Intermittent Ausculation during Labor

[Reha]

Midwives, a question for you:

I have always been taught (and had read) that when using a doppler for intermittent ausculation of FHTs during labor, you want to listen through one whole contraction and a bit after it is over, or at the very least, listen during the peak and on.

I recently attended a homebirth where the midwife never listened during a contraction. She listened 20-30 seconds AFTER the contraction was over for about 45-60 seconds. This seemed odd to me, and I wanted to see what other think.

Am I crazy in thinking that this isn't the best policy? It would seem pretty important to me to hear how babe was doing during contractions, and if there was anything odd, what recovery was like after the peak.

[Reha]

[yeahwhat]

Well, I'm not a birth professional, but I can tell you that in my 4 midwife attended labours, she always listened immediately after a contraction for maybe 15-30 seconds. I guess her concern was more how a baby recovers between contractions rather than what was happening during a contraction. I also can't imagine anyone touching my belly during a contraction.

[Peppamint]

Originally Posted by yeahwhat

Well, I'm not a birth professional, but I can tell you that in my 4 midwife attended labours, she always listened immediately after a contraction for maybe 15-30 seconds. I guess her concern was more how a baby recovers between contractions rather than what was happening during a contraction. I also can't imagine anyone touching my belly during a contraction.

: I've been taught to listen beginning at the end of a contraction.

[~threemoons~]

Originally Posted by busybusymomma

: I've been taught to listen beginning at the end of a contraction.

this is what we do but we also try to listen through at least 1 cntx every hour or so. ('We' meaning the midwife i work with and me the birth assistant)

[CarolynnMarilynn]

Mostly, IA is the practice of listening at the end of a contraction and for a full minute afterwards. You could miss a long late decel, or some cord compressions (because what you are listening to for a full minute might not be the baseline, but a deceleration, missing completely the baseline) so some people listen through a contraction, and for a minute afterwards, once an hour or so, because always auscultating like that would be invasive. However, this approach has no research to back up the claim of increased safety.

Here is a link:

http://www.rcp.gov.bc.ca/guidelines/...rch%202005.pdf

When auscultating I do like to get a maternal pulse to ensure I am listening to the fetus and not the mother, but I do this only once an hour or two, and it is a quick, quick thing.

[Jane]

I might listen as described during pushing - I'd rather listen immediately after pushing, but sometimes it's hard to get to the correct position really quickly. Then I might listen for 30-45 seconds for variability.

I have heard the theory that it's only important what's happening afterwards, with the caveat that "How are you going to know when it's over unless you listen during"

If it's up to me - I've been at births as an assistant where the midwife wanted and modeled the method described here...but my preference really is "before, during, after the contraction, including after the contraction for one minute" I only chart that if I do it, though. I do like to listen for 2-3 contractions when I arrive, I thik that's superstition rather than evidence based.

[Reha]

I guess the part that got me was that she wasn't listening right at the end of the contraction. Sometimes it would be 30 or more seconds AFTER the contraction had fully ended. I know that listening after the contraction is over is important. But, to me, it would be good to get the tail-end of the contraction and then some afterwards.

[Reha]

Originally Posted by CarolynnMarilynn

Here is a link:

http://www.rcp.gov.bc.ca/guidelines/...rch%202005.pdf

Thanks for that link.

[mommyminer]

ACOG guidelines are intermittent auscultation before, during and after a contrax every 30 min. The midwives I've worked for do it this way although if it was me (and it will be soon), I would prefer less monitoring. I just really don't like to be bothered during a contrax.

[momileigh]

In teaching us not to listen during a ctx, my mw said something to this effect:

"You're midwives. You're not supposed to go looking for something that's going to scare you."

I always thought it was a funny thing to say. I think what she meant was that decels are normal during contractions, and they are better left unheard. We NEVER listen through ctx. After 130-something births, I've never felt like we didn't have enough information because we were listening only after/between ctx. If the baby is in significant trouble, there's going to be a tipoff between ctx.

As a side note, I would be annoyed as all hell if someone tried to keep a probe on my belly throughout a contraction.

[lorijds]

I used to work in a birth center.

