CTG = monitoring. As ('monitoring') CTG ist shorter to write, we took the liberty to continue with CTG.

There is a guideline in Germany, Austria and Switzerland  which is closely based on the ‘NICE guideline CG: Intrapartum care for healthy women and babies’. Guidelines are recommendations for hospital staff. We (GreenBirth) provides information so that expectant mothers and parents are aware of the key points as well. Parents are now given significantly more say in decision making than before. This is an important step in the right direction for hospital births. Being well-informed brings peace of mind. Staff can easily tell whether they are dealing with informed or uninformed parents.

Statements from the S3 guideline, summary.
We present the content in non-medical language. Quotations are marked with “…” and numbers. Please note linguistic nuances, such as the difference between “should” and “ought to”.
GreenBirth:
We provide these explanations without claiming to be exhaustive and without guarantee. All emphasis, whether in bold or italics, is by GreenBirth.
Guidelines for hospital admission:
When admitting a woman without increased risk, a CTG should not be performed ‘automatically’. A CTG may and should be omitted during the active stage of labour (cervix 4–6 cm dilated), provided that one-to-one support by a midwife is ensured. Instead of a CTG, the Pinard (stethoscope) should be used, as it offers more advantages than a CTG when used regularly. (5.1)
Note: this text is misleading. There will always be at least a first CTG on admission in order to document the actual condition of the baby and then take decisions for further procedures.

In low-risk births, regular auscultation of the fetal heart rate every 15–30 minutes offers advantages over CTG monitoring. Precondition: Sufficient staff; one-to-one care provided by the same midwife – Experienced staff in heart auscultation using a Pinard (or a Doppler ultrasound scan carried out by a doctor). Heart beats must be recorded reliably as they give information about the baby's wellbeing. The mother’s pulse should also be checked and recorded regularly (5.1). The fact that a CTG is no longer to be automatically administered is a major step forward. However, this is conditional to a one-to-one care provided by the same midwife throughout. We strongly support this key demand, as it is proven that this is the best way to ensure optimal support during childbirth.

A CTG is recommended if labour is to be induced using artificial labour-inducing drugs (oxytocin) or if your own contractions need to be strengthened. From this point onwards, the birth is medically monitored, i.e. placed under medical supervision. The only counteragent is to stay at home (in consultation with your midwife/doctor) until your contractions have properly established themselves. Natural contractions take time to develop. At home, you have the peace and security you need for this unique process.

Induced labour causes the uterine muscle to contract spasmodically. (Induced labour) This is more painful and often leads to the use of medication to relieve the pain. Not every woman can tolerate such pain. The unborn baby also reacts to this, which can be detected in its heartbeat. Therefore this must be monitored using continuous CTG.

Parents need to be aware that in at least 20% of cases, labour-inducing drugs are administered to induce labour or to strengthen existing contractions, even if these are strong enough for a normal labour. Contractions often subside when the surroundings are unfamiliar and untrusted. Autonomous unconscious warning signals play a role in this. Labour-inducing drugs significantly disrupt the natural, autonomous process of childbirth. Both mother and baby react strongly to the effects of the medication. The effects and side effects become more intense as the dose is increased. Artificially induced muscle contractions are considerably more painful than physiological contractions, which are interspersed with pauses that allow both mother and baby to rest and recover. Women often cannot tolerate the pain caused by artificially induced contractions.

Painkillers are then offered as a remedy. These range from mild to highly potent analgesics (PDA) and are by no means without consequences for the children’s experience. The guideline (short version) does not address this issue. It is unclear whether unborn children also experience pain as a result of the medication. Little girls have a uterus. We are not aware of any study that has investigated the effect of labour-inducing drugs on female babies.
In 2013, the manufacturer of Syntocinon (an oxytocin) stated in its package leaflet that postpartum convulsions had been observed in babies. An enquiry to the manufacturer yielded no response. It has not been investigated whether this applies to boys as well, or only girls, with their sensitive little uterus.
We recommend that during the first stage – until the cervix has dilated to 4–6 cm – you stay in the comfort of your own home for as long as possible, in consultation with your midwife or doctor.
In addition, you should do everything you can to familiarise yourself with the place where you will be staying (afterwards,) after admission. Take your time to settle in, move around, and allow yourself the space and time you need. Try to have something familiar with you, such as your own cuddly pillow, or a trusted companion who stays with you and goes for walks with you.

To help your body’s natural contractions to develope, you need rest, dimmed lighting, a sense of security, and the confidence that you can give birth naturally. If you wish to give birth in a hospital, register there in good time so that you do not have to fill in forms when the time comes. To avoid anything that feels strange or unfamiliar, you should already be somewhat familiar with the premises, including the car park and the route to the labour ward. You’ll find it easier to switch off if you feel at ease in your new surroundings. There are things you can do in advance to help with this. Letting go, humming, and tuning out – as you may have heard of or practised before – will then come much more naturally.

Connect with your baby, it can sense when you are close to it in spirit, and when you are comforting and encouraging it both inwardly and outwardly. You and your baby will manage the birth together! Your baby is always with you, and you are with your baby. If you have chosen a sister, friend, mother or doula to be by your side, the same applies here: you are not alone.

05/2025