Fetal Heart Rate Monitoring: Category I, II & III Guide

Quick take: Fetal heart rate (FHR) monitoring during labor is grouped into three NICHD categories. Category I traces are reassuring and usually need routine care; Category II traces are indeterminate and call for closer observation and possible interventions; Category III traces are non‑reassuring and require immediate actions to protect the baby. Knowing which category you’re seeing—and understanding the *why* behind each step—can help you and your care team respond quickly, confidently, and safely.

It’s 2 a.m., you’re on the labor floor, the monitor is beeping, and you catch a quick glimpse of the squiggly line on the screen. A wave of anxiety hits—“Is this okay? Do I need to worry?” You’re not alone. Many expectant parents feel that same knot in their stomach when the fetal heart rate (FHR) monitor blips or spikes. The good news is that clinicians use a standardized system to interpret those patterns, and each category comes with clear, evidence‑based actions.

But here’s what most guides don’t tell you: *how* those actions actually help your baby, what the team is *thinking* in the moment, and how you can advocate for yourself without feeling like you’re interrupting. In this guide, we break down what fetal heart rate monitoring is, how the NICHD categorizes tracings, and exactly what your care team will do for Category I, II, and III patterns. We’ll also cover the *clinical reasoning* behind each step, practical tips for staying informed during labor, and a quick‑reference FAQ you can revisit any time.

By the end of this article, you’ll understand not just the *what* of FHR categories, but the *why*—so you can feel more like a partner in your care, not just a passenger.

What is fetal heart rate monitoring?

Fetal heart rate monitoring, often called electronic fetal monitoring (EFM) or cardiotocography (CTG), records the baby’s heartbeat and uterine contractions in real time. The device places two sensors on the mother’s abdomen: one that detects the fetal pulse (usually 110–160 beats per minute) and another that measures the strength and timing of contractions. The resulting graph—called a tracing—lets clinicians assess how well the baby is tolerating labor.

Why does this matter? During labor, the uterus contracts, temporarily reducing blood flow to the placenta. If the baby isn’t receiving enough oxygen, its heart rate may change in characteristic ways. For example, a healthy baby’s heart rate might briefly accelerate in response to movement (a reassuring sign), while a baby under stress might show repeated drops in heart rate after contractions (a warning sign). By watching these changes, providers can spot early signs of distress and intervene before a problem becomes serious.

FHR monitoring is recommended for most labors in the United States and the United Kingdom, especially when there are risk factors such as maternal hypertension, diabetes, or a history of fetal growth restriction. The American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) both endorse continuous monitoring for high‑risk pregnancies while allowing intermittent monitoring for low‑risk cases. The key difference? *Continuous monitoring* provides a real-time, uninterrupted view of the baby’s status, while *intermittent monitoring* checks the heart rate at set intervals (e.g., every 30 minutes).

Two main technologies exist. External monitoring uses a Doppler ultrasound transducer placed on the abdomen; it’s non‑invasive and works for most deliveries. Internal monitoring involves a fetal scalp electrode that attaches directly to the baby’s head, providing a clearer signal when the external trace is noisy—often during a very active labor or when the mother’s body habitus interferes with the sensor. Both methods are safe, but internal monitoring carries a very small risk of scalp injury or infection, which is why it’s reserved for specific situations (e.g., persistent Category III patterns or when external monitoring is unreliable).

It’s also worth noting that FHR monitoring isn’t just about the baby’s heart rate. The *relationship* between contractions and heart rate changes is what tells the story. For example, if the baby’s heart rate drops *after* a contraction (a late deceleration), it suggests the placenta isn’t recovering well between contractions—a sign of potential oxygen deprivation. On the other hand, if the heart rate drops *with* a contraction (an early deceleration), it’s usually just the baby’s head being squeezed during descent, which is normal.

How are fetal heart rate tracings classified?

• Baseline rate: the average heart rate over a 10‑minute window (normally 110–160 bpm). A rate below 110 is called bradycardia, while a rate above 160 is called tachycardia. Both can be signs of stress, but context matters—brief tachycardia during a contraction is often normal, while persistent bradycardia is more concerning.
• Variability: the fluctuation in baseline rate (good variability is 6–25 bpm). Think of variability as the baby’s “wiggle room”—it shows the nervous system is working well. Absent variability (a flat line) is a red flag, while minimal variability (1–5 bpm) can be a sign of sleep, medication, or early distress.
• Accelerations: temporary rises of at least 15 bpm lasting 15 seconds (a sign of fetal well‑being). These are like the baby’s way of saying, “I’m doing great!” They’re especially reassuring when they happen in response to movement or contractions.
• Decelerations: drops in rate that can be early, variable, or late, each with different implications. Early decelerations mirror contractions and are usually benign, while late decelerations (which occur after contractions) suggest the placenta isn’t recovering well.

