04/08/2026
Hands-On-Listening (Intermittent Auscultation)
Another fetal monitoring option is intermittent auscultation, which we callhands-on listening. With hands-on listening, the care provider listens to the fetal heart rate for short periods of time at regular intervals. They document the fetal heart rate, rhythm (regular or irregular), any fetal heart rate accelerations, and the depth, timing, and duration of any decelerations (Smith et al. 2016). While listening, the care provider also feels the mother’s contractions by placing a hand on the abdomen, and documents the frequency, duration, and intensity of the contractions.
Hands-on listening alone is used with about 11% of mothers giving birth in U.S. hospitals (Declercq et al. 2014), and is the primary method of checking fetal well-being at planned home births and freestanding birth centers. Most guidelines state that hands-on listening should be done for at least 60 seconds at a time, at least every 15-30 minutes during the active phase of the first stage of labor and at least 5-15 minutes during the pushing phase of the second stage of labor (ACNM 2015). The Society of Obstetricians and Gynecologists of Canada proposes that hands-on listening be done at first assessment and about every one hour during early labor (Liston et al. 2007). See the list of resources at the end of this article for links to several professional guidelines for hands-on listening protocols.
There are several different devices that can be used for hands-on listening during labor (Lewis et al. 2015); (Cascade 2018). The most popular option in the U.S. is probably the handheld fetal Doppler ultrasound device. The fetal Doppler detects the fetal heart motion and converts it to sound, which can be heard out loud. Dopplers can be audio-only or come with a digital display of the baby’s heartbeat. The features of the fetal Doppler include:
*Comfortable for the mother
*Everyone in the room can hear the fetal heart beat
*Can be used in many different laboring positions
*Can be used underwater
*Allows for more personal space
*Does not require wearing uncomfortable belts
*May calculate and display fetal heart rate values
Evidence Based Birth ©️2018