how often do heart tones *need* to be checked during labor? - Mothering Forums
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#1 of 19 Old 10-22-2010, 02:50 PM - Thread Starter
 
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Seems like the "official" recommendation is every 15 minutes during 1st stage and every 5 minutes during 2nd stage. That seems like awfully frequent, especially during 1st stage. I prefer to labor alone and having someone come in to check on FHT every few contractions seems like it would get annoying. FWIW my 2 previous homebirths have had 1 FHT check each...1st midwife got there when I was ready to push and I pushed for about 20 minutes with one FHT check during that time. 2nd baby midwife (different midwife) was there for about an hour before the birth and did 1 FHT check when she got there. I pushed for about 5 minutes with that one.

So how often do FHT really need to be checked during labor? Is every 30 minutes frequently enough during 1st stage if there's no indication of a problem? Obviously I want them frequently enough to be safe, but if less frequent is just as safe I would prefer not to have them any more than necessary.
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#2 of 19 Old 10-22-2010, 03:40 PM
 
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I think every 30 minutes during active labor is totally reasonable.

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#3 of 19 Old 10-22-2010, 04:08 PM
 
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I ended up having continuous monitoring with DD (thanks nurse and OB who wanted to treat me as though I had and epi, even though I didn't), but every 15 or 5 minutes seems really disruptive to me, especially if you are laboring in a position where it isn't easy to check the heartbeat.

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#4 of 19 Old 10-22-2010, 04:14 PM
 
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At the hospital in the middle of labor the only did every hour. My homebirth midwife, who arrived about 7cm and 4 hours before birth checked about every 45 minutes I think.
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#5 of 19 Old 10-22-2010, 04:18 PM
 
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I never had fetal heart tones checked during labor, period.

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#6 of 19 Old 10-22-2010, 05:16 PM
 
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I think my mw's checked about every 30min during the 1st stage (they weren't there for much of it really...) and then every 5 min during pushing -- it was very unobtrusive, and they twisted themselves into whatever position necessary to get to my belly, I didn't have to change my laboring position so that they could check.

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#7 of 19 Old 10-23-2010, 12:29 AM
 
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I labor alone (with just DH) and tend not to call the MW until I start to panic (hello transition!). Both times I've started pushing within 20-60 minutes of the MW's arrival. Both times I only remember having the heart tones checked twice. I do distinctly remember with DD telling my poor MW to stop touching me (and not nicely). I was starting another contraction and DD was born about 5 minutes later if that gives you some idea of where I was at mentally at that moment Later when I got my records, I saw a note that I had "refused" the check...that made me laugh. Yes, yes I did

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#8 of 19 Old 10-23-2010, 09:48 AM
 
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I had some funny heart tones during pregnancy and then in labor (which sent us to the local L&D but we returned home) so I wanted to be checked more often.

My MW just came and did it where ever I was; I don't even remember her doing it. Labor has a way of making you ignore some things!

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#9 of 19 Old 10-23-2010, 11:07 AM
 
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Less often during earlier labor, before baby has descended much...more often as baby is descending (more compression involved, more chance of issues needing attention, if only changes of mom's position). Also depends on the labor itself--whether or not there is much descent or even dilation yet, a fast and furious contraction pattern, IMO, warrants a closer look (every 15-30 min if contrax are long, strong, and with only 1-2 min btwn).

Of course, if any hinky heart tones are observed, then more frequent listening is warranted to make sure they are resolving well-- whether or not pattern is holding steady or getting worse.

Not a fan of frequent FHT checking in most labors--though typically will listen more often during any 2nd stage (every 5-10 min, depending on baby and everything else going on--hey, with a fast 2nd stage there may ONLY be time to get gloves on, not to check FHT ). I've found that if there IS anything troubling in baby or mama signs, more frequent FHT checking helps everyone feel better...it's not just about 'safety' or the mw's comfort level, but FHT checking can help a mama stay relaxed too--or give her a signal to change what she's doing (such a solid rationale to push hard, push baby out NOW--unusual, but possible).
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#10 of 19 Old 10-24-2010, 01:08 AM
 
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ACOG's guidelines for low risk intermittent monitoring is every 1 hour in early labor (if the woman is even attended at that time, many are not), every 30 minutes in active labor, every 15 minutes in second stage. This changes to every 15 min in active labor and every 5 min in second stage for higher risk labors. The auscultation should be before, during and after a contraction to really get a sense of how the baby tolerates them.

My personal comfort level is about every 30 min in active labor (unless you are hearing something strange that warrants more frequent listens) and every 2nd or third push with second stage. Our hospital follows ACOG guidelines and thus the nurses generally only listen every 15 min while pushing. If baby has sounded great this is ok, but sometimes I request a little more frequent listens. (I know this is the HB forum, I trained out of hospital and my "comfort level" with intermittent listening came from that training - ACOG actually has looser guides in this instance!).

