Why Checking a Baby’s Heart Rate During Delivery is So Important
Doctors monitor and test expectant mothers during their prenatal visits. They also check on the baby’s well-being using ultrasounds and devices that check their heartbeat.
Fetal heart rate monitoring often becomes critical when labor and delivery begin. During labor, the fetal heart rate can signal that the baby is in fetal distress and trying to compensate for a reduction in oxygen or blood flow. When fetal monitoring strips show signs of fetal distress, doctors, nurses, and midwives must immediately intervene to prevent oxygen deprivation and address reduced blood flow to the baby’s brain.
Parents of a baby showing symptoms of birth injury, including cerebral palsy, may not realize that healthcare providers could have prevented or reduced their child’s injury through proper fetal heart monitoring.
Let’s start by understanding the baby’s heart rate.
The Significance of Fetal Heart Rates
The fetal heart rate does not just tell us how the baby’s heart is doing. It’s also a sign of the baby’s overall health status.
Most of the time, an abnormal fetal heart rate indicates a condition like oxygen deprivation, shock, or infection that could affect the fetal brain. Unless doctors and other medical staff intervene, the baby could suffer from a complete lack of oxygen (“asphyxia”) or a dangerously decreased oxygen (“hypoxia”). When either asphyxia or prolonged hypoxia occurs, a baby can suffer a severe birth injury, including hypoxic-ischemic encephalopathy (HIE), metabolic acidosis, or cerebral palsy.
The average fetal heart rate ranges between 110 and 160 beats per minute. The heart rate can vary from five to 25 beats per minute, which is a sign of a healthy baby.
Why Monitor Fetal Heart Rates During Labor?
The baby’s heart rate fluctuates during labor. Some changes are normal and not cause for alarm. However, certain patterns of decelerations, changes in the heart rate, or variability during labor signal medical providers that something’s wrong.
Common issues that can affect the baby’s heart rate include:
Regardless of the situation, fetal heart monitoring is an essential tool during childbirth. When done correctly, the results of monitoring alert obstetricians, maternal-fetal medicine specialists, nurses, midwives, and other healthcare professionals that the baby could be in fetal distress.
Three Kinds of Fetal Heart Monitoring
Some mothers enter labor with few signs that they might have complications. Still, even women with low-risk pregnancies will be monitored during labor. In fact, fetal heart monitoring is the most common obstetric procedure performed in the United States. But the methods her physicians use might differ based on a mother’s medical condition.
In years past, her medical team would use only intermittent auscultation unless there were signs the baby was not doing well. “Auscultation” means listening to someone’s body sounds, including those made by their lungs and heart. Doctors, nurses, and midwives typically used special stethoscopes to check the baby’s heartbeat.
Now, the standard of care has changed due to the development of new technology. Healthcare providers use an electronic Doppler transducer attached to the mother’s abdomen to monitor the baby’s heart rate. Sometimes another transducer is attached to the baby’s scalp for closer monitoring. The transducer sends and receives sound waves, then amplifies the sounds created by the baby’s heartbeats.
This type of electronic fetal heart rate monitoring is divided into two parts:
External monitoring: When a mother arrives at the hospital, staff members place two belts around the mother’s abdomen. Transducers on the belts electronically monitor the fetal heart rate and maternal uterine contractions
Internal monitoring: This method can only be done when the mother’s water has broken. The doctor or nurse will insert a wire through the cervix and into the mother’s uterus. They then attach an electrode to the fetus, usually on the scalp. Data transmitted by the electrode helps doctors monitor the baby more closely.
Doctors may also insert a catheter into the mother’s uterus that checks uterine pressure during contractions.
A new, wireless fetal heart monitor is available at some hospitals or for at-home use. As technology develops, these wireless monitors might be useful in telemedicine during online doctor’s appointments and in hospital settings during childbirth.
Only trained staff members should use fetal and maternal monitoring equipment. When monitoring is performed incorrectly, or medical staff misinterprets or ignores the results – the result can be severe brain damage, hypoxic-ischemic encephalopathy (HIE), cerebral palsy, or, in severe cases, death.
