Understanding internal fetal monitors can be simple to understand once you learn. Not all labors are smooth and go off without medical interventions. Some women’s labor may stall out, or the baby could be having a hard time inside of the uterus. Internal fetal monitors, specifically the fetal scalp electrode (FSE) and intrauterine pressure catheter (IUPC), play a crucial role in providing accurate and real-time information during labor. In this article, we go into the details of these internal fetal monitors, exploring their functions, benefits, potential drawbacks, and the essential role they play in ensuring a safe delivery.
In this article we will learn:
When are internal fetal monitors used?
What are internal fetal monitors?
What are the risks of internal fetal monitors?
Internal Monitoring During Labor
External fetal monitors are the first ways we monitor babies inside of the uterus. They are noninvasive and do not pose any risk to the mother or baby. But sometimes in labor, complications arise. This could include labor stalling out, drops in the baby’s heart rate, infection or potential labor emergencies. Internal monitors are a great way to ensure that the information we are getting on the external monitors is true and correct. Sometimes when a baby’s heart rate is dropping, it can be difficult to find when the mother is being turned side to side to bring the baby’s heart rate back up. Fetal scalp electrodes can help us find the baby’s heart rate in an emergency and ensure that the baby is safe.
1. Fetal Scalp Electrode (FSE):
The fetal scalp electrode is a tiny, spiral-shaped wire that is attached to the baby's scalp during labor. This electrode measures the baby's heart rate directly, providing a more precise and immediate assessment compared to external monitoring devices.
2. Intrauterine Pressure Catheter (IUPC):
An intrauterine pressure catheter is a slender tube that is inserted into the uterus and measures the strength and frequency of contractions during labor. This internal monitoring method helps healthcare providers gauge the effectiveness of contractions and assess the progress of labor more accurately.
How Internal Monitoring Facilitates Labor Progress
1. Accuracy in Fetal Heart Rate Monitoring:
FSE offers a more direct and accurate measurement of the baby's heart rate by attaching directly to the scalp of the baby. This enables healthcare providers to quickly detect any changes in the fetal heart rate, facilitating timely interventions if needed. In an emergency, this is the most accurate and direct way to ensure that the baby’s heart rate is indeed dropping, or not dropping.
2. Precise Assessment of Contractions:
IUPC provides data on the strength and duration of contractions, allowing healthcare professionals to monitor the progress of labor more precisely. This information helps in ensuring that contractions are strong enough to facilitate cervical dilation and the baby's descent. These may be placed when labor is starting to slow down, or if the baby is having sudden drops in the heart rate and needs additional fluid added back into the uterus. This can happen when the baby is laying or pushing on the cord (which can cut of blood supply and drop the baby’s heart rate).
Pros and Cons of Internal Fetal Monitors
1. Pros:
a. Accuracy: Internal fetal monitors provide more accurate readings of the baby's heart rate and the strength of contractions.
b. Timely Intervention: The immediacy of internal monitoring allows for prompt action in case of any concerns, enhancing the safety of both mother and baby.
c. Continuous Monitoring: Internal monitors offer continuous and uninterrupted monitoring, providing a comprehensive picture of the labor process.
2. Cons:
a. Invasive Nature: The insertion of electrodes and catheters is invasive and may cause discomfort for the mother. The IUPC and FSE can also leave small marks on the baby’s head ( but this goes away within days of delivery).
b. Limited Mobility: The use of internal monitors may restrict the mother's movement during labor, potentially impacting her comfort. However, if you don’t have an epidural you could be able to move around the room.
c. Risk of Infection: There is a small risk of infection associated with the insertion of internal monitors. Anytime a woman’s cervix is rechecked, there is an increased risk of infection.
Potential Risks and Complications
1. Infection Risk:
The insertion of internal monitors carries a slight risk of infection. Anytime anything is inserted into the cervix or beyond, there is an increased risk of infection. Healthcare providers take precautions, such as using sterile techniques and sterile equipment to try and decrease the risk of infection as much as possible.
2. Dislodgment:
There is a possibility of the fetal scalp electrode becoming dislodged or dettached during labor. If this happens, the monitors may need to be replaced.
3. Limited Use in Certain Situations:
Internal monitors may not be suitable for every labor scenario, such as cases of certain infections or complications, limiting their usability.
Fetal Monitoring During Labor
Although external monitoring and natural progression of labor is the best method during labor, sometimes additional help is needed. Internal fetal monitors, including the fetal scalp electrode and intrauterine pressure catheter, offer valuable insights into the well-being of both the mother and baby during labor. While they provide accurate and immediate data for informed decision-making, the invasive nature and potential risks should be carefully considered. As with any medical intervention, the use of internal fetal monitors is a collaborative decision between healthcare providers and the mother, with the ultimate goal of ensuring a safe and healthy delivery. Understanding the role and implications of internal monitoring during labor empowers mothers to make informed choices during their labor. Hopefully, this article helps nurses, students, or even expectant mothers themselves understand what internal fetal monitors are and why they may be potentially used in labor.
Nurses and providers try their absolute best to use the least invasive monitoring as much as possible so a mother can have limited interventions during their labor. But, not all labors are the same, and not all babies behave the same inside of the womb. Some laborers are high-risk and require additional interventions to make sure that their delivery and their baby are safe. To learn more about fetal monitoring during labor go check out my VEAL CHOP article!
Commonly Asked Questions about Fetal Monitoring:
What is the internal fetal monitor screw?
Some people have taken to social media to scare moms about the “screw” that goes on the baby’s head. It is a small spiral needle that goes just under the skin of the baby’s head.
What is the internal fetal monitoring?
Internal fetal monitors use a scalp electrode on a baby’s head to detect their heart rate. They also use a pressure catheter that goes inside of the uterus next to the baby to detect contractions.
What can I use instead of internal fetal monitor?
The best non-invasive way to monitor babies is with an external fetal monitor. If your baby’s heart rate is dropping, internal fetal monitors are recommended for their safety.
What is the internal device to monitor contractions?
An IUPC or intrauterine pressure catheter is a small catheter or tube that goes inside the uterus. It measures the pressure of contractions exerted on the baby to determine if there might be a cervical change.
What is the difference between IFM and EFM?
internal fetal monitors use invasive monitoring on the baby’s head and inside the uterus to determine heart rate and contractions. External monitors just use a pressure button and ultrasound on the belly to find the heart rate.