Based on these features, tracings fall into:

These categories guide the next steps. A Category I tracing typically means labor can proceed with routine care. Category II is a “watchful waiting” zone, prompting interventions like repositioning or oxygen if needed. Category III triggers rapid response protocols—often including emergency delivery.

Guidelines from ACOG (2020) and NICE (2022) emphasize that the classification is not a static label; clinicians must reassess the tracing continuously, because a pattern can evolve as labor progresses. For example, a Category II tracing with minimal variability might improve with maternal repositioning or hydration, while a tracing with recurrent late decelerations might worsen, requiring escalation to Category III. The NICHD system also serves as a common language across the globe, allowing teams in different hospitals—or even different countries—to discuss a case with a shared understanding.

One important nuance: *not all Category II tracings are created equal*. A tracing with occasional variable decelerations is less concerning than one with recurrent late decelerations, even though both fall under Category II. This is why your care team might describe a tracing as “Category II, but reassuring” or “Category II, concerning.” Asking for this level of detail can help you understand how worried you need to be.

Managing Category I fetal heart rate tracings

Category I is the “all clear” zone. The baby’s baseline rate is within normal limits, variability is moderate, and accelerations are present. In most cases, no special actions beyond standard labor care are required. But what does “routine care” actually look like?

First, it means the team will continue monitoring at regular intervals—typically every 30 minutes in the first stage of labor (when the cervix is dilating) and every 15 minutes in the second stage (when you’re pushing). These checks are usually brief, just long enough to confirm the tracing is still reassuring. If you’re low-risk, your provider might even recommend intermittent monitoring, where the sensors are removed between checks to allow for more movement.

Key actions for Category I:

1. Continue routine monitoring: Intermittent checks (every 30 minutes in the first stage, every 15 minutes in the second) are usually sufficient, unless other risk factors dictate continuous observation. If you’re on continuous monitoring, the team will still check in with you regularly to explain what they’re seeing.
2. Maintain maternal comfort: Adequate hydration, pain control, and positioning (often left‑lateral) help preserve optimal uteroplacental blood flow. For example, lying on your left side can relieve pressure on the vena cava, a large vein that returns blood to the heart, improving circulation to the placenta. If you’re more comfortable on your back or side, let the team know—they can adjust the sensors to keep the tracing clear.
3. Document baseline and variability: Even with reassuring tracings, the care team records the baseline rate and variability trends for medicolegal completeness. This documentation also helps if the tracing changes later—it gives the team a baseline to compare against.
4. Prepare for transition: While Category I is low risk, labor can evolve quickly. Staff should stay ready to respond if the tracing changes. For example, if you’re planning a natural birth but the tracing shifts to Category II, the team might suggest interventions like IV fluids or repositioning to avoid escalation.

Guidelines from ACOG’s Practice Bulletin on intrapartum fetal monitoring (2020) advise that for a stable Category I tracing, the focus should be on maternal well‑being, not aggressive interventions. In other words, keep the environment calm, encourage movement as tolerated, and let the baby’s own signals guide the process. This is also a great time to use comfort measures like a birthing ball, shower, or massage to help you relax and progress in labor.

Even in a reassuring pattern, clinicians watch for subtle shifts—such as a gradual loss of variability or the appearance of occasional decelerations—that could herald a transition to Category II. If that happens, the team will promptly initiate the algorithm for indeterminate tracings, which we discuss next. It’s also worth noting that some medications, like epidurals or opioids, can temporarily reduce variability. If you’ve recently received pain relief, the team will factor that into their interpretation of the tracing.

Managing Category II fetal heart rate tracings

Category II covers the gray area—tracings that aren’t clearly reassuring nor clearly worrisome. Because the stakes are higher, clinicians follow a systematic algorithm to improve outcomes. But what does that algorithm *actually* look like in practice?

First, the team will assess whether the tracing is *stable* or *worsening*. A stable Category II tracing (e.g., minimal variability without decelerations) might only need closer observation, while a worsening tracing (e.g., recurrent late decelerations) might require immediate interventions. The goal is to correct any reversible causes of distress—like low maternal blood pressure or cord compression—before the tracing deteriorates further.

