FHT Question: How? How Long? How Often?

My training has been with one midwife. I'm wondering how others check FHT. In latent phase we check every 1-2 hours (if we're even there). In first stage (active labor) every 30 minutes. Pushing every 5-15 mins, every other contraction as the head descends and is born. We never listen for long, and rarely during a contraction. Frequently right as a contraction is over, though.
I know from experience that a doppler on the belly during UC is intense, but I'm not comfortable w/o listening through the UC. How often do you listen through? How do you prepare moms for those times? How do you deal with it when the mom says it's too intense and doesn't want you to do it? Do you count 10 second intervals like in holistic midwifery or you you have a digital doppler and watch the count on it?
Just looking for some input...


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All the midwives I work and have worked with fallow basic portocals as you just stated above. Some times they have been really relaxed and other times really active with listenting. its up to the midwife


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I listen every 30 minutes in active labor, after every other push during second stage. I listen during the entire contraction and after, counting in 5 second counts. I don't trust - and no one should for a long period of time - the digital display on dopplers. It often can pick up mom's heartbeat through uterine arteries, etc.
I don't push the doppler into the mom's belly, so I don't know about it hurting. At least, I haven't had a client say that. Some get tired of the noise, and I have headphones in that instance. I also have had clients tell me that they only wanted me to listen every hour, which I've done.
I always listen for the whole contraction in first stage and then afterwards.


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head phones are a great idea!!!!!!!!!!!
I have seen moms push off the doppler and in that case the midwife pulls out the fetoscope (Leff) you dont have to push that one into the belly


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I don't push the doppler into mom's belly either. It's more the sensation of having something on the belly that bothered me, and seems to bother them (maybe I'm projecting?). I remember asking as Atley crowned why they had that stupid doppler on my belly since he was coming out anyway. S. said "we have to make sure he's okay" and I was like, what are you going to transport me as he comes out?!" I was such a pain in the butt during labor....I'll either be lots more understanding of procedures during the next birth or lots less understanding, after my training.
I've never had anyone complain about the noise, but probably b/c we don't listen through the entire contraction.
S's protocols are doppler only during labor. She had a bad experience with fetoscope and a stillborn baby during her training. We only have one client who prefers fetoscope to doppler, so I'm getting my fetoscope practice in with her.


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get a doppler and enough gel on that you don't have to push, they really work with just sitting on the belly. I listen through a contraction till the tones come up after. Sometimes I just want to listen and not count- counting can make my mind too busy, this is not to say i don't count, I just wanted to say to you that I also just listen sometimes- I want to hear rhythm,force,changes- note changes in response to movement . In latent phase it depends on like you said if we are there, and if it seems that the labor is rolling right along or is going to be latent for a while... active every 30 min, every other contraction pushing--- other things may change what I do, like ruptured bag, presence of mec, detection of decelerations- I want to know if changing position helps, is it repeating.
also count in 5 second increments- I tried 6 for a while but it is too hard to change old habits. listening after a contraction only, doesn't always catch the late decels depends on when you start listening.


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Question from an outsider (I'm not a midwife or ob or doula, just a curious woman) - do you ever use a fetoscope during labor or is a doppler always used? Any reasons?
Also, when you say that you listen every 30 minutes does that mean you listen for one contraction and that's that or is it listening for 5 minutes at a time or is it something else?
Thanks!


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I don't use a fetoscope during labor for a variety of reasons, but the first being that I cannot hear. I was in radio for four years when younger and I blew my hearing quite a bit. I cannot pick up on the subtleties of the tones during contractions. I can hear well during prenatal visits, but once the contraction starts, it fades away. :(
I also feel like using the doppler is less invasive because the mom doesn't have to be quiet, she can be in any position, she can be in the water, etc.
I listen every 30 minutes through one contraction and awhile afterwards. So, every 30 minutes I'm listening for about two minutes.


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I have used both, and have been able to hear most of the time all the way through with a fetal scope. But hearing ability is just that it depends on hearing and if someone has developed the skill to hear with a fetalscope. a fetal scope usually takes a certain amount of tolerance in changing position for mom- like it is very hard to hear heart tones underwater with a fetalscope.You also have to have the placement right over the baby's chest area most of the time.
with a doppler everyone in the room can hear the heartones if they want so you are sure that the midwife is hearing something, it is smaller and comes in a water proof version so mom can often stay in a comfortable position in or out of water while the baby is being listened to. it is also faster to find heart tones because you don't have to be right over to pick up the heartones.


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I have been trained in a couple of ways: the first as stated by the OP and the second to do a 3-minute-read initially upon active labor (every 3 hours) where you listen for at least 3 minutes catching a contraction from start to finish and after - documenting fht every 15 secs. Then listening again every 30 - not during a contraction.
I like the 3 minute read. It feels like getting a baseline and in long labors, I have seen that it can really document fetal distress. I'm not sure about useing it myself though. I need more research.
Anyone else hear of this, or know where it's come from?
Lesley


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Lesley, I've never heard of that. So you get a 3 minute read once an hour during a contraction, but then you only listen every 30 minutes NOT during a contraction? how do you hear decelerations?
interesting!


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The 3 minute read (really somtimes it's more like 4 or 5) is done upon active labor and then again every 3 hours. The idea is to get a good minute before, then during, then a good minute after a contraction.
And then every 30 minutes you listen - not during a contraction, but immediately after. A quick listen - 15 -30 secs, unless a longer listen is indicated. You can hear decels if you catch it on the tail end or after the contraction.
I also worked with midwives that only listened after contractions, for 15 secs, every 30 minutes. There was never any long listens. It was very laid back and unworried. How do you hear decels? Don't know, but usually more signs present themselves if baby's not well and/or labor's not normal.
If there is anything happening (meconium, funky heart tones, stress) I want to listen more - and longer, remembering that babies are sturdy and built to survive - 95% of them do!
I'm not a big fan of listening a whole lot during 2nd stage. Why - exactly do we do it? I'm interested in hearing you all's reasons. I feel that it doesn't tell us a whole lot - unless pushing is going on a long time (course, it's hard to tell who's going to be pushing a long time and who isn't!).


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a slow second stage with non-recovering heart tones I want to be ready and I may have an ambulance on the way. We may even transfer-- depends on parents. How long would you wait with a no- slow progress and non reassuring heart tones? What about complete with high head-- are you listening to be sure everything is still ok... I will hang for a long time as long as everyone is well but...
I have worked with midwives who did not listen during contractions just after or between, I chalk this up to poor training. They have missed some pretty worrisome stuff. Mec does not always mean any trouble at all so, I want it coupled with something--


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Hi,
I listen q 15-30 in early active, q15 in active, and q 5 minutes or after every contraction in second stage.
I don't listen through contractions, I listen just as the contraction ends, and for a full minute. You definately hear decelerations, it is much less invasive for the mom, and what would it change if you heard a decel during the contraction but if it is not a late decel? These are based on the Society of Obstetricians and Gynecologist of Canada guidelines and the Association of Ontario Midwives guidelines. WHen I was first trained I was trained to listen through contractions, but research has changed that (at least around here).
Carolynn


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heard a decel during the contraction but if it is not a late decel?
maybe moms position, also this gives me a clue that the baby is reacting to its environment still. Late decels and non-reactive heart tones...make my heart skip a beat.


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I like to hear accelerations *not* associated with a contraction, and often hear that in between contractions. I would be concerned if that were not present. Also, I do 4 counts over that minute to make sure there is variability. If the decel is a variable due to position, if you are listening right after a contraction, you will hear it as that contraction is fading away. Late decels and no variability make me shudder too -- time for a transport for EFM.
Carolynn

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