In today's episode, we dive into the essential topic of fetal monitoring, especially during labor.
Here's a snapshot of what you'll learn:
- The Basics of Fetal Monitoring: Discover what fetal monitoring is and why it's important for your baby's health during labor.
- Your Rights and Choices: Learn about your rights regarding fetal monitoring and how you can make informed decisions during your birth experience.
- Interpreting Fetal Monitor Readings: Get insights into how to read a fetal monitor strip and understand what it indicates about your baby's well-being.
- The Role of Movement in Monitoring: Find out why baby's movement is a key indicator of health and how it relates to fetal monitoring.
- Options for Monitoring: We discuss continuous versus intermittent monitoring, external monitors, and the innovative option of wireless monitoring for greater mobility.
- Upcoming Live Classes: Get excited for our free live classes in the Fearless Birth Experience Facebook group, starting soon! We'll cover topics like managing labor pain and more in-depth aspects of fetal monitoring.
- Exclusive Downloadable Content: Listen in to learn how you can get our Third Trimester Birth Prep Pack, which includes a fetal monitor guide, a hospital packing list, and a customizable birth plan template.
- Support for All Births: Whether you're planning a hospital birth, birth center delivery, or home birth, we support your choice and provide information to ensure a healthy outcome for mom and baby.
- Listener Interactions: Head to IG and on any post/reel comment ‘third' to receive valuable resources that support your journey through the final trimester.
Remember, knowledge is power when it comes to your birth experience. Empower yourself with the information you need to make the best choices for you and your baby.
Shoot a DM to @labor.nurse.mama with the word “third” and we will send you a Third Trimester Prep Pack.
Head to this video to see a fetal monitoring strip class with visuals and comment #third to get our Third Trimester Birth Prep Pack.
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[00:00:00] My name is Trish Ware and I am obsessed with all things pregnancy and birth and helping you to navigate with the practical and the magical seasons of this journey called motherhood. I'm an all day coffee sipping mama of seven. I've had the amazing privilege of delivering many babies in my 15 plus year career as a labor and delivery nurse and as a I'm here to help you take the guesswork out of childbirth so you can make the choices that are right for you and your baby.
Quick note, this podcast is for educational purposes only and does not replace your medical advice. Check out our full disclaimer at the bottom of the show notes.
We're going to talk about fetal monitoring and we're going to talk about specifically fetal monitoring during [00:01:00] labor. I'm, it's going to be about a 10 15 minute teaching topic, because I want to keep it nice and low. And I've had very little sleep. Y'all know I have a new puppy. It's like having a newborn.
I'm going to go into this a little bit.
So we're going to talk about fetal monitoring during labor because I get asked questions. all the time about whether or not I think, do I have to have fetal monitoring? Do I have to have, it continuous if I agree to it? Can I have it intermittent? Can I not have it at all? So we're going to talk a lot about that.
And then for anyone who's on here, who is a VBAC mama, specifically for you guys, I get a lot of questions of they're like they're saying I have to have it. The very first thing I want to say, as always, no one can tell you what you have to have. No one. You have every right in the world [00:02:00] to say no and to refuse.
However, if you're one of my students in one of my birth classes or one of my members You know that I always say you have every right to refuse, but should you? We're not doing any kind of refusing willy nilly. So if anybody's on here and they want to get into tizzy and say labor nurse mama said that I don't have to.
No, labor nurse mama said you should understand when, why you say yes. And when and why you say no, because you have a right to say yes or no when it comes to your labor experience. I don't care where you are. You have a right. And if you have to make a huge fuss, then make a huge fuss. But you should understand why you should never ever go into your birth experience, willy nilly throwing out the yeses or nos when you don't know what you're talking about.
Because [00:03:00] you want to stay safe. So if you're going to refuse fetal monitoring, then you need to know why. If you're going to ask for intermittent monitoring, you're going to need to know why that is appropriate. And is it appropriate for you? So a lot of people will say labor nurse mama is crunchy with a side of medical.
That is true. I am but I do believe that you can absolutely 100 percent have a birth that is completely hands off. You do not have to have anything medical But you want to know your situation like are you high risk if you're high risk, then that might not be wise So starting it off with you can refuse.