Step‑by‑step approach for Category II:

1. Re‑evaluate maternal factors: Check blood pressure, blood glucose, temperature, and oxygen saturation. Correct any abnormalities (e.g., treat hypertension, administer insulin, give a fluid bolus). For example, if your blood pressure drops after an epidural, a fluid bolus can help restore circulation to the placenta.
2. Maternal repositioning: Turn the mother to the left side or use a wedge to relieve aortocaval compression, which can improve placental blood flow. If left-side positioning doesn’t help, the team might try hands-and-knees or a semi-reclined position to see if the tracing improves.
3. Oxygen therapy: A short trial of 10 L/min supplemental oxygen via face mask for 10 minutes may be considered, though recent NICE guidance (2022) notes limited benefit and advises use only if hypoxia is suspected. Oxygen is often given as a precaution while other interventions (like repositioning) take effect.
4. IV fluid bolus: Give 500 mL of crystalloid (e.g., normal saline) if the mother shows signs of dehydration or low blood pressure. Dehydration can reduce blood flow to the placenta, so fluids are a simple but effective way to improve fetal oxygenation.
5. Scalp stimulation: A gentle pinch on the scalp (if a vaginal delivery is imminent) can provoke accelerations, helping to assess fetal reserve. If the baby responds with an acceleration, it’s a reassuring sign that the nervous system is intact and the baby is tolerating labor well.
6. Amnioinfusion: For variable decelerations caused by cord compression, a small volume of sterile saline may be infused into the uterus under ultrasound guidance. This can “float” the cord away from the baby’s head, reducing compression and improving the tracing.
7. Consider operative delivery: If the tracing worsens despite corrective measures, the team may move to assisted vaginal delivery (forceps or vacuum) or cesarean section. The decision depends on how quickly the tracing is deteriorating, how far along you are in labor, and whether the baby’s head is low enough for a safe assisted delivery.

Crucially, each intervention should be documented, and the tracing re‑assessed after 15–20 minutes to see if the pattern improves. The American College of Nurse‑Midwives (ACNM) recommends that any Category II tracing that persists for more than 30 minutes without improvement be escalated to Category III protocols. This doesn’t mean an emergency is imminent—it just means the team will start preparing for the possibility of a rapid delivery if the tracing doesn’t improve.

For parents who want to understand the numbers, the CTG Categorization (NICHD) calculator lets you input baseline rate, variability, and deceleration type to see which category your tracing falls into. It’s a great way to familiarize yourself with the system before labor begins.

One common question parents ask is: *How long can a baby stay in Category II?* The answer depends on the specific features of the tracing. For example, a tracing with minimal variability and occasional variable decelerations might be tolerated for hours if the baby is otherwise stable, while a tracing with recurrent late decelerations might require delivery within 30–60 minutes. Your care team will balance the risks of continuing labor against the risks of an early delivery, taking into account factors like gestational age, cervical dilation, and the baby’s estimated weight.

Managing Category III fetal heart rate tracings

Category III is the emergency alarm. The tracing shows absent variability plus one or more of the following: recurrent late decelerations, severe bradycardia (<110 bpm), or a sinusoidal pattern. These findings suggest the baby may be experiencing hypoxia or metabolic acidosis. But what does that *mean* for your baby, and what happens next?

First, it’s important to understand that Category III tracings are rare—only about 0.5–1% of labors involve them. When they do occur, it’s usually because the placenta isn’t delivering enough oxygen to the baby, often due to conditions like placental abruption, umbilical cord prolapse, or severe maternal hypotension. The team’s goal is to deliver the baby as quickly as possible, ideally within 5–10 minutes of recognizing the pattern, to minimize the risk of long-term complications like cerebral palsy or developmental delays.

Immediate actions for Category III:

