Midwifery Myths - Listening to the baby's heart beat

Myth of the day - Listening to Fetal Heart Tones in Labor Is Beneficial

I'll keep this musing as short and sweet as I am capable of. Even the people in the medical world are uncertain about whether continuous fetal monitoring has any benefit beyond looking good in court in case they get sued. It reduces neonatal seizures, but increases cesarean sections. The benefits do not appear to outweigh the risks (although parents should certainly have the choice if they want it). Here is some initial reading for you to check out if this is a new concept for you. The interpretation, classification and treatment of different FHT patterns is highly ambiguous, and can be complex, so take your time!

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000063/full
http://www.sciencedirect.com/science/article/pii/S000293780271524X
http://www.ncbi.nlm.nih.gov/pubmed/24412117
https://www.nccwebsite.org/resources/docs/final_ncc_monograph_web-4-29-10.pdf

On the other side of the coin though, there are lots of midwives who DO listen in labor, thinking it is beneficial (and their clients think so too even though they usually haven't been given this information about it probably not being beneficial), but they are listening in a way that doesn't even provide any of the (ambiguous) information that they should be interested in (if they are going to bother listening that is). Many midwives listen for 10-30 seconds, get a sense of the baseline rate, maybe listen for variability and then say "baby sounds great". This is just false reassurance and some sort of facade of expertise and "safety" that I assume midwives cling to either knowingly or not. I wouldn't dispute that perhaps very experienced midwives can develop some skill of knowing exactly what to hear and when, and are able to do that with some internal metronome, but to gather the information that perhaps matters (but probably doesn't) they really need to be listening through a few contractions and documenting in some way the baseline, variability, and detailed information about any accelerations or decelerations that are present. This is also not really possible with a doppler that doesn't have a read out on it. I feel strongly that is a case of "do it right, or don't do it at all". That said, I think it is something that should be thoroughly discussed with the parents as far as the benefits versus the risks of listening at all, and what treatment they would want if any category 2 or 3 patterns were heard in labor.

I advocate for another approach that doesn't necessarily include routine listening, but does include thorough and educated listening when more information is needed about a labor that isn't straightforward, and a plan for what to do based on the information gained from listening.

Did your midwife go over these options and research with you? If you're a midwife, what do you do as far as listening in labor goes?

12 comments
Add a comment...

Your email is never published or shared. Required fields are marked *

  • Rain

    I'm so grateful I had a midwife that honored my request not to listen to the heartbeat during labor. I followed my intuition and knew everything was perfect. With this pregnancy now I am unassisted and have not heard a heartbeat the entire pregnancy, I am now almost 9 months and I know mama and baby are doing great and I feel very confident in my birth!

  • Paige

    It would be nice if you explained your approach!

  • Cindy

    In the early days of my apprenticeship all three midwives did what you said, listened for 6-30 seconds. Then I trained around the country-14 other preceptors in all. The best summary I remember was, "The only thing listening for 6 seconds tells you is that the baby was alive for those 6 seconds." Now, if mommas want to, I listen for at least 2-3 minutes, before, during and after contractions. And, if mommas are ok with it, prenatally I get a few, longer listening/counting sessions (several 2-3 min. sessions over 20 minutes) after 29-30 weeks to get a true baseline. But I'm a new midwife, what do I know?

  • Carly

    I absolutely agree with this analysis and look forward to a day when it can feel "acceptable" to even have this discussion with clients. There are many things I "recommend" or "offer" not because I think it would be helpful or needed in that particular case, but because it is the "community standard" and I would be harshly judged for not having done it or at least offered it. There are other times when I am having discussions with clients where I don't necessarily believe in the community standard, but don't have enough evidence to offer either side to say whether that intervention is beneficial or harmful.