Okay, so Fetal monitoring we want to know How is baby doing inside of you? A lot of my moms will say isn't fetal monitoring the only way that I can know that baby's doing inside of me? They're doing well inside of me. No, it's [00:04:00] not. It's the only way I can know because the best way that you know And you're doing it already if you're in your third trimester is Monitoring baby's movement.
So baby's movement says to us Hey, I'm getting enough oxygen. Guess what we're looking at when we look at the fetal monitor? We're looking to see, is baby getting enough oxygen? So let me show you how. Here's the monitor, right? I've got a 10 minute strip here. This is a fetal monitor strip. Down on the bottom, those are contractions.
On the top, in the blue, is baby's heart rate. So what I'm going to show you is what we are looking for in the hospital. And I'm sorry for the shakiness because I should be able to get this where it's not so shaky, but it's shaky. Let me see if I can make it better. And if you're just listening while you're driving or whatever, You can watch [00:05:00] this video when you get home.
This is not working. Oh, there we go. Let's see if I can make it lower where it doesn't shake. I did it. Y'all know I'm technically challenged. The joke is I can deliver your baby, but not a link. Okay. So if you're looking at this strip, let me make it where you can actually see the whole thing. If you're looking at this strip right up here, this is baby.
This is a contraction. So for those of you who have gone in to get a non stress test, a non stress test is looking up here at what baby is doing, while nothing is happening under here. Because guess what? Each one of those That's stressing your baby out. That's why the reel I did today about not breaking your water, decrease that stress by not breaking your water.
It doesn't need to be broken, unless it needs to be broken. And there are specific circumstances, and that's again, why you want to be educated. Okay, so if you're looking at this strip right here, See up here in blue. This is [00:06:00] 110 beats a minute up to 160 beats a minute and we want to see baby Inside of this blue that means baby's doing great now sometimes maybe you'll ride down here and ride up here This baby right here has about a 145 to 150 heart rate Okay now what I love about this baby is this baby's heart pattern is Telling me that it's got a lot of oxygen.
It's well oxygenated. And I can see this because I can see the beats per minute, I can see that it's nice and wiggly, and then it's going up, coming back down. Those are called accelerations. So if you're having a non stress test, we want to see a certain amount of accelerations. on this. Okay, so back to here.
I want to see baby between 110 and 160 and I want to see that baby's having these accelerations. This baby is looking fantastic. You can see the contractions down here and the other thing that I want to show you [00:07:00] and if you're commenting third, let me know if you get a DM so I know that it's working.
If not, go to the last post, go to the post I just did, the reel I just did, and comment third. I know it's working on that one. Okay. So if you see these red lines, these are one minute. Each of these little boxes are 10 seconds. So not only do we want to see that baby's heart rate's going up, we want to see that it's going up and lasting because this just says, Hey, this baby is doing really good.
So I want to go back to what I said. Okay. I'm coming back to me. Oh, what did I do? I did a reaction. Okay. So what I was saying before is when you ask me, do I have to have a fetal monitor during labor? Not necessarily because someone tell me, what did I say? Also tells us that baby's doing good. What else is going to tell me that baby has good oxygenation?
And this is why I'm totally [00:08:00] 100 percent good with birth centers and home births. I support all birth if you're a healthy mama and a healthy baby, right? So if you are feeling your baby move, that is saying same as this, right? This is a healthy baby who's moving. If you're feeling your baby move, guess what?
You know your baby's getting enough oxygen. That's why we have you tracking baby's movement, which also in the third trimester prep pack is a fetal movement. Tracker because it's not just about kicks. It's about movements in general minus hiccup hiccups Don't want that. Those you don't count. Okay, so the different types of fetal monitoring that's available.
We've got continuous external fetal monitor, then we have intermittent external fetal monitor, which means it's going to be on your belly. The continuous one is just like you said, you get admitted to the hospital, [00:09:00] we put it on, we leave it on. You got to deal with it your whole labor. Guess what?
You're tied to the machines. That's not really conducive to what I really want you doing, which is moving. Now, I have been induced, and I have had to have continuous monitoring myself, and I may do. I just stayed moving around the monitor, attached to the monitor. But the best case scenario, if you have to have continuous, is wireless monitoring.
