A major part of midwifery care during labour is listening to and recording your baby’s heartbeat to help identify if there are any problems.

Most babies come through labour without any problems, but there are a few babies who run into difficulties. The best way of finding out which babies are having trouble is to listen to every baby’s heartbeat regularly throughout labour.

What is the midwife listening to?

The normal range for the rate of the baby’s heartbeat is between 110 and 160 beats a minute, although this can be higher or lower without meaning that the baby is in difficulty. The variation in the baby’s heart rate may be caused by the womb contracting, which affects the blood flow to the placenta (afterbirth). This is normal and most babies cope without any difficulty.

If your baby is not coping well, this may well be reflected in the pattern of their heartbeat.

As well as monitoring your baby’s heartbeat, your pulse (heartbeat) will also be checked in order to tell the difference between them.

How is my baby’s heart rate is listened to and monitored?

Your baby’s heartbeat can be listened to in a number of different ways, either at regular intervals (intermittent auscultation) or continuously (electronic fetal monitoring (EFM).

Intermittent auscultation - is where your baby’s heart beat is listened to at regular intervals with either a pinard or a small hand-held ultrasound device called a Doptone. If you are healthy and have had a trouble free pregnancy this is the recommended way of listening to your baby’s heartbeat during labour. When pregnancy and labour are uncomplicated, research has now shown that the use of continuous Electronic fetal monitoring does not improve the outcome for the baby.
Midwives and doctors listen to your baby’s heartbeat over a full minute, every 15 minutes once your labour is established and then more frequently as you get nearer the birth.

Continuous Electronic Fetal Monitoring (EFM) - is where your baby’s heart beat is listened to continuously using a machine that produces a paper printout called a cardiotocograph (CTG). The EFM machine works by having two pads (transducers) each about the size of a drinks coaster, held in place on your abdomen with two elastic belts. One is placed towards the top of your abdomen, so that is lies over the upper end of your womb(uterus) to pick up your contractions; the second one will be positioned on your abdomen, over the area where your baby’s heartbeat can be heard best.

The information received by the transducers is converted by electronics within the machine to produce a graph. EFM using the two external transducers is a non-invasive method. Sometimes, for reasons which would be explained to you, the baby’s heart beat is picked up by using a small electrode which is placed onto the baby’s head, and attached by a thin wire to the machine, and this would mean you would need to have an internal (vaginal) examination in order for this to happen.

Which method will be used?

If, when listening to your baby’s heart beat with a pinard stethoscope or doptone device, your midwife or doctor thinks there may be a problem, they may recommend that you change to EFM. If you are in labour at home, you will need to transfer to the Central Delivery Suite for EFM.

If you have had problems during your pregnancy and the midwives or doctors have some concerns about how your baby will cope with labour, they may recommend the use of EFM as soon as you have regular contractions and your labour is becoming established. National guidelines (NICE - National Institute for Clinical Excellence) recommend the use of EFM in the following circumstances:

• Your baby (from external assessment) seems smaller than expected
• You have high blood pressure
• You are expecting twins or triplets
• You had a caesarean birth with any of your previous pregnancies
• Your labour has been induced for any reason on this list.
• Your baby is overdue (more than 42 weeks)
• Your baby is premature (before 37 weeks).

Other factors that may affect your decision about which type of monitoring to choose are the method of pain relief (intermittent or continuous use of EFM is recommended with an epidural), or a ‘drip’ (infusion into a vein) to start (induce) or speed up labour. In these instances your midwife will recommend EFM.

EFM will also be recommended in the following circumstances:

• You have a health problem such as; Diabetes; problems with your heart or kidneys or infection
• Your baby is breech presentation (going to be born bottom first).

What are the benefits and risks?

Listening to your baby’s heart beat in labour is standard normal practice and is for the benefit and wellbeing of you and your baby. In certain situations, as described earlier, the extra information provided by EFM may be appropriate to further monitor your baby’s wellbeing. EFM in itself has no known risks, but when internal EFM is used there may be a very small risk of infection. EFM may also restrict your mobility in labour which may not be helpful, although there is no need for you to be immobile.

If your baby is being monitored by EFM and it shows a problem with the baby’s heartbeat, you may be offered a test called fetal blood sampling. In this test a small sample of blood is taken from the baby’s scalp and tested for the amount of oxygen. This test is performed during an internal examination and it is recommended as being the most accurate way of detecting whether your baby is in difficulty. The doctors can use this information to decide whether your baby needs to be delivered by caesarean birth or it may prevent an unnecessary caesarean birth.

