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The What and Why of Fetal Heart Rate Monitoring

Michael Becker

A successful pregnancy culminates in labor and delivery or a healthy baby. During this period of childbirth, the obstetrician monitors the mother and baby through the different stages of labor. The baby must be checked for any signs of distress. One of the methods of keeping an eye on the baby’s condition is fetal heart rate monitoring.

What is Fetal Heart Rate Monitoring?

During pregnancy, and especially during labor and delivery, doctors use specialized equipment to monitor the baby’s heart rate. This is done to detect any variation from the normal pattern of fetal heartbeats. This type of monitoring can be reassuring to the mother and her medical team that all is well with the baby. A normal fetal heart rate is an indication that labor is progressing well and the baby is not in any apparent distress.

How Is Fetal Heart Rate Monitoring Performed?

Doctors monitor the fetal heart rate during labor with two types of monitoring. One way is to listen to the baby’s heartbeat from time to time through auscultation. This requires a special device – either a stethoscope or a Doppler transducer. The device is pressed against the mother’s abdomen to hear the baby’s heart. Monitoring with auscultation is done periodically in all women and more frequently if the mother has risk factors or develops problems develop during labor.

Electronic fetal heart rate monitoring is a method of continuously recording the baby’s heartbeat and the contractions of the mother’s uterus. This method of more intensive monitoring is typically done in women with high-risk pregnancies and those who receive an epidural or induction of labor. It also depends on the hospital provider policy and how well labor is progressing. Electronic fetal monitoring provides an ongoing and continuous record of the baby’s condition. Special equipment records a tracing that the doctors can review at any time. Electronic monitoring of the baby’s heart is of two types:

  • Internal: An electrode is inserted through the mother’s cervix and placed on the baby, usually the scalp. This device measures the baby’s heart rate more accurately. An intrauterine pressure catheter may also be inserted into the uterus through the vagina to record uterine contractions. Internal monitoring can only be performed after the mother’s water has broken, i.e., the amniotic sac has ruptured.
  • External: Two belts are wrapped around the mother’s abdomen. One records the baby’s heart rate and the other measures the duration and interval between contractions.

What Do Abnormal Fetal Heart Rate Patterns Mean?

An abnormal fetal heartbeat pattern is sometimes, but not always, indicative of a problem. This includes a heart rate that is too slow (less than 110 beats per minute) or too fast (more than 160 beats per minute). Abnormal patterns may indicate that the baby isn’t getting enough oxygen. They may suggest that the baby is in distress and needs to be delivered emergently. If there are dips in the baby’s heart rate, the doctor may institute simple measures such as a change in the mother’s position, supplemental oxygen, or IV fluids. More worrisome changes in the baby’s heart rate could prompt interventions such as stopping or starting certain drugs. If the healthcare practitioner decides it is not safe for the baby to be delivered via the birth canal anymore, the decision for an assisted delivery or cesarean section may be made.

Why Is Fetal Heart Rate Monitoring Necessary?

Failure to recognize a fetal heart rate concern in time can lead to devastating consequences such as hypoxia (oxygen deprivation), brain damage, paralysis, and stillbirth. Therefore, fetal heart rate monitoring is a method of avoiding potentially dangerous situations during childbirth. If any concerns arise during labor and delivery, this monitoring of the baby’s heartbeat is able to prompt the healthcare team to take timely action.

Negligence in Fetal Heart Rate Monitoring

Some forms of negligence when it comes to fetal heart rate monitoring include:

  • Failure to identify abnormal heartbeat patterns
  • Failure to monitor when necessary
  • Failure to take timely action when needed
  • Improper interpretation of tracings
  • Confusion between the mother’s and baby’s heart rate
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