That is going to allow you way more freedom of movement, way more ability to, cope with the pain of labor because gravity and movement is like the best mix to deal with the pain of labor. Okay as far as wireless, wireless is fantastic if you have to be on continuous. Wireless is also fantastic if you just don't feel like fighting with your provider to refuse continuous monitoring. It's like a good compromise. So if you don't know that you're, if you don't know if your [00:10:00] hospital provides wireless, all you have to do is my tip of the day.
Call your hospital, ask to be transferred to labor and delivery, and ask them if they have wireless monitoring. But take it a step further. If they do, ask them how many they have on the floor. If every room has them, you're good. If only a few rooms have them, or if they only have a few of them available, Then what you want to do is when you go into labor or if you're being induced, ask to be put in that room.
So that's an insider pro tip from a longtime labor and delivery nurse. Okay, so wireless is a great alternative to continuous. What's even better for those of you who don't necessarily need continuous is intermittent. And what intermittent monitoring means is that we're going to put you on the monitor about 20 minutes of every hour.
It's a pain in the tush. But it's an option. Another option is that we use the old fashioned Doppler. And we check you with a Doppler. This is great [00:11:00] if you're in the water, if you're having a water birth, or you just want to have a lot more freedom. If you're squatting, if you're on the ball, if you're on hands and knees, we can get up under you and listen to baby, make sure baby's doing good.
So those are some different alternatives to traditional continuous monitoring. Now again, this really depends on you. If you have any kind of high risk situation that baby needs to be watched more closely, that's different. Oh goodness. Okay, let me take another drink. Oh my gosh. Okay. So now let's talk about internal fetal monitoring.
So internal fetal monitoring is exactly what it sounds like and what we do is we have a long wire at the end of it is a coil. The coil is actually turned and inserted into the top layer of the baby's scalp. It is a [00:12:00] invasive procedure. So it should not be used just because maybe the nurse can't keep the baby on the monitor or just because the doctor wants to.
I have worked with doctors that break a mama's water and put it on. That is not an appropriate use for an internal fetal monitor. That has very specific parameters and I'm not going to go over it now, but it should not be used willy nilly for everyone. It is invasive. Some of you that have experienced and had that, you know what I'm talking about.
Okay, so the internal fetal monitor is usually used in a situation where maybe the baby's in distress, or maybe you're being induced and we don't know what's going on with baby because we can't get them on the monitor. For some of us who get a little Fluffier during pregnancy, if then you might need the internal fetal monitor if baby needs to be tracked.
And that's a big if you're healthy and you're doing well, then they need to keep trying with the external. I have some tricks that I teach inside of my birth classes that you can [00:13:00] tell a new nurse how to do to keep the baby on so that you're not tracked with an internal. So you've got the external.
We've got the internal. The other monitors that you're going to have on during fetal monitoring is your contraction monitors. Those are going to be monitoring how far apart they are, how long they're lasting. And all right, the one thing that the external fetal monitor cannot tell me about your contractions is how strong are they?
So if you look at a contraction on a monitor and you see it starts, it goes up, it peaks, it comes down. And I'm going to teach you a really fun fact about that next week during the pain of labor class. But if you see It, this might look like it's a strong contraction, but it's not able to tell me from an external monitor.
An internal monitor or you or me palpating your tummy is the only way that I know how strong your contractions [00:14:00] are. So if your family and your friends are in your labor room and they're like, Oh my God, you had a huge contraction. I bet that hurts so bad. And you're like, I didn't feel it. That's because it's only tracking that uterine activity.
It's not telling us how strong it is. So again, the 3 ways we can tell is an internal contraction monitor, which is called a, an IUPC for short. Or if I palpate your tummy or if you tell me verbally. So I have a little bit of a trick, but I'm going to teach you guys next week, how to tell just by touching if it's a strong, a mild or a moderate contraction.
Hopefully you guys learned some nice little nuggets. I wanted to keep this down to 15 minutes, but sorry, I got a little bit wordy. All right, you guys, I hope you enjoyed that. If you haven't signed up for fearless birth experience, go to any post, any real and comment hashtag fearless right now. It's live next week and then it will be [00:15:00] available on demand in a few weeks.
All right, you guys have a great day. I hope you enjoyed this recording from an Instagram live that we did all about fetal monitoring. If you want to see the video that's attached, go to Instagram and look for the live that says fetal monitoring 101. All right, you guys have a fantastic day. I will see you again next Friday.
Bye for now.