We would try to listen through and after a contraction; but honestly, if baby sounds great between contractions, I don't care what the baby is doing during a contractions. A baby who is in the 140s inbetween contractions is not dipping into the 40s during a contraction, you know? And even if he/she is having some decels, if there is a nice and strong recovery, it's not a problem.

During labor we'd listen every 30 minutes, during and after a contraction. During pushing we'd listen every 10 minutes or sooner (depended upon the situation). Every once in a while I'd listen through and after a contraction; the rest of the time I'd just listen for 10-20 seconds, to hear what the baseline was between contractions.

[Peppamint]

I should add that we do listen after every pushing ctx, sometimes just a quick listen and other times we listen for a bit.

[maxmama]

Originally Posted by lorijds

I used to work in a birth center.

We would try to listen through and after a contraction; but honestly, if baby sounds great between contractions, I don't care what the baby is doing during a contractions. A baby who is in the 140s inbetween contractions is not dipping into the 40s during a contraction, you know? And even if he/she is having some decels, if there is a nice and strong recovery, it's not a problem.

Actually, I had a baby last night who had beautiful variability, baseline 140s and was having variables to the 40s-50s with pushing. Needless to say, that baby had a lot of reserve and was fine. I agree that a good baseline and good recovery are, IMO, most important, but it is possible to have deep decels with normal baseline.

Now, whether those decels mean anything other than making me sweat is a whole other issue.

[lorijds]

My point being, those decels meant nothing, because the baby came up nicely and had a great baseline.

The only thing that type of monitoring would get in my hospital is a section for fetal intolerance to labor--never mind that babe is actually doing great.

My point was it is extremely rare for an infant to have a normal baseline and then to have a significant drop to the 40s, consistently, during contractions. And for this drop to mean ANYTHING in terms of the infant's health. So listening consistently during the contracts gives you much less valuable information than listening to the heart rate after contractions. Because VERY VERY VERY rarely are you going to get an infant who is baseline in the 140s and then decels to the 40s during contractions. And even if you get that, if the infant is returning quickly and consistently to a great baseling, this information is only going to make you nervous. And I should add that I would feel differently about these decels if we were discussing a labor patient who wasn't even close to pushing. But in a mom who has had a normal pregnancy, a normal labor with no signs of distress from mom or baby, and who is pushing effectively with good progress, I would not fret about these decels.

[Reha]

I just wanted to add that I also don't listen to baby during contrax in 2nd stage.

[Reha]

Originally Posted by lorijds

And I should add that I would feel differently about these decels if we were discussing a labor patient who wasn't even close to pushing. But in a mom who has had a normal pregnancy, a normal labor with no signs of distress from mom or baby, and who is pushing effectively with good progress, I would not fret about these decels.

I agree about not being concerned about those sort of decels during pushing. But, in regards to the part that I bolded above, how would you know if baby was having those sorts of decels during contrx in the 1st stage of labor if you aren't listening from the peak of the contx onward?

This is such an interesting topic to me, and I appreciate everyone sharing their expereinces and opinions.

[lorijds]

You wouldn't. But I would put out there that an infant who is decelling into the 40s during a contraction when mom is 4 cm is not going to continue to return to 140s for long. Once again, listening after the contraction would soon pick up this infant's intolerance.

[maxmama]

Originally Posted by lorijds

The only thing that type of monitoring would get in my hospital is a section for fetal intolerance to labor--never mind that babe is actually doing great.

So why would they section, given the baby clearly was not in distress (no rising baseline, moderate variability, variable decels that come up with the end of the contraction, even the occasional accel)? I get much more nervous over a baby whose baseline has minimal variability, has been rising or who has lates, no matter how shallow. That to me is fetal intolerance of labor (though depending on where mom is in labor we still might not section her for it). HOw are the docs justifying calling that FIL when the baby is clearly showing reassuring signs?

[lorijds]

I don't know; it's very frustrating to me. I totally agree with you. Everything makes our docs nervous. Deep variable=section, no matter other evidence of healthy baby. The hospital I currently work in is just so freakin conservative. Our section rate sits just above 35%. It is very difficult for me sometimes.