1. Call for rapid response: Alert the obstetrician, anesthesiologist, and neonatal team simultaneously. In many hospitals, this is done via an overhead page or a dedicated emergency button. The team will assemble in the room within minutes, often bringing a crash cart and neonatal resuscitation equipment.
2. Maternal repositioning: Move the mother to the left lateral decubitus position without delay. This position relieves pressure on the vena cava, improving blood flow to the placenta. If the tracing doesn’t improve, the team might try other positions, like hands-and-knees or Trendelenburg (head-down tilt).
3. Administer 100 % oxygen: Use a non‑rebreather mask at 10–15 L/min to maximize fetal oxygenation. While oxygen won’t fix the underlying problem (like a prolapsed cord), it can buy time while the team prepares for delivery.
4. Stop uterotonics: If oxytocin or prostaglandins are being used, discontinue them immediately. These medications stimulate contractions, which can worsen fetal distress by reducing blood flow to the placenta. Stopping them can sometimes improve the tracing within minutes.
5. Consider tocolysis: A short‑acting agent such as terbutaline may be given to reduce contraction frequency if hypertonic uterine activity is present. Tocolytics relax the uterus, giving the baby more time to recover between contractions. This is usually a temporary measure while the team prepares for delivery.
6. Prepare for delivery: If the cervix is fully dilated, expedite assisted vaginal delivery (forceps or vacuum). If not, proceed to emergency cesarean section. The decision depends on how quickly the baby needs to be delivered and whether a vaginal delivery is feasible. In most cases, a cesarean section is the fastest option.
7. Continuous fetal scalp blood sampling (if available): Measure fetal scalp pH to confirm acidemia; however, many centers now rely on the tracing alone due to time constraints. Scalp blood sampling involves taking a small blood sample from the baby’s scalp to measure pH and lactate levels, which can confirm whether the baby is truly acidotic. However, this test takes time, so it’s often skipped in favor of rapid delivery.

Guidelines from the Society for Maternal‑Fetal Medicine (SMFM) (2021) stress that no more than 5 minutes should elapse between recognizing a Category III pattern and initiating delivery, if the baby’s condition does not improve with repositioning and oxygen. This timeline is based on studies showing that babies delivered within 5–10 minutes of a Category III tracing have better outcomes than those delivered later. However, the exact timing depends on the hospital’s resources and the mother’s clinical status. For example, if the mother is hemorrhaging or has a severe infection, the team might prioritize stabilizing her before delivering the baby.

After delivery, the newborn is assessed with Apgar scoring, cord blood gases, and, if needed, neonatal resuscitation. The outcome for Category III tracings varies, but prompt, coordinated response dramatically improves odds of a healthy baby. Most babies born after a Category III tracing do well, especially if the delivery was expedited. However, some may need temporary support in the neonatal intensive care unit (NICU), such as oxygen therapy or help with feeding. Your neonatal team will explain what to expect and how to support your baby’s recovery.

Understanding deceleration types and their significance

Decelerations are drops in fetal heart rate that occur in relation to uterine contractions. Three main types exist, each with a different clinical implication. But why do these drops happen, and what do they *really* mean for your baby?

First, it’s helpful to visualize the tracing. Imagine the fetal heart rate as a line on a graph, with contractions represented as peaks. A deceleration is a dip in that line, and its *timing* relative to the contraction tells the story:

• Early decelerations: The nadir (lowest point) aligns with the peak of a contraction. They usually result from fetal head compression during a normal descent and are considered benign. Think of it like the baby’s head being squeezed as it moves down the birth canal—it’s uncomfortable but not dangerous. Early decelerations are common in the second stage of labor and don’t usually require intervention.
• Variable decelerations: The nadir occurs before the contraction peak and varies in timing and shape. They often signal cord compression; persistent, deep variables may push a tracing into Category II or III, prompting amnioinfusion or operative delivery. Variable decelerations can look like sharp V- or U-shaped dips and are often caused by the umbilical cord being temporarily squeezed (e.g., wrapped around the baby’s neck or compressed by the baby’s body). Most variable decelerations are mild and don’t require intervention, but deep or prolonged ones can reduce oxygen flow to the baby.
• Late decelerations: The nadir appears after the contraction peak and returns to baseline after the contraction ends. This pattern reflects uteroplacental insufficiency and is the hallmark of fetal hypoxia, moving the tracing toward Category III if frequent. Late decelerations suggest the placenta isn’t recovering well between contractions, which can happen in conditions like pre-eclampsia, placental abruption, or maternal hypotension. Even a single late deceleration is concerning, and recurrent ones usually require immediate action.

In addition, a sinusoidal pattern—a smooth, wave‑like oscillation with a regular rhythm—is rare but ominous, indicating severe anemia or hypoxia. When this appears, immediate delivery is indicated. Sinusoidal patterns look like a series of gentle waves, almost like a sine wave on a graph. They’re often associated with conditions like fetal-maternal hemorrhage or severe Rh disease and require urgent delivery to prevent stillbirth or long-term complications.

