Understanding Fetal Distress - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 13 Old 07-19-2009, 03:21 PM - Thread Starter
 
OMama's Avatar
 
Join Date: Feb 2005
Location: in the moment
Posts: 1,935
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Can someone share with me their working definition of "fetal distress?" Do different providers define this differently or is there a standard definition? Is fetal distress synonymous with non-reassuring heart tones or are these different? Is it fetal distress if heart tones drop below a certain number, even if just for a couple of beats, or is it fetal distress if they stay down for a given period of time--and how long would that time be? Or is it related to some type of pattern? If so, what is that pattern like? I ask because of a recent thread on "pit to distress" and I'm trying to figure out what the significance is of fetal distress and if it always means an automatic cesarean or if some providers will try other measures before going ahead with a cesarean. Thanks!

Amazing Mama Birth Services
CD(DONA) and Birthing From Within Mentor and Birth Doula
OMama is offline  
#2 of 13 Old 07-19-2009, 08:08 PM
 
AugustLia23's Avatar
 
Join Date: Mar 2004
Location: In the present
Posts: 3,576
Mentioned: 3 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
There are several types of hearttones that are classified as fetal distress, which deserve a more complete answer than I can give now. So I will give brief descriptions of the more common types.

When the baby's hr goes up over the baseline over the generally accepted 120-160 bpm, infection and/or dehydration are often the cause. This is tachycardia.

When the baby's hr drops down at the beginning of contractions and recovers relatively quickly, this is early decels, and usually indicates head compression on the descending baby.

When the hr drops with the peak of the uterine contractions, or variable decels, cord compression is often the cause

When baby's hr drops with the end of contractions and doesn't recover well, the baby is having late decels. It indicates placental insufficiency, and a baby that is not handling labor well. Often is accompanied by the thick green pea soup meconium that can cause severe RDS if asirated/inhaled(I've seen this recently, not pretty!).

The the baby's hr loses variability for a long period of time, it may indicate that baby has low reserves for the stresses of labor/birth. Or it could be a sleeping baby. By itself, not generally a cause for concern.

With any types of fetal distress that is far below baselines and sustained could become a serious situation if not watched closely. If the hr pattern and/or other signs are "nonreassuring" but birth is imminent, then it may become an assisted birth, depending on where it is taking place. If the above is occuring, but the birth is a ways off, a c-section is indicated if position changes haven't made a difference.

Non Practicing Midwife, going back to school! Mamma to my 3 loves, living each day to the fullest.
AugustLia23 is offline  
#3 of 13 Old 07-19-2009, 08:26 PM
 
ErinsJuneBug's Avatar
 
Join Date: Nov 2006
Location: Massachusetts
Posts: 1,367
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
There’s an easy acronym to remember - VEAL CHOP

Variable decels = Cord compression (bad)
Early decels = Head compression (normal and fine)
Accelerations = Ok if within the 120-160ish range
Late decels = Placenta insufficiency (bad, obviously)

So variable decels are when the heart rate goes UP above baseline during a contraction then down then Up again above baseline and then returns to normal. If you look on a strip it will look like "shoulders"

Early decels are when the heart rate goes down DURING a contraction. This is totally normal.

Late decels are when the heart rate goes down AFTER a contraction.
ErinsJuneBug is offline  
#4 of 13 Old 07-19-2009, 08:54 PM - Thread Starter
 
OMama's Avatar
 
Join Date: Feb 2005
Location: in the moment
Posts: 1,935
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thank you so much to both of you! This was very helpful!

Amazing Mama Birth Services
CD(DONA) and Birthing From Within Mentor and Birth Doula
OMama is offline  
#5 of 13 Old 07-20-2009, 02:22 AM
 
SalmonBayDoula's Avatar
 
Join Date: Jul 2005
Location: Seattle
Posts: 642
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
also maternal fever can make baby tachy too! (sometimes when mom has been in a hot birth tub for a long time!) Of course fever could be from infection, but sometimes just getting mom out of the tub for a while helps bring the FHT down to the original baseline range again!

Sharon

Birth doula, doula trainer, ican leader, lamaze childbirth educator, and most importantly, mom of 2 great girls!
SalmonBayDoula is offline  
#6 of 13 Old 07-20-2009, 08:53 AM
 
MsBlack's Avatar
 
Join Date: Apr 2007
Location: SE MO
Posts: 3,609
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Yes, thanks for VEAL CHOP--I love acronyms as memnonic device.

I will say that IME, late decels are unlikely to be problematic unless the decel goes on for many seconds and hr does not recover well. Good recovery is key for all types of heart tones--if baby's heart resumes normal baseline and variability btwn contrax, this is very good.

I want to add though, that even if the med ppl believe that late decels are caused by placental insufficiency, we should be EXTREMELY wary of accepting this theory. OBs/staff just hate to think that they might not know what is going on for babies, but sometimes we just don't! Plain and simple. I've seen a fair amount of late decels over time (rarely prounounced or lengthy, and always good recovery), and I can't say that I think any of them could be positively linked to placental insufficiency.

I won't say they never were, but there are some important things to remember here:
It's only a THEORY, with no real proof to back it up. The placenta is an amazingly powerful, resilient, highly competent organ, able to handle quite a lot of stress and disruption while still feeding baby just fine. (no, it's not indestructible, occasionally it's function might truly be insufficient).

Late decels, from what I've seen, are viewed with horror and dismay, a very nearly *certain* sign of impending fetal distress. Simply NOT TRUE.

