition of a Guideline: Guidelines are recommendations or principles developed by experts or authoritative bodies to assist in decision-making and standardize practices in a particular field. They typically outline best practices, procedures, or criteria for diagnosis, treatment, or management of specific conditions or situations, with the goal of optimizing outcomes and promoting consistency in care.
2. Evidence
All suggestions made to you should be evidence based, remember to also consider that all evidence quality does vary.
Definition of ‘Evidence’: Evidence refers to factual information, data, or observations that support a claim, hypothesis, or conclusion. In various fields such as science, medicine, law, and policymaking, evidence is used to substantiate arguments, make informed decisions, and draw reliable conclusions. Types of evidence may include empirical research findings, expert testimony, statistical data, experimental results, or anecdotal accounts, depending on the context and standards of inquiry within a particular discipline.
3. Hospital Policy
These policies are in place to protect the hospital or it’s staff from litigation - they are their policies not yours - equally, you can have you own policies and it’s ok to frame it that way when talking about it too.
Definition of a policy: A policy is a set of principles, guidelines, or rules established by an organisation, government, or authority to guide decision-making and action in a particular area. Policies can address various aspects such as governance, operations, behavior, or regulations, aiming to achieve specific objectives or outcomes.
4. Maternal Instinct
Circling back to our Rachel Reed quote of the day: “Maternal instinct is the best assessment of baby’s wellbeing” - This is ALWAYS the most important factor here. This is not fluffy hippie stuff, you and your baby are connected on a neurological level. This is one of many reason’s why it is so important to let our neocortex switch off during birth as outside influences such as people talking to you or noisy monitoring machinery can interfere with you being able to listen to this very important intuition.
Definition of a Maternal Instinct: This neurological connection encompasses various hormonal, physiological, and emotional mechanisms that enable maternal caregiving, protection, and nurturing instincts during pregnancy, promoting the well-being and development of the unborn child.
Decision making
So with all of these considerations in mind, let’s now reflect this back to our midwives and doctors who’s job it is the provide us with trustworthy, balanced evidence based information.
Ask the person providing you with the information required to present it in the following manor to ensure that both the benefits and the risk of every offer is available to you. This will help you avoid coercion and emotional decision making.
A copy of this is included on in our Birth Prep cards.