Continuous vs Intermittent Foetal Monitoring: What’s Best for Your Pregnancy?

When expecting a baby, one of the many considerations parents need to make is the type of foetal monitoring they want during labour. Monitoring the baby’s heart rate is an essential part of antenatal care, ensuring the baby is coping well with the demands of labour. There are two primary methods of foetal monitoring: continuous and intermittent. Both have their benefits and considerations, and the choice between the two often depends on various factors, such as the mother’s pregnancy history, labour progression, and the hospital’s policies.

This article will help expectant parents understand the differences between continuous and intermittent foetal monitoring, the benefits and risks of each, and what the research says about which method may be the best for different situations. By the end, you’ll be better equipped to discuss your preferences with your healthcare provider during antenatal appointments and make informed decisions about your pregnancy care.

What Is Foetal Monitoring?

Foetal monitoring involves tracking the baby’s heart rate and, in some cases, the strength of uterine contractions during labour. The goal is to ensure that the baby is handling labour well and to detect any signs of distress, which could indicate a problem that requires intervention.

Intermittent foetal monitoring is where the baby’s heart rate is checked at regular intervals during labour. This is typically done using a handheld Doppler device or a Pinard stethoscope, allowing the mother freedom of movement between checks. Intermittent monitoring is often recommended for low-risk pregnancies where there are no immediate concerns about the baby’s well-being.

Continuous foetal monitoring, on the other hand, involves the baby’s heart rate being tracked continuously using an electronic monitor. This is typically done with sensors strapped to the mother’s abdomen, though in some cases, an internal monitor may be used. Continuous monitoring is more common in higher-risk pregnancies or when specific medical interventions, such as induction or epidurals, are being used.

You can find more detailed information about both types of monitoring through the NHS guidance on foetal heart rate monitoring.

Continuous Foetal Monitoring: How Does It Work?

Continuous foetal monitoring (CTG), also known as cardiotocography, uses electronic sensors to measure the baby’s heart rate throughout the duration of labour. It provides real-time information, which is particularly useful in situations where there may be concerns about the baby’s condition, such as if the mother has pre-eclampsia, diabetes, or if the pregnancy is post-term.

There are two types of continuous foetal monitoring:

1. External Monitoring: Sensors are placed on the mother’s abdomen using elastic belts. One sensor measures the baby’s heart rate, while the other tracks uterine contractions.
2. Internal Monitoring: In some cases, an internal sensor may be used. This involves attaching a small electrode to the baby’s scalp to provide more accurate readings, especially if external monitoring is difficult due to the mother’s weight or the baby’s position.

Advantages of Continuous Monitoring:

• Provides constant information about the baby’s heart rate.
• Allows for early detection of any distress or complications.
• Is recommended in high-risk pregnancies or where labour is being induced or augmented with medication like oxytocin.

However, continuous monitoring can also come with some drawbacks:

• It often limits the mother’s ability to move around freely during labour, which can affect comfort and the progress of labour.
• Some studies have raised concerns that continuous monitoring can lead to higher rates of medical interventions, such as caesarean sections, without necessarily improving outcomes for babies.

For more on continuous foetal monitoring and its role in labour, see the National Institute for Health and Care Excellence (NICE) guidelines.

Intermittent Foetal Monitoring: How Does It Work?

Intermittent foetal monitoring involves checking the baby’s heart rate at regular intervals, rather than continuously. This is typically done every 15-30 minutes during the first stage of labour and more frequently during the second stage. Midwives or doctors will use a handheld Doppler device or a traditional Pinard stethoscope to listen to the baby’s heart rate.

Intermittent monitoring is often used in antenatal clinics for low-risk pregnancies and is considered the standard practice in many settings when there are no immediate concerns about the baby’s health.

Advantages of Intermittent Monitoring:

• It allows the mother to move freely during labour, which can help ease discomfort and may speed up labour.
• It avoids the potential for unnecessary interventions, as the heart rate is only checked periodically.
• Intermittent monitoring has been associated with a more natural birth experience and a lower risk of caesarean sections.

However, intermittent monitoring may not be suitable for all pregnancies, particularly those classified as high-risk. In these cases, more frequent or continuous monitoring may be necessary to ensure the baby’s safety.

