3.3. Maternal and fetal monitoring during the second stage
Maternal parameters should be monitored when the second stage
of labor is confirmed and thereafter, and for specific indications such
as a history of high blood pressure, prolonged labor, and previously
identified abnormal fetal heart rate.
Equipment in good working order and devices that simplify detection
of the fetal heart should be available at the recommended frequency
. The frequency of fetal heart auscultation should be
every 5–10 minutes or more often when bradycardia is suspected.
One can get the best information about the condition of the fetus,
and it is easiest to hear, by auscultating immediately after a contraction.
The care provider should have the skills to interpret the fetal
heart rate and take appropriate action when needed. While the traditional
Pinard stethoscope (fetoscope) may be adequate in very quiet
labor rooms, it is often difficult to use reliably owing to surrounding
noise or maternal obesity, and especially in the second stage because
of the woman's naturally vigorous movements. Wide availability of
robust handheld Doppler devices with battery backup and/or
wind-up recharging technology should be part of standard equipment
provision for safe maternity care. Service planners and managers
should prioritize procurement and regular maintenance of
such devices.