What Fetal Heart Monitoring Results Mean
Physicians and other medical providers caring for an expectant mother know the importance of fetal heart monitors. But medical negligence or poor training can cause warning signs to be overlooked.
When analyzing a fetal heart tracing in conjunction with uterine contractions, staff members start with the baby's baseline rate. This number ranges from 110 to 160 beats per minute (bpm). Medical staff may mention two types of abnormal heart rate: tachycardia and bradycardia.
Tachycardia means the baby’s heart rate is over 160. This increase is potentially dangerous for the baby. Tachycardia can mean that the baby’s heart is working harder than normal to pump blood and oxygen to the rest of the body to compensate for low oxygen levels. A sustained fast heart rate puts babies at risk for cardiovascular failure.
Bradycardia means the baby has a potentially dangerous slow heart rate. This condition can be caused by fetal oxygen deprivation, which can be caused by complications like uterine tachysystole or hyperstimulation, placental abruption, or uterine rupture. Maternal health issues like hypotension or seizures can contribute to bradycardia.
Then medical professionals look for the following patterns:
Accelerations
Decelerations
Variability
Accelerations show up on the fetal heart tracing as an abrupt increase from the baby’s baseline rate. Most accelerations are normal and indicate that the baby has enough oxygen. When accelerations are absent and other abnormal signs exist, the baby is suffering or has suffered a birth injury caused by oxygen deprivation.
Decelerations (also called decels) are decreases in the baby’s heart rate, but there are several types:
Early decelerations occur as the mother’s contraction peaks. These can often happen as the baby passes through the birth canal because of pressure on the baby’s head. Early decelerations are usually not a sign of fetal distress.
Late decelerations begin after the contraction peaks or after the contraction is finished. Recurrent decelerations that cannot be corrected with interventions are glaring signs that the baby is in trouble, and an emergency C-section is necessary.
Variable decelerations show as jagged, exaggerated dips in the fetal heart rate. This usually means the baby’s umbilical cord is being compressed, cutting off oxygen to the fetal brain. These can be dangerous signs, especially when coupled with decreased variability. A C-section might be needed to prevent brain damage and asphyxia when this happens during labor.
Variability refers to differences in the fetal heart rate over several minutes. A baby’s heart might accelerate or decelerate but should return to or near its baseline rate. When fetal tracings are flat—showing minimal or absent variability (less than 5 beats per minute), it can mean the baby has or is suffering from a lack of oxygen.
Medical professionals should watch for several types of variability:
Absent Variability
Minimal Variability – below 6 bpm and absent when nonvisible (increased risk of fetal acidemia)
Moderate Variability – presence of accelerations and no decelerations (6-25 bpm) Healthy baby
Marked Variability – may represent an increased response due to a stressful event
Normal fetal heart rate (baseline): approximately 110 bpm - 160 bpm Slow fetal heart rate (bradycardia): under 110 bpm Fast fetal heart rate (tachycardia): more than 160 bpm
Acceleration and deceleration fetal heart rate patterns in response to contractions are signs of the baby’s overall well-being. Doctors and nurses can tell if the baby is not getting enough oxygen or blood to their brain.
Classifying Fetal Heart Rates
Medical professionals must communicate clearly and efficiently about a patient’s status. This is particularly true in the type of emergency situations obstetricians, midwives, and nurses encounter during labor and delivery.
The following method of classifying fetal heart rates should assist them in quickly identifying and addressing problems.
Category I: The baby’s baseline heart rate is normal, between 110 and 160 beats per minute, with good variability and no variable or late decelerations. This reading usually means the fetus has a normal acid-base status which means they have not or are not suffering from a lack of oxygen. Unless there are signs of complications, medical staff usually do not need to intervene.
Category II: The fetal heart rate monitoring strips show any one of the following:
moderate variability with recurrent late or variable decelerations
minimal variability with recurrent variable decelerations
absent variability without recurrent decelerations
bradycardia with moderate variability
prolonged decelerations
tachycardia
A Category II Fetal Heart Rate Strip is a worrisome sign that the medical staff must closely evaluate. Category II readings that persist – especially when delivery is not near – could indicate that the doctor should perform a C-section to avoid subjecting the baby to prolonged potential hypoxia.
