Fetal Heart Rate dropping in labour...

[halfadozen]

What would you consider a normal drop in fetal heart rate during labour? I have read so many birth stories lately with this commonality, "the baby's heart rate was dropping during contractions so they decided to do a c-section."

Is it normal for the heart rate to drop during a contraction, or does this mean fetal distress? By how much can it drop and still be safe? And is it okay to drop a bit, as long as it goes back up in between contractions? I am interested to hear your experiences and wisdom on this.

Thanks! I am interested since my next baby will be born in the hospital and I want know as much as I can about this possible scenario playing out.

[SalmonBayDoula]

Outside my scope of practice but...

I am not a MW, L&D Nurs or MD. As a doula, fetal heart rate assessment is out of my scope, but I had a couple brief comments and would love to hear from those who do use these as an assessment tool in labor.

1. I have seen and read how so many people can interpret the information seen on a strip of FHR differently, and studies have shown the huge range of interpretation and diagnosi when people have been shown the same strip..

2. Sometimes, it seems that everyone is so focused on what the machines are saying that no-one focuses on the labor and mom!

3. We have only been "looking" at FHR in such detail in the past how many years? (first external monitor is how old?) But maybe, just maybe, some of the things that cause concern have been normal and happening for a million years, and babies are designed to handle it just fine!

4. I have been at birth where, one dip into the 70's and we on our way to surgery, and at another with a different nurse and doc, and they are happy with hours (7-8 hours) of the same dip, with every ctx..."oh, just cord compression, no worries"

5. It is more than how low does it go, but, for how long, how does the baby recover, how quickly does the baby recover, what is the baseline, are there any accelerations too? is it just flat, has the baseline changed, when is the decel compared to the ctx and many other subtleties that others can elaborate on...

6. Many reliable and accepted studies have shown that continious FHR monitoring does not provide more information or a better outcome than intermittent monitoring and is often the reason for unnecessary interventions. See item 3 above...

7. I hate having the machine play such a big part of my clients' labor and encourage them to keep the sound off and the machine turned away from them, so we can labor and proceed using the cues and needs of mom as our guide.

Will appreciate others' comments on this thread!

Best,
Sharon

[mwherbs]

deciding what might need to be done depends on baseline heart rate, variability( short and long term),what stage of labor (other signs ,symptoms), meds being used, contraction pattern and heart rate in relation to contractions.
consistent heart rate dips that bottom out after the contraction is over- are the most concerning dips and indicate poor recovery baby is not handling labor well , oddly occuring dips or certain variability patterns probably the cord is getting compressed -(one baby was squeezing her own cord in labor changing heart rate),

[kate3]

Everyone's baby has decels during labor. But as mwherbs posted, there are so many factors involved in determining whether or not they are concerning. Late decels are always worrisome. Varaible decels occur due to cord compression (common during transition and second stage) any pretty much every baby has them. You need to look at how long the decels go on for and how much of a change there is from baseline. A beautifully reactive strip with some decels is one thing. A change from reactive to flat with decels or change in baseline (ie tachy) with decels is another.

My second had a terrible strip-decels everywhere. I'm quite sure I would have ended with a c/s if my labor had not been really quick. She had a double nuchal cord that was very tight and needed to be resuscitated after birth. Thankfully, she had no long term deficits. But no one would have let that HR pattern go on for hours.

[calpurnia]

Originally Posted by salmonbay

3. We have only been "looking" at FHR in such detail in the past how many years? (first external monitor is how old?) But maybe, just maybe, some of the things that cause concern have been normal and happening for a million years, and babies are designed to handle it just fine!

Pinnards have been found in ancient Egyptian archaeological (sp?) digs, so we have been listening to FHR for a long time.

Interesting thread, I've been wondering about this as well.