Intermittent auscultation involves listening to the fetal heartbeat periodically and recording a single measure of the fetal heart rate at a time (Martis et al. 2010).
- Palpate the maternal abdomen to ascertain fetal position (FHR is usually best heard over the fetal back/anterior shoulder) (Martis et al. 2010).
- A Pinard or Doppler ultrasound (NICE 2017) should be used at initial assessment to establish the real sound of the fetal heart and to aid confirmation of presentation and position (RCM 2012).
NICE (2014) recommend:
- The maternal pulse should be palpated at the initial assessment, hourly throughout the first stage of labour, every 15 minutes in the second stage of labour and if a fetal heart rate abnormality is detected to differentiate between the two heart rates. Maternal heart rate should be documented on the partogram.
- Auscultate the fetal heart for a minimum of 1 minute immediately after a contraction at least every 15 minutes in the first stage of labour and record as a single figure. This should be documented on the partogram.
- Auscultate the fetal heart for a minimum of 1 minute immediately following a contraction at least every 5 minutes in the second stage of labour and record as a single figure. This should be documented on the NHS GG&C ‘Fetal heart – auscultation record’. This record card is completed every 5 minutes in conjunction with the partogram and is signed and filed in the labour ward booklet after the birth.
- Record accelerations and decelerations if heard
- Palpate the maternal pulse to differentiate between the maternal and fetal heartbeats (NICE 2017)
Both intermittent auscultation and continuous CTG provide information on the baseline heart rate (usually between 110 and 160 beats per minute in the term fetus), accelerations (transient increases in the FHR) and
decelerations (transient decreases in the FHR). It is known that some aspects of labour will cause natural alterations in FHR patterns. Some of these changes are subtle and can only be detected by continuous CTG, e.g. baseline variability, temporal shape of decelerations.
Take the following into account when assessing baseline FH rate:
- this will usually be between 110 and 160 beats/minute – clear and regular on auscultation (NHSQIS 2009)
- Be aware of a rising or changing baseline as an indicator of potential fetal compromise (NHSQIS 2009)