1 Understanding the fetus during labour

1. What is fetal wellbeing?

This is the general condition of the fetus. If the fetal wellbeing is good during pregnancy the fetus should grow and develop normally. With good fetal wellbeing the fetus should be able to tolerate the normal stresses of labour and delivery. It is important to monitor the fetal condition both during pregnancy and labour to assess the fetal wellbeing.

2. How is the condition of the fetus monitored clinically during pregnancy?

The fetus is monitored clinically by assessing fetal growth and fetal movements:

Fetal growth is assessed by determining the increase in the size of the uterus. From 18 to 36 weeks of pregnancy, this is done by measuring and plotting the symphysis-fundus height.
Fetal movements are assessed by the mother. All mothers should be aware of the importance of normal fetal movements.

Note: Ultrasonography can also be used to assess the condition of the fetus. If the fetal wellbeing is good, the fetus should be growing normally with normal amounts of amniotic fluid. Placental function is normal if a Doppler ultrasound shows normal umbilical artery flow.

3. Is it helpful to count the fetal heart rate during pregnancy?

The presence of a fetal heartbeat confirms that the fetus is alive. However routinely counting the fetal heart rate at antenatal visits is of very little value if the fetus is growing and moving normally.

4. What clinical signs can be used to monitor the fetal condition during labour?

The clinical condition of the fetus during labour can be monitored by:

Counting the fetal heart rate.
Looking for meconium-stained amniotic fluid (liquor) once the membranes have been ruptured.

The fetal heart rate is used to monitor the condition of the fetus during labour.

5. What else should be monitored during labour?

The condition of the mother.
The progress of labour.

6. How do you decide whether a woman is in labour?

A woman is in labour when she has both:

Regular painful uterine contractions with one or more contractions every 10 minutes.
Cervical changes (effacement and/or dilatation) or rupture of the membranes.