Canada: How Fetal Heartrate Monitoring Prevents Birth Injuries: Part 1

Last Updated: August 20 2018
Article by Roger Shoreman

There are certain moments in your birth story that you will likely always remember. The first inkling that you may be pregnant; the overwhelming emotion when your suspicion is confirmed; the first time you feel the little one move or kick; and, of course, the adrenaline rush as you go into labour.

But one moment often stands out for many soon-to-be parents and their loved ones - the first time they hear their baby's heartbeat.

The fetal heartrate might provide a special moment or memory, but it's also very important to ensure both the fetus and mother are in good health at key moments of pregnancy - especially during active labour.

A non-reassuring or abnormal fetal heartrate can be a sign of fetal distress from oxygen deprivation. Medical providers must act quickly and exercise good judgment in responding to troubling readings to prevent serious birth injuries.

In this two-part blog series, we'll explain how the fetal heartrate is monitored during labour, describe how a medical provider knows when to act, and explain how fetal heartrate charts and records may become critical pieces of evidence in a birth injury lawsuit (obstetrical malpractice).

Can You Hear My Heartbeat?

Once the fetal heartbeat is detectable, checking the fetal heartrate becomes a normal part of prenatal care. A normal fetal heartrate baseline is in the range of 110 to 160 beats per minute.

During the latter stages of a pregnancy, if a medical practitioner providing obstetrical care observes certain risk factors (for instance, if a fetus is small for its gestational age, if there is decreased fetal movement, or if there is a preterm premature rupture of membranes), they may decide to perform some antenatal tests that observe and evaluate changes in the fetal heartrate.

For example, a nonstress test (NST) can be used to determine if the fetal heart rate accelerates (as expected) according to fetal movements reported by a pregnant woman. A 'reactive' heartrate is reassuring. Although a 'non-reactive' heartrate does not necessarily mean there are problems with a pregnancy, it may prompt trained medical providers to use other assessments (such as a biophysical profile) and a review of a woman's medical history to determine if they should intervene in a pregnancy, and potentially deliver a fetus prior to term.

All these steps are part of professional guidelines and standards of practice set out by the Society of Obstetricians and Gynaecologists of Canada (and its American counterpart, the American College of Obstetricians and Gynecologists) and used obstetricians, gynecologists, midwives and other regulated birth practitioners. Every hospital must also have their own up-to-date policies and guidelines based on the documents these groups release.

Heartrate Monitoring During Labour

During the 20th century auscultation of the fetal heart (periodic listening with a stethoscope or Doppler ultrasound) during active labour became a universal standard of care. Within the past few decades, however, electronic fetal heartrate monitoring (internal or external) has become the preferred method for tracking during active labour - particularly if a pregnancy is deemed to be higher risk or if auscultation readings are non-reassuring.

Whether using auscultation, electronic fetal heartrate monitoring, or a combination of the two during different parts of labour, professional guidelines recommend that fetal heartrate monitoring should be continuous during the whole of active labour and increase in frequency in the active second stage of labour.

Not only does this monitoring help practitioners to make decisions about intervening during labour, but these charts or printouts of electronic monitoring data are often key pieces of evidence in legal proceedings if a preventable birth injury occurs. (Birth records must be stored and saved for 20 years).

When Trouble Occurs

In the second part of this series, I'll explain how medical providers use fetal heartrate monitoring to gauge normal variability, what is required when they detect an abnormal reading, and what you should know if a loved one has experienced a preventable birth injury due to negligent or incompetent obstetrical care.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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