Recognizing these patterns helps the team decide whether simple measures (like repositioning) might suffice or whether rapid delivery is necessary. For example, a single early deceleration is usually harmless, while recurrent late decelerations demand swift intervention. It’s also worth noting that decelerations can *change* over time. A tracing with occasional variable decelerations might improve with amnioinfusion, while one with late decelerations might worsen, requiring a cesarean section.

One question parents often ask is: *Can decelerations be prevented?* The answer is sometimes. For example, staying hydrated and avoiding lying flat on your back can reduce the risk of cord compression and variable decelerations. However, some decelerations—like those caused by placental abruption—can’t be prevented. The key is early detection and prompt intervention to minimize the baby’s exposure to low oxygen levels.

Intermittent versus continuous monitoring: when each is appropriate

Not every labor requires continuous monitoring. The choice depends on maternal risk factors, gestational age, and hospital policy. But how do you know which method is right for *you*?

Intermittent monitoring involves checking the fetal heart rate for a short period (usually 10 minutes) every 30–60 minutes. It’s often used for low‑risk pregnancies, when the mother is ambulating, or when a birthing center prefers a less invasive approach. Studies cited by ACOG (2020) show that intermittent monitoring does not increase adverse neonatal outcomes in low‑risk women, while allowing greater maternal mobility. This can be especially helpful if you’re planning a natural birth or want to use comfort measures like a birthing ball or shower.

However, intermittent monitoring has limitations. Because it only captures the heart rate at set intervals, it might miss brief but significant changes in the tracing. For example, if the baby has a late deceleration between checks, the team might not detect it until the next monitoring period. This is why intermittent monitoring is only recommended for low-risk pregnancies where the likelihood of fetal distress is low.

Continuous monitoring provides a real‑time trace throughout labor. It’s recommended for high‑risk situations such as pre‑eclampsia, diabetes, intra‑uterine growth restriction, or a history of a previous stillbirth. Continuous monitoring also becomes mandatory if a Category II or III pattern emerges, because rapid detection of changes is essential. The advantage of continuous monitoring is that it provides a complete picture of the baby’s status, allowing the team to respond quickly to any changes.

But continuous monitoring isn’t without drawbacks. It can restrict movement, making it harder to use comfort measures or change positions. Some parents also find the constant beeping of the monitor stressful, especially if the tracing is Category II. Additionally, continuous monitoring has been associated with higher rates of interventions like cesarean sections, though this is likely because it’s used more often in high-risk pregnancies where interventions are already more likely.

Both methods have pros and cons. Continuous monitoring can restrict movement and increase the perceived need for interventions, but it offers the most detailed view of fetal status. Intermittent monitoring preserves freedom of movement and may reduce unnecessary cesarean rates, but it requires vigilant staff to ensure timely checks. Discuss your preferences with your provider early in prenatal care so the birth plan reflects your comfort level and clinical needs.

One common misconception is that continuous monitoring is *always* safer. In reality, the best method depends on your individual risk factors. For example, if you have gestational diabetes but are otherwise low-risk, your provider might recommend intermittent monitoring with more frequent checks. On the other hand, if you have severe pre-eclampsia, continuous monitoring is usually the safest choice. The key is to have an open conversation with your provider about the risks and benefits of each method *for your specific situation*.

Preparing for fetal monitoring: what to expect in the delivery suite

Knowing what will happen can reduce anxiety. When you arrive at the labor unit, a nurse will place two adhesive patches on your abdomen—one for the fetal pulse and one for uterine activity. The patches are painless and usually stay in place for the duration of labor. If the team anticipates a need for an internal scalp electrode (for example, if external signals become unreliable), they will explain the procedure and obtain your consent.

While the monitor is attached, you’ll still be able to move, change positions, and use comfort measures such as a birthing ball or shower. Many units provide a “quiet zone” where the screen’s audio is muted, allowing you and your partner to focus on breathing and bonding. If the monitor’s beeping is distracting, ask the nurse to turn down the volume or mute it—this is a common request, and most hospitals are happy to accommodate.

If you have a preferred position—such as side‑lying, hands‑and‑knees, or upright walking—let the staff know. Comfort measures not only help you cope but can improve uteroplacental blood flow, which may positively influence the tracing. For example, if you’re lying on your back and the tracing shows variable decelerations, simply rolling onto your side might improve the pattern. The team can help you find a position that’s comfortable *and* keeps the tracing reassuring.

It’s also a good idea to ask the nurse to explain what they’re seeing on the monitor. Most nurses are happy to give you a quick update, like “The baby’s heart rate is steady at 140, and the contractions are coming every 3 minutes—everything looks great.” This can help you feel more connected to the process and less anxious about the unknown.