Do I have a choice on the type of monitoring?

It remains your choice as to what kind of monitoring you have during your labour. It might be helpful to consider:

• The hand held doptone can be used whatever position you are in; you can therefore move around as much as you like during labour and it can also be used if you are labouring in water.
• EFM will limit your movement, although you can stand up or sit in a chair, but you may need to ask your midwife for assistance. However, there are electronic monitors available, sometimes, which use a “telemetry” process to pick up the baby’s heart rate and your contractions and this means you will be able to be more mobile e.g. walk away from the monitor, as there will be no leads coming from the transducers around your abdomen (tummy).

If you would like to know more about monitoring your baby’s heart beat during labour please discuss with the midwife.

What affects my breathing in labour?

• Excitement
• Pain
• Tiredness
• Worries/anxiety
• Fear
• Contractions.

All of these responses may be experienced during labour. These feelings may change your normal breathing pattern in either of these ways:

• Breath holding
• Panic breathing (hyperventilation).

These may make you more tense, frightened and anxious.

Breathing for the first stage of labour

Contractions are felt as the uterine muscles tighten and the muscles of the cervix relax and open. Some may be experienced as backache, aching in legs or similar to deep cramp of period pain. It is important to maintain a regular breathing pattern to assist the uterus by:

• Relaxing
• Listening to your breathing
• Use a phrase with your breathing.

‘Sigh Out Slowly’ (SOS)

‘Breathe in through my nose and sigh out through my mouth’ (in 2,3 out 2,3).
Breathe in through your nose and imagine, as you sigh out, that you are causing a candle flame to gently flicker.

You may find it useful to greet the contraction with a sigh and end with a sigh.

You and your birth partner

Practice breathing together, before the birth.

You

• Imagine a contraction is arriving
• Greet the first discomfort with a sigh
• Relax and breathe through the pain
• End with a sigh.

Your birthing partner

• Can time your breathing for you, to practice the length of contraction
• Can learn to breathe at the same rate as you
• Can help to remind you of a phrase if you are using one for labour
• Can help you to concentrate on your breathing and relaxation throughout labour.

Breathing and relaxation through a contraction will help release endorphins (the body’s own natural pain reliever) and ease your discomfort.

Breathing for second stage of labour

During the second stage of labour, you need to use your breath control to help push your baby out. Work with your body, listen to what your body is telling you. Your midwife may feel she can help you with this. Try to relax your pelvic floor muscles and not hold your breath while pushing.

As the baby begins to emerge, stretching the perineum, the midwife may ask you to stop pushing. Panting can sometimes help you with this.

Either slow panting or gentle blowing (just hard enough to make a candle flame flicker) will allow the baby to emerge slower and the midwife will be able to control its arrival whilst trying to avoid tearing.

Body Mass Index (BMI) is a measure of your height and weight and indicates if you are overweight. Pregnant women with a BMI over 35 are at higher risk of complications than those with a normal BMI (20-25).

However, with careful planning and discussions with your midwife, obstetrician and anaesthetist these risks can be kept as low as possible. We need your help to do this and we might suggest certain things. 

If your BMI is over 50 we will book you an appointment with a consultant anaesthetic doctor to discuss any concerns you or we might have. We will aim to do this in the final few weeks of your pregnancy before you go into labour.

If your BMI is over 40 but less than 50 an anaesthetic doctor will visit you when you come into Southmead Hospital in labour. If you wish to see an anaesthetist earlier in your pregnancy you are very welcome to ask for an appointment in antenatal clinic and in some cases, your obstetrician may advise an appointment.

Is there anything I need consider?

Women who have a high BMI have as much as twice the risk of needing a Caesarean Section delivery of their baby and this may need to be done as an emergency for the birth of their baby. A high BMI can cause problems when you have a general anaesthetic (go to sleep) for an operation. In most cases it is safer for you to have an epidural or a spinal block if you need a Caesarean Section birth. This means an injection is given into your back to make your lower body numb.

You are awake for the operation and this has many advantages for you and your baby however, making you numb in this way can be difficult if you have a high BMI. It may be harder to find the correct place to put the needle in your back than if your BMI was lower, and sometimes it is more difficult to get the numbness to work straight away.

