Frequency

Every 15 to 30 minutes in active phase of first stage of labor; every 5 minutes in second stage of labor with pushing

Indications

Assess FHR before: initiation of labor-enhancing procedure; ambulation of patient; administration of medications; or initiation of analgesia or anesthesia

Assess FHR after: admission of patient; artificial or spontaneous rupture of membranes; vaginal examination; abnormal uterine activity; or evaluation of analgesia or anesthesia

Procedure

1. Palpate the abdomen to determine the position of the fetus (Leopold maneuvers)

2. Place the Doppler over the area of maximal intensity of fetal heart tones

3. Differentiate maternal pulse from fetal pulse

4. Palpate for uterine contraction during period of FHR auscultation to determine relationship

5. Count FHR between contractions for ≥ 60 seconds to determine average baseline rate

6. Count FHR after uterine contraction for 60 seconds (at 5-second intervals) to identify fetal response to active labor (this may be subject to local protocols)