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#11 of 19 Old 10-24-2010, 10:05 AM
 
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My homebirth was pretty consistent with my hospital birth. Hospital birth, they came in twice with a handheld doppler during a span of 4 hours. Then about every 15 minutes during pushing. With the homebirth, I only had one check with the doppler shortly after the MW arrived. I began pushing about an hour and half later and pushing lasted just a couple of minutes. I imagine if my pushing had lasted longer, they would have done a check. I'm so freaking thankful that they didn't attempt to check it during pushing which was a true fetal ejection reflex. I would have hated to have been messed with during those moments.
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#12 of 19 Old 10-24-2010, 06:50 PM
 
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Huh. I had no idea most people did it so frequently. With my birth (medical, induced for pre-e) I was checked... maybe 3 times during the 18-hour labour? And not at all during pushing, which took maybe an hour. They weren't quick checks though, I had to wear the strappy thingy and lie down (which I HATED) for maybe 20 minutes each time.

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#13 of 19 Old 10-24-2010, 07:23 PM
 
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I don't remember how often FHT was checked during labour with ds but during pushing it was very frequent, after every contraction I think. I was a VBAC and ds's heart tones were going down. I would squat to push and then the midwife would have me stand up after the contraction. That seemed to really help ds's heart rate go back up to normal. I think if I wasn't a VBAC and if the heart tone's were not going down I don't think she would have checked that often as she is more of a hand's off midwife.

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#14 of 19 Old 10-25-2010, 03:39 PM
 
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Quote:
Originally Posted by dogmom327 View Post
I do distinctly remember with DD telling my poor MW to stop touching me (and not nicely). I was starting another contraction and DD was born about 5 minutes later if that gives you some idea of where I was at mentally at that moment
That exact scenario happened with me! I remember my midwfie reaching her hand down there to place the doppler, and I very abruptly ripped her hand away. Yeah, baby's head was out a few minutes later. So they never got a chance to check heart tones at that birth.

Original poster -- why do you ask? Just curious because you've had two (I'm assuming uneventful) home births, and I'm wondering what's causing you to think about this particular thing this time.

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#15 of 19 Old 10-25-2010, 07:31 PM
 
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My last labor FHTs were checked once (before, during, and after a contraction) in early active labor. My baby was born about 3 hours later with no further monitoring (in either the first or second stage). I didn't have to refuse it; it wasn't offered. This was in a hospital.

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#16 of 19 Old 10-25-2010, 07:55 PM
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I don't even remember! I did a strip as I settled into the hospital, for maybe 15 min, then they did a handheld doppler sometimes. I barely remember them doing it, I couldn't really feel it and they just came to me in my position, and I was far away, deep deep in laborland. I think it must have been not too often, because I remember really hanging out for a good long time with just DH and the doula. I do remember them checking at least once while I was pushing and they encouraged me to take some deep breaths, but it was noninvasive overall. I was there for maybe 3.5 hours so I'm guessing they checked, after the strip, 3 times? Maybe as many as 5, but I have no memory of it...
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#17 of 19 Old 10-26-2010, 06:21 AM
 
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My MW and i agreed ahead of time that every 20-30mins would be fine, since the NICE guideline for every 15 isn't actually evidenced based. At the time i was in the bath on my side and needing to roll onto hands and knees the first time she suggested it (i declined it through my body language basically!) and the next time was literally the last contraction before i was pushing in earnest. Baby was moving after EVERY contractions and turned her head about 35degrees clockwise when it was coming through the cervix so i knew she wasn't going to arrive floppy and distressed.
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#18 of 19 Old 10-26-2010, 11:12 AM
 
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Originally Posted by GoBecGo View Post
My MW and i agreed ahead of time that every 20-30mins would be fine, since the NICE guideline for every 15 isn't actually evidenced based. At the time i was in the bath on my side and needing to roll onto hands and knees the first time she suggested it (i declined it through my body language basically!) and the next time was literally the last contraction before i was pushing in earnest. Baby was moving after EVERY contractions and turned her head about 35degrees clockwise when it was coming through the cervix so i knew she wasn't going to arrive floppy and distressed.
Right--there are other signs of baby well-being besides FHTs, other signs to watch for, that might help clarify what is heard in FHTs. It's not always necessary or possible to assess FHT (like w/a fast labor-- or someone who pushes the dop away and immediately then gives birth ). To me, guidelines are guidelines not commandments. Besides, I wouldn't feel a mw was doing her job right if she was fixated on FHT readings but just getting in the way of normal birth with the clock and the scope...especially if FHT was her main measure and she couldn't read those other signs of 'normal birth' or 'need for assistance'.
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#19 of 19 Old 10-30-2010, 07:12 PM
 
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The recommended intermittent auscultation protocol calls for auscultation every 30 minutes for low-risk patients in the active phase of labor and every 15 minutes in the second stage of labor. http://www.aafp.org/afp/990501ap/2487.html

It is going to depend on your midwife though. Some are comfortable taking heart tones less often, some want them more often.

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