There are times when we need to deliver your baby as quickly as possible. If you have already had an epidural put in during your labour, and it is working well, we can often use it to give very quick anaesthesia (numbness) for a Caesarean birth, or if we need to deliver your baby using forceps or ventouse (suction cup). This cuts down delays and reduces the chance of you needing to have a general anaesthetic (go to sleep) in an emergency.

For this reason, if your midwife or obstetric doctor feels that your labour is not entirely straightforward, we normally suggest that you should think about having an epidural sooner rather than later in labour. This allows the anaesthetist more time to put it in and to make sure it is working well for you.

Can I eat during labour?

We will give you medication to reduce the acid in your stomach during your labour. We strongly recommend not eating any food or having fizzy drinks when you are in labour. Water and sports isotonic drinks are much safer. We suggest that you bring a couple of bottles with you when you come in to hospital in labour.

What are the risks of blood clots/DVTs?

From the start of pregnancy you have been at a higher risk of getting a blood clot in your legs. Whilst you are moving around your risk is lower but during labour, and in the few days after your baby is born, you may be in bed a lot more.

To reduce the risk of clots we may need to give you:

• Elasticated stockings
• Heparin injections once or twice a day to thin your blood for 7 days after the birth. We will teach you and/or your partner how to do this, if appropriate.

For more information visit www.nhs.uk/conditions/pregnancy-and-baby/pages/overweight-pregnant

During pregnancy your baby’s brain is developing and growing very quickly. While you are pregnant you can help your baby’s brain to grow as you start to get to know your baby. Here are some suggestions:

• stroking your bump
• talking to your baby/singing/playing music that you like
• thinking about your baby and talking with your partner and other close family about your baby.

Try and take a little bit of time each day when you can sit and talk to your baby. When you do these things you release hormones that help healthy development and growth of your baby’s brain. 

If you have any questions about feeding your baby please talk to your midwife. If you have any particular concerns about feeding your baby your midwife can refer you to the infant feeding specialist midwife.

For more information:

• Building a Happy Baby www.unicef.org.uk
• Off to the best start - information about feeding your baby 

Community Midwives and Maternity Support Workers (known as MSW’s) will care for you during your pregnancy and in the early days when you are at home with your baby. The MSW’s work under the direction of the Community Midwives who coordinate your care and they work together to support you until your baby is approximately 10 days old, when your care is then transferred to a Health Visitor.

The Community Midwifery teams are based at a variety of places such as GP surgeries, Health Centres, Clinics or Children’s Centres. Where you see yours will depend on where you live. 

Maternity Notes

Once you have completed our online self-referral form, a member of the booking team will be in contact with you to set up access to your maternity notes. At NBT we use digital notes called Badger Notes, which can be accessed on the web or an app on your phone. Find out more about Badger Notes.

Contacting Your Midwifery Team

For general advice about your pregnancy, your baby or your appointments please contact your Midwifery Team. Monday to Friday calls will be dealt with within 48 hours. The telephone numbers can be found within the ‘hospital contacts’ tab of your Badger Notes or by visiting the Contact Maternity Services page on our website. Remember; you can also get general health advice from your GP service or NHS 111.

Many parents choose to support Maternity Services at Southmead through fundraising or donations to mark the birth of their child or as a thank you for the care they received.

Fundraising and donations to maternity through Southmead Hospital Charity contribute to projects like these which have already made a huge difference to mums and babies.

Improving facilities - improving labour and post-labour wards create better environments for mums and babies. Last year the charity funded a £120,000 new family room. New equipment like birthing pools and ongoing general refurbishments are now needed.

Balloon Mural - Since 2016, our balloon mural has taken pride of place in the Mendip Ward with hundred of families adding a balloon to celebrate the arrival of their children in return for a donation to maternity services. Our Charity is planning to refresh and improve its appearance to encourage more families to join the mural and more donations that will support parents, babies and the staff that care for them. If you're an existing supporter and would like to know more about the plans, please get in touch with Southmead Hospital Charity on southmeadhospitalcharity@nbt.nhs.uk. We hope to welcome new families to the mural in early 2024, with more information coming soon. 

Visit our charities website to find out more about how donations support maternity services and our hospitals.

You can donate online to support maternity services or call the Charity team on 0117 414 0170.

Three-quarters of the 800 beds in the Brunel building are single rooms. The most striking feature of the single rooms is how spacious they are; each single room is 16.6sqm in floor area with the en-suite toilet and shower being 5.3sqm.