    There is so much pressure put on caregivers to offer and recommend things but not the same amount of pressure or expectation put on patients to stand up for what they trust in and believe in because they aren't the 'experts.' Where you have a strong client who truly trusts in her body and understands the risks of doing or not doing something you also need a strong provider who truly trusts in women and birth and understands that ultimately it is the women's choice. However, the reality is never this cut and dry. When something goes wrong, we are quick to blame. If the caregiver did one thing wrong, their career is over. If the caregiver did everything right and the patient did everything right, it was just a sad tragedy. If the patient did one thing wrong, they lose their children and are judged by society. Heck, women are judged by society even when they do make good decisions for themselves and their families. And this all becomes muddled when caregiver and patient start blaming each other.

    Unfortunately, we don't birth in a vacuum. Women can never, and should never, birth alone. But while we need each other to lean on, we also need to trust the latest and best research, technologies, interventions, instincts, intuitions, and most of all, each other. Not much of what our medical culture dictates is all that evidence, research, or fact based and even less so when it comes to what our general culture dictates. I look forward to a day when I can be sure that what I am offering clients is truly what they, as an individual autonomous person, needs, and not what someone else said should be offered as a blanket standard. And in return, my clients can freely agree with my recommendation if it fits for them, or they can leave it and trust in their own thing knowing I will be there for them either way.

  • Sure! Let me know what questions you have - that helps me crank content out faster 🙂

  • Rachel

    I must say I agree with your stance on continuous fetal monitoring causing increased c/sections and not helping much in low risk birth. But I feel that during labor at a home or birth center birth women should have their babies listened too. The research shows that listening during and after a contraction once every 30-60 minutes in labor and then more often during pushing can "see" a problem before mom or I do. I have seen instances in peer review where listening would have potentially saved the baby and in not listening properly the midwife did not "see" the problem. I do agree that women should have the choice, but liability prevents a real choice from happening in most things birth.

  • All the research I have seen does not support continuous monitoring and there has not been research on intermittent monitoring versus no monitoring, so I'm not sure what research you are referring to. The research HAS shown a very high rate of ambiguity when interpreting FHTs, and a very high rate of false positives when we think a baby is in distress (and then it turns out there were not once we can assess them on the outside).

  • Any advice on how to listen during pushing? Most of my mom's are in hands and knees and moaning lovely and moving during pushing. This makes it very difficult to listen before, during and after. I was just wondering if anyone has advice on this?

  • Hilary Schlinger

    I attended homebirths for approximately thirty years, and experience leads me to strongly disagree with this articles conclusions. As I read it, I recalled a number of births where a dramatic alteration in the heart tones were a clear signal of a cord problem significant enough to jeopardize the baby's life. Accessing this information (via intermittent auscultation) allowed me to take action to prevent such an outcome. I find it irresponsible to suggest lack of benefit from monitoring fetal heart tones.

  • Firstly, I never said to never listen. Secondly, where is the science to support even IA?

  • When listening in, in labour, I am only looking for a perisitent bradycardia; A baby, that is 'holding its breath' to save energy, may be getting 'tired'. I measure this against the particular features of the Woman, the Pregnancy & the Labour, the actions required will vary according to the necessity determined by these considerations.
    Listening to a fetal heart through out several contractions interrupts the requirements of undisturbed mammalian birthing process. Further, as we contest the dominance of the medical patriarchal view of childbirth, lets not sully natural birth with practices and recommendations that serve to increase cesarean birth rates.

    My inner metronome is well tuned to CTG machines, so maybe I am at an advantage here. however, I fear that we have so bought into the fear that underpins the medical model that we continue to utilise the practices and truths of medicine to define good midwifery.

    When interpreting CTG readings, we look for the features of fetal movement ie accelerations & variability etc...So just for a moment, lets consider that when the mother is feeling the baby snuggling in, then we know that the CTG would likely be reactive? Yeah? So let's encourage Women to be in touch with their babies when in labour and not tie her to disembodied objective measures..

  • I'm not sure I understand what you are suggesting - just listening here and there for persistent bradycardia? I don't think there is a "right" answer, only lots of questions.

FEATURED POSTS