How do Midwives monitor mother and baby's wellbeing in labor?
Monitoring Low Risk Women:
Intermittent Fetal Heart Tones:
Fetal well being is assessed with a hand-held doppler which will allow the laboring woman to move about freely. The best way to assess the baby is to listen before, during, and after a contraction.
We use a finger pulse ox every 1-2 hours or anytime we think our doppler is picking up the mother's pulse rather than fetal pulse.
Nourishment in Labor:
We encourage eating and hydrating in labor. We recommend water, labor tea, coconut water, electrolyte drinks, smoothies, broth, juice. Most people eat during labor to keep their vigor. We offer those who test positive for GBS, or who are unable to keep drink/food down.
Unmedicated pain relief:
At home, Epidurals are replaced with other pain relief techniques such as mind-body modalities, use of water, massage, continuous support and mobility.
Blood Pressure (BP) is assessed every hour with a BP cuff temporarily placed on your arm between contractions and removed after each reading.
We prefer movement to the toilet vs routine urinary catheters. The toilet is a great labor spot. Humans are used to “letting it all go” there. Occasionally, if a woman cannot urinate in labor or has a postpartum hemorrhage, we will recommend it.
Monitoring Low Risk Women: Hospital Birth
Continuous Fetal Monitoring:
This is recommended in high-risk, medicated (Pitocin) labor, or if an epidural is placed. EFM consists of disc held over the belly with strap or is a probe attached to the baby’s scalp.
Continuous monitoring of the mother’s heartbeat. The laboring person’s pulse is able to be read remotely. *Differentiation from the maternal and fetal heartbeat are important in case the fetal monitor accidentally traces the mom instead of the baby.
Most laboring women will have an IV site set when they are admitted to the hospital. It is placed with a needle that is removed & a plastic catheter takes its place, allowing for fluids and medication direct access to the bloodstream. An IV is necessary if a woman would like an epidural.
An epidural may be necessary to allow the laboring person to relax and cope with labor. It can be a kind use of medication, but it is not without risk. An epidural labor is a bed labor.
Continuous Blood Pressure Monitoring:
A BP cuff is often left on the laboring persons arm throughout labor and inflates at a set rate. (Doesn't discern if you're contracting.) It tightens every 5 minutes when an epidural is placed and then hourly. BPs are read remotely. *This is vital equipment if a woman has high blood pressure.
A bladder catheter is a bulb & tube system to allow continuous bladder drainage for a bed-bound laboring person with an epidural. These are routinely used.