Category III Fetal Heart Rate Strip: When the fetal heart rate falls into this category, the baby needs immediate attention. The fetal heart tracings will show:
Minimal or absent fetal heart rate variability and
• Recurrent late decelerations
• Recurrent variable decelerations
• Bradycardia (slow heartbeat)
Sinusoidal patterns indicate conditions like intrauterine bleeding, severe fetal anemia, Rh disease, severe oxygen deprivation
Babies in Category III often need to be delivered as quickly as possible using assistive delivery methods. Under almost all circumstances, this means performing an emergency C-section.
With Category I or Category III readings, the baby’s status is easier to determine. A heart rate classified as Category I probably requires no intervention. On the other hand, Category III requires immediate attention to prevent or minimize birth injury.
Category II is more difficult to understand – the baby might or might not be in distress. But a baby’s healthcare providers should be concerned when the baby’s heart rate is Category II. Doctors, labor and delivery nurses, and other medical professionals must conduct further monitoring and testing to determine if the Category II strip does indicate fetal distress.
Medical staff can try interventions with a Category II baby. However, they must deliver the baby when interventions do not work and the heart rate falls into Category III. If obstetricians and delivery nurses fail to act, the baby can suffer a lifelong birth injury, including hypoxic-ischemic encephalopathy or cerebral palsy.
Where Medical Providers Can Go Wrong
An expectant mother usually has a team of medical professionals guiding her and her baby through labor and delivery. And childbirth usually occurs in hospitals and other facilities that should have trained staff and adequate equipment.
Even so, the doctors, nurses, midwives, medical staff, and hospitals make mistakes that harm mothers and babies.
Physicians and midwives sometimes fail to observe a mother’s progress through labor. It’s especially critical for them to pay attention to the fetal rate heart monitoring strips and other signs that a baby is in fetal distress. In addition, they must consider the baby and mother’s overall medical condition. When they fail to do so, babies can be born with preventable brain damage, hypoxic-ischemic encephalopathy, and cerebral palsy.
Nurses typically watch the fetal heart tracings and report back to the doctors. Overlooking troublesome test results and failing to report them to a mother’s physician or midwife can contribute to any birth trauma the baby suffers.
Hospitals have a responsibility to provide safe, effective care to their patients. But sometimes they fail to train staff properly. Fetal heart monitoring is too important to be performed by untrained or undertrained personnel. Also, many hospitals are understaffed. When there are not enough adequately trained nurses and other providers in Labor and
Delivery, will patients get the care they need?
When hospitals fail to have a properly trained staff, signs of fetal distress on fetal monitoring strips can be missed. In such cases, state medical malpractice laws allow for a recovery not only against the nurses and doctors but also the hospital where the malpractice took place.
Is Your Child’s Birth Injury the Result of Medical Malpractice?
The parents of children who suffered birth injuries often want answers. They want to know what happened to harm their child’s brain. Were there signs on the fetal monitoring strips that were missed or that were seen but not properly responded to by the doctors and nurses?
We diligently investigate the facts and hold responsible parties accountable by pursuing medical malpractice claims against them. We are trained to review the fetal monitoring strips with a fine-tooth comb—just like the medical providers should have been doing during your delivery. We have a team of nurses experienced in birth injury that assists us in not only reviewing the fetal monitor strips but the entire labor and delivery and newborn medical record chart.
When we find the necessary evidence, we pursue every means possible to obtain you and your child appropriate compensation. The compensation our clients receive helps them pay for their child’s current and future medical treatment, assistive technology and equipment, and the other expenses associated with caring for a child with brain injuries, seizure disorders, and cerebral palsy.
Sometimes families are nervous to talk to lawyers about their child’s case. Others may simply feel consumed by their circumstances and unable to participate in a lawsuit involving their child’s birth injury. We are here to take a large part of that burden off of you and your family.
Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?
The only way to find out if you have a birth injury case is to talk to an attorney who understands birth injury.
At Miller Weisbrod Olesky, a team of committed professionals uses our detailed case review process to assess your potential claim. They start by learning more about you and your child.
Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.
If we feel medical malpractice was present, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.
At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.
