Electronic Fetal Monitoring

Birth Injury Attorney Pennsylvania

In recent decades electronic fetal monitoring has been a mainstay of managing the care of expectant mothers in labor. The goal of such monitoring is to gauge the well-being of the fetus and, when signs of so-called fetal distress arise, to “rescue” the fetus by immediate vaginal delivery or cesarean section if necessary. Electronic fetal monitoring strips are often a key piece of evidence in birth injury cases.

How Does Electronic Fetal Monitoring Work?

Here are the basics of how electronic fetal monitoring works. First, the basic equipment involved is a large wrap similar to a belt that is fitted around the mother’s abdomen. The belt contains two sensing devices, one that tracks the heart rate of the fetus and the other which measures the pressure of contractions by the mother.

What Nurses Should Look For In Fetal Monitoring Strips

All obstetricians and nurses who work in labor and delivery are specifically trained on how to interpret the tracings or graphs printed out by the monitoring equipment. There are certain key things that they look for when assessing the graph, including the following:

Presence of contractions — What they are looking for is how frequently the contractions occur and how intense they are, the intensity being measured by the pressure sensitive gauge contained within the belt. Normal is roughly five or fewer contractions over a 10-minute period.
Baseline heart rate — It is very important to determine what is the starting point or baseline for the baby’s heart rate when the mother enters labor. Typically, the doctors like to see this rate somewhere between 110-160 beats per minute. This “baseline” becomes the standard against which changes in heart rate are assessed.
Accelerations — Accelerations are usually defined as increase of at least 15 beats per minute that lasts for at least 15 seconds. The doctors are looking at when those accelerations occur and how long do they last.
Decelerations — These are decreases in the baby’s heart rate and again, the doctors are looking at when those accelerations occur and how long do they last.

By looking at the overall relationship between the heart rate and how it is responding to contractions, the doctor and the nurses determine overall fetal well-being. If the heart rate is not responding appropriately to contractions, e.g., if the heart rate falls below the baseline (this is called bradycardia) or it decelerates beginning well after a contraction (a so-called late deceleration), these are considered signs of fetal distress. When distress is present, it may mean that the supply of oxygen to the baby’s brain has decreased or been interrupted entirely. Either way, this threatens the well-being of the baby and if not corrected can lead to death or serious brain damage.

When Fetal Distress Is Suspected, Staff Must Act Quickly

Therefore, when the tracings from the electronic fetal monitoring suggest that the baby is experiencing fetal distress, two things much happen, and they must happen quickly. First, the doctor has to correctly interpret the tracing and recognize that it is signaling fetal distress or if the doctor is not in the room, the nurses have to observe that there is some abnormality in the tracings and immediately notify the doctor. Second, once the doctor is aware of the fetal distress, he/she has to make the appropriate decision as to whether the distress can be corrected with conservative measures such as changing the mother’s position, administering oxygen, etc., or whether the baby must be immediately rescued from its hostile environment by immediate delivery, either vaginally or through an emergent cesarean section. If mistakes are made in either of those steps, i.e., not recognizing the change in the heart rate tracing or not taking the appropriate corrective action, serious brain injury or death can occur.