Their size means that we’ve been able to incorporate features that make nursing more efficient and this means better care for our patients. Put simply, the ample space means we’ve been able to make it easier to work.

Each 32-bed ward has 24 single rooms and two four-bed bays. We know that single rooms provide considerable benefits for patients, including control of infection, reducing risk of clinical errors (there are fewer distractions) and allowing privacy.

Each room has a wall-mounted medication cabinet, overhead tracking for a hoist, over-bed table, bedside basin, bedside cabinet and a TV. The size of the rooms allow for an electric profiling bed and reclining chair, which can also be used by visitors. A ‘smart-wall panel’ to the side of the bed-head incorporates oxygen, medical air, suction and, in some rooms, monitors. Throughout the room there are multiple power points.

Doorways are angled so that four single rooms can be observed at once and each room has an observation window.

Between each pair of rooms there is a standing perch at which staff can write up notes or enter information electronically while maintaining good observation of patients.
The main nursing stations have a drug preparation area and each has a system of tubes enabling the immediate delivery of drugs to key points. An electric call panel flashes to show the room the patient is calling from.

The 4 bed bays are single sex, spacious and have their own bathroom.

Upon entering the building, one of the most striking elements of the Brunel building is its 280 metre long atrium connecting one end of the building to the other.

This large open space has large areas of glass walls, with different colours marking the different areas, and a fully glazed concourse roof bringing light into this space.
From here you check in using the self-check-in screens available and then take the lifts or stairs to the area required. There is a welcome desk with staff able to help with any questions about check-in.

At the front entrance of the Brunel building, the height of the atrium is the same as the nave of Westminster Abbey and at the other end, where the Emergency Department (ED) is located, as high as Bristol Cathedral’s nave.

Our brief to bidders was less conventional than for other new hospital developments as we wanted this hospital to stand out from the crowd not only for its excellent clinical services but also for its high quality building and site design. Good internal and external design was as important to us as getting the clinical functionality right.

Our strong belief, based on research, is that good design reaps its own rewards in terms of wellbeing and recuperation rates for patients and boosts moral and job satisfaction for staff.

We set out six themes in our strategic design vision which were:

• Innovation and patient care – providing cutting edge design geared for top performance
• Flexibility – design in at the outset the ability for the hospital to respond to changes in the way healthcare is provided
• Welcoming Landscape – apply urban design principles to the development of the whole site, rather than only focusing on the building
• Connecting the inside to the outside – bring views from outside in, get light into the building through glazing and layout and get long views out
• Excellent finishes – high quality, non-institutional building and internal finishes
• Sustainable development – low carbon footprint, sustainable construction practice, waste minimisation.

General Fertility, Reproductive Endocrinology and Surgery 

Southmead Hospital provides a fully funded NHS fertility service now known as Southmead General Fertility Clinic. 

Southmead General Fertility Clinic offers couples with fertility problems a full assessment of factors that may be affecting chances of conceiving. The clinic arranges further tests, provides advice and treatment, and when appropriate referral for assisted conception treatment.

The clinic provides the assessment and treatment for couples below (apart from assisted conception services) as detailed below.

Male and female assessment

• Full range of diagnostic tests.
• Hormone, androgen profiles.
• Ovarian reserve assessment (for example AMH).
• Genetic and chromosome testing.
• Fertility ultrasound scans.
• Tubal testing: hysterosalpingography (HSG), laparoscopy and dye test.
• Repeat semen analysis if required.

Treatments

• Fertility monitoring for clomifene.
• Ovulation induction with FSH and monitoring for anovulation.
• Repair of fallopian tubes.
• Fertility surgery for fibroids and endometriosis.
• Hysteroscopic surgery for Asherman’s or uterine abnormalities.
• Assisted conception treatment advice: expert advice on appropriate treatment options such as IVF/ ICSI/ IUI/ donor sperm.
• Pre-implantation genetic screening.
• Arrange referral for the appropriate assisted conception treatment.

The Southmead General Fertility Clinic complements the excellent range of Reproductive Medicine services provided by the Gynaecology Department at North Bristol NHS Trust including:

• Reproductive Endocrine Clinic (PCOS, amenorrhoea, premature ovarian failure, hirsutism)
• Recurrent Miscarriage Clinic (patients who have experienced 3 or more miscarriages)

Please look at your local ICS referral guidelines for Fertility.

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003774