Finally, don’t be afraid to ask questions if something doesn’t feel right. For example, if the monitor keeps slipping off or the tracing is hard to read, let the nurse know—they can adjust the sensors or switch to a different monitoring method. Your comfort and confidence are just as important as the technical details of the tracing.

How to advocate for yourself during fetal monitoring

Fetal monitoring can feel overwhelming, especially if the tracing isn’t reassuring. But you have the right to understand what’s happening and to be involved in decisions about your care. Here’s how to advocate for yourself—and your baby—without feeling like you’re overstepping:

1. Ask for clarification: If the team uses medical jargon, don’t hesitate to ask for a plain-language explanation. For example, if they say, “We’re seeing minimal variability,” you might ask, “What does that mean for my baby, and what are you going to do next?” Most providers are happy to explain things in a way that makes sense to you.

2. Request a summary of the tracing: After each monitoring check, ask the nurse or provider to give you a quick summary. For example, “The baseline is 135, variability is moderate, and we’re seeing occasional variable decelerations—this is a Category II tracing, but it’s stable for now.” This can help you feel more informed and less anxious about the unknown.

3. Understand the plan: If the tracing is Category II or III, ask what the next steps are and how long the team will wait before intervening. For example, “If the tracing doesn’t improve in 30 minutes, what will you do?” Knowing the plan can help you feel more prepared and less caught off guard if things escalate.

4. Speak up about your preferences: If you have strong feelings about interventions—like wanting to avoid a cesarean section if possible—let the team know. They can work with you to explore alternatives, like repositioning or amnioinfusion, before moving to more invasive options. However, keep in mind that some situations (like a Category III tracing) require immediate action, and your preferences may need to be balanced against the baby’s safety.

5. Bring a support person: Having a partner, doula, or family member with you can help you feel more confident and less alone. They can also help you remember questions to ask or advocate for you if you’re feeling overwhelmed. For example, if you’re in pain and struggling to focus, your support person can ask the team to explain the tracing or the plan.

6. Trust your instincts: If something doesn’t feel right—like the monitor keeps beeping or the team seems unusually concerned—speak up. You know your body and your baby better than anyone, and your intuition is a valuable tool. For example, if you feel like the baby isn’t moving as much as usual, let the team know—they can check the tracing or perform an ultrasound to reassure you.

Advocating for yourself doesn’t mean you have to be confrontational. Most providers appreciate patients who are engaged and informed, and they’ll work with you to make sure you feel comfortable and confident in your care. If you’re ever unsure about something, a simple “Can you explain that again?” or “What are my options?” can go a long way.

The role of technology in fetal monitoring: what’s new?

Fetal monitoring has come a long way since the first electronic monitors were introduced in the 1960s. Today, new technologies are making monitoring more accurate, less invasive, and even portable. Here’s a look at some of the latest advancements and what they might mean for your labor:

Wireless monitoring: Traditional fetal monitors use cables to connect the sensors to the machine, which can restrict movement. Wireless monitors, like the Monica AN24 or the Novii Wireless Patch System, use Bluetooth or other wireless technologies to transmit data, allowing you to move freely during labor. These systems are especially helpful if you want to walk, use a birthing ball, or take a shower while still being monitored. However, wireless monitors aren’t yet standard in all hospitals, so check with your provider to see if they’re available.

Remote monitoring: Some hospitals now offer remote monitoring, where the fetal heart rate and contractions are transmitted to a central station or even to your provider’s smartphone. This can be especially helpful in rural or underserved areas, where specialists might not be on-site. Remote monitoring can also reduce the need for transfers, as providers can review the tracing and make recommendations from afar. However, it’s important to note that remote monitoring still requires a trained provider to interpret the tracing and make decisions about care.

Artificial intelligence (AI): AI is being used to analyze fetal heart rate tracings and predict which ones are likely to worsen. For example, some AI systems can flag tracings with subtle changes that might not be obvious to the human eye, allowing providers to intervene earlier. While AI isn’t yet widely used in clinical practice, it’s an exciting area of research that could improve outcomes in the future. However, it’s important to remember that AI is a tool, not a replacement for clinical judgment—your provider will always have the final say in your care.

Fetal ECG monitoring: Traditional fetal monitors use Doppler ultrasound to detect the baby’s heart rate, which can be affected by movement or maternal body habitus. Fetal electrocardiogram (ECG) monitoring,