For an in-depth look at intermittent monitoring, you can visit NCT’s guide on foetal monitoring.

The Benefits of Continuous Foetal Monitoring

Continuous foetal monitoring is an essential tool in certain situations, especially when the pregnancy is considered high-risk or when there are complications during labour. It provides a continuous stream of data on the baby’s heart rate, allowing healthcare providers to react quickly if any signs of distress or abnormalities appear.

It is often recommended in the following cases:

• High-risk pregnancies: For example, if the mother has conditions such as gestational diabetes, hypertension, or pre-eclampsia.
• Induced labour: When labour is induced using medications such as oxytocin, continuous monitoring helps to ensure that the baby is tolerating the contractions well.
• Epidurals: Continuous monitoring is recommended if the mother has an epidural, as it helps to track how the baby is responding to the medication.

While continuous monitoring has its clear benefits, particularly in high-risk situations, it can also lead to increased medical interventions, such as instrumental deliveries or caesarean sections. Studies, including those from Cochrane, suggest that while continuous monitoring can help detect foetal distress, it has not been conclusively proven to reduce the risk of serious outcomes like cerebral palsy or infant death.

The Benefits of Intermittent Foetal Monitoring

Intermittent monitoring, while less high-tech than continuous monitoring, is considered safe and effective for low-risk pregnancies. The main advantage is that it allows the mother to remain more mobile during labour, which can enhance comfort, reduce stress, and even promote the progress of labour.

Studies have shown that intermittent monitoring is just as effective as continuous monitoring for low-risk pregnancies in ensuring the baby’s well-being. It has also been associated with lower rates of medical interventions. Women who use intermittent monitoring are less likely to experience a caesarean section or instrumental delivery than those who undergo continuous monitoring.

For mothers who want a more natural birth experience, intermittent monitoring can help them feel more in control and comfortable. Many antenatal education programmes, such as antenatal classes near me, provide information about the benefits of intermittent monitoring for low-risk pregnancies and how to discuss it with your healthcare team.

You can read more about intermittent monitoring on the Royal College of Obstetricians and Gynaecologists (RCOG) website.

Continuous vs Intermittent: What Does the Research Say?

The debate over continuous versus intermittent foetal monitoring has been ongoing for decades, with studies showing mixed results. According to research from Cochrane and the Royal College of Midwives, continuous monitoring has not been shown to significantly reduce infant mortality or severe complications, but it is more likely to result in caesarean sections or instrumental deliveries.

On the other hand, intermittent monitoring appears to offer similar outcomes for low-risk pregnancies, with the added benefit of allowing more mobility and reducing the likelihood of medical interventions.

For many women, the decision will come down to their personal preferences and their individual risk factors. Some mothers may feel more reassured with continuous monitoring, while others may prefer the freedom and mobility offered by intermittent monitoring. Discussing your options with your healthcare provider during antenatal checkups will allow you to make an informed decision that suits your situation.

Choosing the Best Option for You

The best method of foetal monitoring depends largely on your individual pregnancy and labour circumstances. For women with low-risk pregnancies, intermittent monitoring may be the best option, allowing for a more natural and active labour experience. For women with higher-risk pregnancies, or those receiving certain interventions such as epidurals, continuous monitoring may be the safer choice to ensure the baby is tolerating labour well.

When attending your antenatal clinic appointments, it’s important to discuss your preferences with your healthcare provider. Understanding the benefits and risks of both continuous and intermittent foetal monitoring can help you make the best choice for your labour and delivery.

For expectant parents, taking part in antenatal classes can also provide valuable insight into your birth plan options, helping you to make informed choices regarding monitoring and other aspects of your labour.

Conclusion: Continuous vs Intermittent Foetal Monitoring

Both continuous and intermittent foetal monitoring have their place in modern pregnancy care. For some women, continuous monitoring offers peace of mind and constant reassurance that their baby is being

closely observed. For others, intermittent monitoring provides the freedom to move around and feel more in control of the birthing process.

Whichever option you choose, ensure that it is the best fit for your unique pregnancy situation, and always have an open conversation with your healthcare provider to make informed decisions about your labour and birth.