About Birth Injuries Caused by Fetal Distress
Fetal distress is a general term used to describe experiences of the unborn baby which, if not resolved, carry a high risk of developing into serious and oftentimes irreversible injuries. Many children with cerebral palsy and developmental delays develop those conditions because fetal distress was not timely identified or treated.
The American College of Obstetricians and Gynecologists (ACOG) is the organization that purports to represent the interests of doctors who provide gynecological and obstetric care to mothers. They recommend discontinuing the use of the term “fetal distress,” believing that it is too imprecise. They recommend instead “nonreassuring fetal status.” Whatever the terminology, the end result is the same—the baby may face problems that could have a significant effect on her long-term health, and the medical team must act quickly to prevent those injuries.
Causes and Effects of Fetal Distress
Fetal distress has a number of causes, including:
- Shoulder dystocia
- Umbilical cord prolapse
- Placental abruption
- Uterine rupture
- Cephalopelvic disproportion
- Eclampsia and preeclampsia
- Gestational diabetes
In many situations, such as shoulder dystocia or prolapsed umbilical cord, the effect is that the baby might not receive enough oxygen or blood to the brain. When deprived of oxygen or blood for even a few short moments, serious injuries like cerebral palsy and developmental delays can occur. Often, these injuries are preventable.
Signs and Symptoms of Fetal Distress: Electronic Fetal Monitoring
Careful nurses and obstetricians must be on the lookout for any signs of fetal distress, including decreased movement by the baby. The primary way to determine whether a baby is in distress is through electronic fetal monitoring (EFM), which allows obstetricians and nurses to monitor the baby’s heart rate and the timing and intensity of the mother’s contractions. This technology has been around for over 50 years, and every hospital still uses it.
How Electronic Fetal Monitoring Works
There are two types of electronic fetal monitoring—external and internal. External monitoring involves a belt-like device which straps around the mother’s belly, and which records the baby’s heartbeat (by ultrasound) and the mother’s contractions (as the pressure against the belt increases and decreases).
The internal monitor can be used when the cervix is 2-3 centimeters. A small lead is attached to the baby’s scalp, which will give a more accurate measurement of the baby’s heart rate. The external belt is still used to measure the mother’s contractions.
The information is passed from the belts through wires to a machine that records the information. In the past, this was printed out onto paper in realtime. Most hospitals now have machines with digital readouts, and doctors can scroll back and forth to get an accurate history.
Understanding Electronic Fetal Monitoring
There are two parts to every electronic fetal monitoring “strip.” The top line represents the baby’s heartbeat; the bottom line represents the mother’s contractions.
The baby’s normal heart rate is between about 120 and 160 beats per minute (bpm). Higher than 160 is called tachycardia, and lower than 110 or 120 for an extended amount of time is called bradycardia. Both of those situations signify possible problems with the baby. Some important aspects of reading electronic fetal monitoring strips:
- Short-term variability: the baby’s heart rate should move up and down by a range of about 5 to 10 beats per minute from beat to beat, though if the short-term variability is absent it may simply indicate that the baby is sleeping. A somewhat jagged line is a good sign.
- Long-term variability: the baby’s heart rate should move up and down by a range of 6 to 25 beats per minute over the course of a minute. Like short-term variability, a jagged line is a good sign.
- Early decelerations: the baby’s heart rate must be read in conjunction with the mother’s contractions. Early decelerations begin and end at about the same time as contractions. They are usually caused by compression of the baby’s head during a contraction.
- Late decelerations: late decelerations begin at the top of a contraction and slowly return to baseline after the contraction has ended. These are the most concerning type of deceleration, and indicate problems for the baby.
- Variable decelerations: variable decelerations occur at any time and tend to drop more quickly than early or late decelerations—they are usually caused by compression of the umbilical cord.
Interpreting electronic fetal monitoring strips is a complicated task—obstetricians and nurses must undergo extensive coursework and studies to understand them, and to know what is happening to the baby. A simple misinterpretation can mean that the baby is deprived of vital oxygen, and may result in long-lasting injuries.
During labor and delivery, the parents should be aware of any emergency situation, including rushing doctors or nurses, an urgent tone in their voices, or the words bradycardia, tachycardia, late deceleration, non-reassuring, and fetal distress. Those terms may indicate that there was trouble during the delivery. If your baby has cerebral palsy, developmental delays or some other injury, our medical malpractice lawyers can examine the labor and delivery records. We are able to interpret fetal monitor strips, and can tell you if the doctor should have called for an emergency cesarean section to prevent injury to your baby. Call us at (440) 252-4399 or contact us by filling out our online form.