Electronic Fetal Monitoring Device
Continuous Electronic Fetal Monitoring (EFM) is the standard of care in labor and delivery departments of most hospitals. Monitor printouts provide information for professional caregivers but they can also give labor support persons clues on help the laboring woman.
Reading the Monitor Strip
1. Find the Baseline Fetal Heart Rate in the top of the fetal monitor strip. Tracings of the normal fetal heart rate are between 120 and 160. The baseline will be stable with a ten-beat variability, for instance 120 to 130, or 134 to 144.
2. Find the toco, or uterine contraction tracing, in the bottom half of the strip. The baseline when the woman’s abdomen is relaxed will be from zero to 10. The tracing starts to rise when the contraction begins, bell curves to indicate peak tension, and comes back to baseline when the contraction ends.
3. Ascertain how far apart contractions are and how long they last from the toco tracing. Monitors are set at a rate of either one or three minutes per inch. Unless an intrauterine catheter is used, the tracing will not indicate the force of contractions. Tracings will vary by the size of the woman and placement of the external toco.
4. Watch the pattern of fetal heart rate in relation to contractions. It is fine if fetal heart rate follows a ten-beat variability baseline during labor. The presence of variability is good. A rise in fetal heart rate at the beginning of a contraction is reassuring. Variable decelerations, sudden V-shaped dips below the baseline, may indicate compression of the umbilical cord and a need to change positions. Late decelerations, when the heart rate dips below baseline and only gradually recovers after a contraction, are signs that the unborn is stressed by lack of oxygen. Low heart rates during pushing stage, however, are a normal reaction to head compression and will quickly recover between contractions, which naturally are farther apart then.