Heck, my last baby was born in the hospital (first hossie birth)--and my OB let me labor through a couple of hours of very very bad late decels (FHT going down to about 60, several seconds remaining that low, very slow recovery--and there was thick mec present). I remained hopeful because his recovery was very good, and contrax were spaced far enough (5min) that my baby seemed to continue to be ok--stressed but not DIS stressed. It was me who finally asked for surgery, because even *I* started to worry that my baby would crash--making everything much worse (IMO) for him and me both than a csec under spinal would be. The OB said he was willing to give it 'another hour or 2'! But I said I thought surgery was best and so we went. Anyway, even after those hours of such very poor FHTs, my boy was just fine--came out pink and crying, no RDS, not a moment of worry for him.

Believe me, most women would be sectioned LONG before I was, with the kind of tracing we were getting on my son. Kudos to my doc for not overreacting, and for staying out of my way of decisions.

By the way, I had the internal EFM, extremely unlikely that we were just missing beats as can happen with the external/belt monitor.

I always like to remember that for some babies, there is more stress during labor than for others....but 'stress' does NOT equal 'distress'.
MsBlack is offline  
#7 of 13 Old 07-20-2009, 08:16 PM
 
SalmonBayDoula's Avatar
 
Join Date: Jul 2005
Location: Seattle
Posts: 642
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Great reply MsBlack! thanks!

Birth doula, doula trainer, ican leader, lamaze childbirth educator, and most importantly, mom of 2 great girls!
SalmonBayDoula is offline  
#8 of 13 Old 07-20-2009, 09:57 PM - Thread Starter
 
OMama's Avatar
 
Join Date: Feb 2005
Location: in the moment
Posts: 1,935
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I second Sharon. Great response MsBlack! Thank you so much! This was all very helpful information and just what I was looking for.

Amazing Mama Birth Services
CD(DONA) and Birthing From Within Mentor and Birth Doula
OMama is offline  
#9 of 13 Old 07-21-2009, 12:30 AM
 
clovergirl33's Avatar
 
Join Date: Jul 2008
Location: south central PA
Posts: 145
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
What has been posted is descriptions of the things you can see on the monitor, but the actual interpretation of "fetal distress" is VERY subjective to the interpreter (as MsBlack suggests). Early decels are almost never concerning, in fact they are an encouraging sign that the head is coming down. Some practitioners will tolerate deep variables, low baselines, high baselines, lates, etc, (esp if variability is good). Others will rush to delivery.The only thing that I see that is pretty much universally considered fetal distress at my hospital is a prolonged decel of longer than 2-3 minutes.

The issue of "pit to distress" is when the baby shows subtle signs of distress and you keep upping the pit (instead of turning it off like you should to give the baby a rest). Practitioners like to do this so the baby will "declare" itself -- then they can say it won't tolerate labor and do a c/s. But again, where that line is is totally subjective to who is doing the deciding.
clovergirl33 is offline  
#10 of 13 Old 07-21-2009, 02:05 PM
 
blissful_maia's Avatar
 
Join Date: Feb 2005
Location: Alberta
Posts: 3,563
Mentioned: 9 Post(s)
Tagged: 0 Thread(s)
Quoted: 6 Post(s)
Here in Canada, our guidelines are that "fetal distress" cannot be diagnosed in labor. This is because, as a pp stated, interpretation is very, very subjective. You can label a FH tracing "non-reassuring" (actually, they just recently changed the nomenclature to "normal", "abnormal" and "atypical"), but true fetal distress is something that can only be diagnosed afterwards, by combining an abnormal tracing and the baby's cord blood gases showing fetal compromise.

 Grateful midwife and peaceful mama to three blissfully birthed, amazing children: dd (10)dd (7) and  ds (5).
blissful_maia is online now  
#11 of 13 Old 07-22-2009, 02:15 AM
 
readytobedone's Avatar
 
Join Date: Apr 2007
Location: not dissertating
Posts: 3,677
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by blissful_maia View Post
Here in Canada, our guidelines are that "fetal distress" cannot be diagnosed in labor. This is because, as a pp stated, interpretation is very, very subjective. You can label a FH tracing "non-reassuring" (actually, they just recently changed the nomenclature to "normal", "abnormal" and "atypical"), but true fetal distress is something that can only be diagnosed afterwards, by combining an abnormal tracing and the baby's cord blood gases showing fetal compromise.
can you tell me about the cord blood gases, and how they show fetal compromise?

do doctors typically send this off for testing when there seems to have been fetal distress?

i know after DD's birth they sent off my placenta (at least) to "pathology" for testing. what would that tell them?

i've always wondered why they sent it off...

dissertating wife of Boo, mama of one "mookie" lovin' 2 year old girl! intactlact:: CTA until 7/10 FF 1501dc
readytobedone is offline  
#12 of 13 Old 07-22-2009, 11:34 AM
 
clovergirl33's Avatar
 
Join Date: Jul 2008
Location: south central PA
Posts: 145
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
They send the placenta off to look for placental abnormalities and infection which might have compromised the baby (or you).

Cord gasses look at the oxygenation of the baby via acid/base balance and direct measurement. It measures the pH of the blood along with the oxygen and CO2 levels (among other things).

Hope this helps.
clovergirl33 is offline  
#13 of 13 Old 07-22-2009, 11:59 AM
 
vermontmomma's Avatar
 
Join Date: May 2009
Location: green mountains
Posts: 267
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by AugustLia23 View Post
The the baby's hr loses variability for a long period of time, it may indicate that baby has low reserves for the stresses of labor/birth. Or it could be a sleeping baby. By itself, not generally a cause for concern.
this was the cause of my cs though, we tried to induce naturally at home for a couple of days and were getting stronger and regular bh contrations but nothing solid. the night before we went in for tests i had one *big* feeling which turned out to be the baby flipping to breech we found out in the operating room. she had gone completely breech because something wasn't right and was too tired to be born normally i was told. she's perfectly fine now though and as much as the cs sucked we're thankful she's here.

raising and growing in the green mountains.chicken3.gif

vermontmomma is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off