Fetal Heart Rate Patterns And Your Baby’s Well-Being

Young happy woman lying on a bed in a hospital while doctor setting a cardiotocography sensor to examine fetus heartbeat stock photo

Written By: Richard Halpern, Senior Counsel & Lawyer

Injury to a newborn can occur any time during pregnancy, during labour and delivery or in the first hours of life. In a Birth Trauma medical malpractice case, it is essential to determine whether the injury occurred during labour and delivery. Evaluating the Fetal Heart Rate pattern during labour is essential in determining whether the baby was injured during labour.

How is the baby's heart rate monitored?

Monitoring the fetal heart rate during labour is essential. Information about the fetal heart rate provides vital information about how well the baby is coping with the stress of labour and whether there should be any concerns about fetal oxygenation. The obstetrical nurse is required to assess the fetal heart at regular intervals throughout labour.  The nurse must record all findings and interpretation from each assessment in the records. There are two ways to monitor the fetal heart during labour. The first is to listen periodically with a handheld device, called intermittent auscultation (IA). The second is to have continuous assessments using an electronic fetal heart monitor (EFM). Most labours today are monitored by EFM. IA is only appropriate in low-risk pregnancies but tends not to be used in most labours. At the same time as the fetal heart rate (FHR) is monitored, so must the uterine contractions.  Accurate interpretation of the fetal heart rate depends on assessment of the corresponding uterine activity. The use of IA is promoted in low-risk pregnancies, but the fact is that IA provides less data about the fetal heart rate than EFM. It is clear that, in the face of any abnormal features in the fetal heart rate, the nurse is required to switch from IA to EFM to get a clearer picture of fetal well-being.

EFM provides information about how your baby is coping.

EFM provides a "tracing" of the fetal heart rate pattern that is printed on a continuous strip of graph paper. There is also a tracing of the uterine contractions that corresponds to the fetal heart rate patterns on the same tracing. Specific fetal heart patterns are known to be reassuring signs of a healthy well-oxygenated baby.  These patterns are to be characterized as "normal."  Other patterns are more worrisome and can be indicative of possible problems with fetal well-being that may need to be addressed. Some patterns should be considered ominous and require immediate action by your obstetrical care team. These latter patterns are to be characterized as "atypical" or "abnormal." Fetal heart rate patterns are assessed and interpreted by midwives, nurses and physicians. Where a pattern is normal, it is safe to allow the labour to continue to achieve unassisted vaginal delivery. On the other hand, where the pattern deviates from normal, either atypical or abnormal, there are specific steps that must be taken to protect the baby from harm. If these patterns occur, safe vaginal delivery may not be feasible, and the baby may have to be delivered quickly.

Does EFM show signs of fetal stress?

Labour is stressful for the fetus, but a healthy fetus is very resilient and capable of withstanding the usual stress of labour. The key to fetal well-being during labour is to ensure a well-oxygenated fetus. During uterine contractions, the supply of oxygenated blood to the fetus can be diminished, and between contractions, the healthy fetus recovers. Potential problems with fetal oxygenation will be reflected in changes in the fetal heart rate. Oxygen is transferred to the fetus through the mother's uterus, the placenta and delivered in the blood through the umbilical cord. When the uterus contracts, there can be a temporary interruption in blood flow to the fetus and a brief pause in the supply of oxygen. These periodic interruptions in oxygenation are followed by periods of rest that, in normal labour, allow the fetus to recover.  Where oxygenation is interrupted for too long, it may be difficult for the fetus to recover. Uterine contractions that last too long, that occur too frequently, or that do not permit sufficient time to rest between contractions can cause fetal stress and changes in the heart rate pattern. Where these patterns occur, they require the attention of the obstetrical care provider and, in some circumstances, action to protect the fetus from undue stress and potential injury.

Reduced oxygenation is revealed as changes in the heart rate pattern.

Where fetal oxygenation is reduced, the fetus will communicate this through certain changes in the fetal heart rate pattern. The fetal heart rate patterns can be seen on the fetal heart tracing, which is a continuous chronological record in real time. A normal pattern is reassuring for fetal well-being. A pattern that is either atypical or abnormal is non-reassuring for fetal well-being. Non-reassuring fetal heart rate patterns must be detected by the obstetrical team, adequately interpreted and responded to appropriately. These patterns may reflect excessive fetal stress that, if not addressed, might expose the fetus to the risk of severe neurological injury. Action must be taken to relieve the cause of fetal stress. The fetal ability to cope with hypoxic stress is significant, but not unlimited. In the setting of patterns suggesting excessive fetal stress, it is mandatory to take steps to reduce that stress and see the FHR pattern returns to normal. Where action is taken to relieve fetal stress, and the pattern fails to return to normal within a reasonable time, the obstetrical team must take further action to get the baby delivered quickly. It should be made clear that the goal of EFM is to detect potential harm based on fetal heart rate patterns and to intervene before an injury occurs. Interventions may be as simple as maternal position changes or reducing uterine activity by turning off oxytocin. In some cases, more dramatic steps are required, including expedited delivery by cesarean section. Unfortunately, there are times where the obstetrical team fails to act as quickly as they should, allowing these alarming patterns to develop and continue. In these situations, the newborn may suffer injury to the brain that may have been avoidable with proper care. In a Birth Trauma medical malpractice case, the fetal heart rate patterns are essential for determining the cause and timing of the injury to the baby. The patterns help one to understand what errors occurred during labour and delivery and what should have been done to avoid the injury. In a Birth Trauma case, EFM patterns will allow the experts to refine the timing of injury once experts in neuroradiology and neonatology have described the window of opportunity for injury and how the injury occurred. Pulling together the evidence needed to prove a case requires coordinating multiple experts to deliver opinions that complement each other. Interpretation and evaluation of the fetal heart rate pattern are essential to establishing a Birth Trauma case. One of the most critical functions of the Birth Trauma lawyer is to pull together the evidence pointing to the injury's timing. Fetal heart rate patterns and their interpretation are vital to proof of the case.

How a birth injury lawyer can help

When a medical practitioner is negligent or fails to meet the applicable standard of care in monitoring the fetal heart rate, and it leads to a preventable birth injury, you can take legal action. As one of the country's top personal injury firms, Gluckstein Lawyers understands what it takes to put together a strong case for medical malpractice, and Birth Trauma in particular. At Gluckstein Lawyers, our commitment to full circle care always begins with a free initial consultation. If you're in doubt about what happened, pick up the phone and give us a call. Whether you opt to file a claim or choose another way to get a sense of closure, we're here to help you know your rights and to give you the tools you need to make an informed choice. To learn more about how our firm can help contact us.


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