Labor and Delivery How to Read a Fetal Monitor During Labor By Robin Elise Weiss, PhD, MPH Updated on October 17, 2022 Medically reviewed by Brian Levine, MD, MS, FACOG Print Fetal monitoring, in one form or another, has been around for a long time—over 350 years, in fact. Prior to the 1970s, a healthcare provider (usually a doctor, nurse, or midwife) would use a stethoscope designed for pregnancy (fetoscope) to listen to the heart sounds (auscultation) of a fetus. The technology for electronic fetal monitoring arrived in the 1960s and 1970s but had to undergo reliability testing before hospitals and clinics started to use it. Electronic fetal monitors provided a graph (on a paper printout at first, and later, on a computer screen) that showed how a fetus's heart rate responded to contractions. Fetal monitoring is one way your provider can monitor how well your baby is coping with labor. An advantage of electronic monitoring over the fetoscope method was that it could be done without requiring the provider to be at the patient's bedside. Here's a quick overview of how electronic fetal monitoring is used, as well as how to interpret what you see (and hear) on the monitor. What Is Fetal Distress in Labor? 1 Understand Your Labor Johner Images / Getty Images Fetal monitoring can be performed in several ways, depending on the needs of the patient and the capabilities of the facility. Physically, fetal monitoring can be done externally or internally. The timing of the monitoring can be continuous or intermittent. The American College of Obstetricians and Gynecologists (ACOG) states that intermittent fetal monitoring with an electronic fetal monitor, handheld doppler, or stethoscope can be used to monitor low-risk women during labor. 2 What Electronic Fetal Monitoring Measures REW Electronic fetal monitoring produces a display on a computer monitor or paper graph that records the fetal heart rate and contractions. In the image above, you can see the fetal heart rate marked with the blue indicator. Contractions are in red. When you're looking at the screen, the fetal heart rate is usually on the top and the contractions at the bottom. When the machine prints out graph paper, you'll see the fetal heart rate to the left and the contractions to the right. Sometimes it's easier to read printouts by looking at them sideways. The monitoring strip in the labor room will also be visible from a bank of monitors at the nurses' desk, which lets staff watch the monitors without having to come to a patient's room. 3 The Y Axis of Fetal Monitoring REW On the left-hand side of the image above, you'll see a y-axis in each of the graphs. The blue indicator shows the marking of the fetal heart rate. These are beats per minute (bpm), which are measured in increments of 10 with markings every 30 beats. The red indicator on the bottom tracing shows the strength of a contraction, measured in millimeters of mercury (mmHg). The higher the number, the stronger the contraction. Unless an internal uterine pressure catheter (IUPC) is being used, this measure simply provides a graphical representation of each contraction. 4 The X Axis of Fetal Monitoring REW The horizontal line, or x-axis, is measured in minutes. Between the blue and red indicators is a single minute. Within each minute are lighter lines, each of which measures a ten-second increment. There are six sections for every minute. Combining both the top and bottom (x and y-axes), the graphs line up with the heart rate directly above a contraction that is happening at the same time. Once you are settled in your labor room, ask your nurse, midwife, or doctor for a quick tour of the fetal monitoring strip or monitor. 5 What Type of Monitoring Is Best for You? MICHAEL DONNE/SCIENCE PHOTO LIBRARY / Getty Images No single type of fetal monitoring will be right for everyone. How often it's necessary to check on the baby and labor will differ from person to person—and even from labor to labor in the same person. If your labor is considered high-risk, you will likely need to have continuous fetal monitoring. You might need continuous fetal monitoring if you:Are experiencing fetal distress in your current laborAre having an epiduralAre having an induction of laborHave certain medical conditionsHave had a previous cesarean birthHave had multiple babies A Word From Verywell When you're in labor, fetal monitoring helps your healthcare team monitor how your baby is coping. There are different types of fetal monitoring, and the kind you will need will depend on your situation, as well as your provider's preference. Start having a conversation with your provider about fetal monitoring at your prenatal visits. Ask them how they use fetal monitoring during labor, including when they would recommend continuous or internal fetal monitoring. How Internal Fetal Monitoring Works 8 Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Ayres-de-Campos D. Electronic fetal monitoring or cardiotocography, 50 years later: What's in a name? Am J Obstet Gynecol. 2018;218(6):545-546. doi:10.1016/j.ajog.2018.03.011 Stout MJ, Cahill AG. Electronic fetal monitoring: Past, present, and future. Clinics in Perinatology. 2011;38(1):127-142. doi:10.1016/j.clp.2010.12.002 Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017;2(2):CD006066. doi:10.1002/14651858.CD006066.pub3 American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: Nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009;114(1):192-202. doi:10.1097/AOG.0b013e3181aef106 Johns Hopkins Medicine. Fetal heart monitoring. Zhao Z, Zhang Y, Deng Y. A comprehensive feature analysis of the fetal heart rate signal for the intelligent assessment of fetal state. JCM. 2018;7(8):223. doi:10.3390/jcm7080223 Harper LM, Shanks AL, Tuuli MG, Roehl KA, Cahill AG. The risks and benefits of internal monitors in laboring patients. Am J Obstet Gynecol. 2013;209(1):38.e1-6. doi: 10.1016/j.ajog.2013.04.001 Heelan L. Fetal monitoring: Creating a culture of safety with informed choice. J Perinat Educ. 2013;22(3):156-165. doi:10.1891/1058-1243.22.3.156 By Robin Elise Weiss, PhD, MPH Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Helpful Report an Error Other Submit