Fetal Monitoring (CTG)

Fetal heart rate monitoring is used during labour to assess your baby’s wellbeing and how they are responding to contractions. Changes in your baby’s heart rate can provide your maternity team with important information throughout labour and help identify when closer assessment may be needed.

There are two main approaches a fertility specialist may use for fetal monitoring during labour: intermittent monitoring and continuous cardiotocography (CTG). The most appropriate approach will depend on your pregnancy, your baby’s wellbeing and how your labour progresses.

Monitoring the baby during labour helps your obstetrician and midwife assess how your baby is coping with labour and contractions.

A healthy fetal heart rate naturally changes over time. Your maternity team considers the overall heart rate pattern rather than focusing on a single reading. Certain types of changes may require closer monitoring or further assessment.

Fetal heart rate monitoring is particularly important when there are present factors that could increase the likelihood of complications during labour.

Intermittent fetal monitoring involves checking your baby’s heart rate at regular intervals rather than monitoring it continuously.

This is commonly performed using intermittent auscultation, where a handheld Doppler device is placed against your abdomen to listen to and measure your baby’s heartbeat.

Intermittent auscultation may be appropriate during uncomplicated, low-risk labour when there are no concerns about you or your baby. One advantage is that it generally allows greater freedom to move between assessments.

Your care team will continue to assess your circumstances throughout labour and may recommend changing to continuous monitoring if concerns or additional risk factors arise.

CTG monitoring, or cardiotocography, records your baby’s heart rate and your uterine contractions over time.

A CTG machine typically uses two sensors placed against your abdomen. One monitors the fetal heart rate, while the other records your contractions. This produces a continuous record that your maternity team can assess for patterns and changes.

CTG during labour can provide your obstetrician and midwife with ongoing information about how your baby is responding to contractions.

Continuous fetal monitoring may be recommended when certain pregnancy or labour-related factors mean your baby requires closer observation.

This can include situations involving high blood pressure, premature labour, induction of labour or concerns about your baby’s wellbeing. Continuous monitoring may also be recommended if changes are identified during intermittent monitoring.

With continuous CTG monitoring, your baby’s heart rate and your contractions are recorded throughout labour. Your individual circumstances will determine whether continuous monitoring is recommended and for how long.

A CTG provides information about your baby heart rate during labour and how it changes in relation to contractions.

When interpreting a CTG, your maternity team assesses several features of the heart rate pattern, including the baseline rate, variability, accelerations and decelerations.

These features are all taken into consideration within the broader context of your pregnancy and labour. Therefore one individual change in heart rate does not necessarily mean something is wrong.

You might hear the term “fetal distress” used to describe concerns that a baby isn’t coping well during pregnancy or labour. Clinicians often prefer more precise language, like concerns about fetal wellbeing or a non-reassuring fetal heart rate pattern.

Changes in the fetal heart rate pattern are one sign your care team watches for during labour, but they’re never read on their own. They’re considered alongside everything else known about you and your baby at the time.

If monitoring raises any concerns, your maternity team has several options. They might ask you to change position, run further checks, or recommend other interventions depending on what’s happening.

Traditional continuous CTG monitoring uses sensors attached to your abdomen, connected by leads to the monitoring equipment. That can make it harder to move around freely during labour.

How much you can move depends on a few things: the equipment your hospital has, how clear the heart rate recording is, and your own circumstances on the day. Some hospitals have wireless monitoring systems, which give you more freedom to move.

If moving during labour matters to you, raise it with your maternity team. They can talk you through what’s available and what might work best for you.

There is no single approach to fetal monitoring that is right for every labour.

Intermittent fetal monitoring may be more appropriate for women experiencing uncomplicated, low-risk labour, while continuous CTG monitoring could be recommended when additional risk factors or concerns are present.

Your monitoring requirements can also change during labour. If concerns arise, your obstetrician or midwife may recommend closer monitoring to better understand how your baby is coping.

During your pregnancy, a fertility specialist will discuss any factors that may influence your labour and birth, including when fetal heart rate monitoring or continuous CTG may be recommended. This gives you an opportunity to understand why monitoring is used and ask questions about what to expect during labour.