Monitoring The Fetus During Labor
Among the most unfortunate cases our office handles are those involving death or injury to a fetus or newborn child. Too often what should be a time of great joy is instead filled with sadness because obstetricians, nurses or hospitals fail to assure that mother and child receive appropriate medical care during labor and delivery.
A still too common cause of injury or death to a child in utero occurs when obstetricians and obstetrical nurses fail to timely recognize and respond to fetal distress. During the stresses of labor a child in utero may have problems which require urgent delivery or emergency C-section. In order to identify potential harm to the fetus before it occurs, nearly every laboring mother is attached to a monitoring device upon their admission to a labor and delivery room in the hospital. This monitor, called a tocometer is wrapped around the mother’s waist. The tocometer measures the force and frequency of the mother’s uterine contractions. A second device called a fetal heart monitor is connected to the mother’s belly or to the baby’s scalp through the birth canal. This device measures the fetus’s heart rate. The mother’s uterine contractions and the baby’s heart rate are plotted on the same screen or sheet of graph paper, one wavelength above the other, second by second and heartbeat by heartbeat.
Obstetricians and obstetrical nurses are trained to interpret the fetal heart monitor to detect patterns which represent a potential or imminent threat to the health and safety of the fetus. It is not unusual for a baby in utero to experience a level of stress resulting in an abnormal fetal heart rate pattern. An example of a condition that often creates a concerning heart rate pattern is cord prolapse. Cord prolapse occurs when the umbilical cord descends in the birth canal in front of or alongside the presenting part of the baby. Cord prolapse is considered a threat to the welfare of the baby because it can cause compression of the umbilical cord between the baby’s body and the mother’s pelvis, uterus, or cervix. When umbilical cord compression occurs, the supply of oxygenated blood which normally flows through the umbilical cord to the fetus is disrupted. The disruption of normal blood flow will have a direct impact on the fetal heart rate pattern, including the effect of increasing the baseline fetal heart rate above a normal level for a fetus.
The obstetrical nursing staff must keep a watchful eye on the fetal heart monitor and immediately contact an OB-GYN if they believe they see an abnormal fetal heart rate pattern. Obstetricians and nurses are trained to recognize certain fetal heart rate patterns as either “non-reassuring” or
“ominous”. A fetal heart rate pattern characterized by one or a combination of the following may signal the fetus is experiencing trouble in the womb:
- abnormal decrease in the fetus’s baseline heart rate
- persistent loss of fluctuation in the amplitude and frequency of the fetal heart rate as determined in a 10-minute period (a.k.a. loss of variability)
- recurrent late or variable decelerations (a gradual or abrupt drop in fetal heart rate associated with uterine contractions);
- prolonged decelerations (a deceleration of the fetal heart rate by greater than 15 beats per minute, lasting greater than or equal to two minutes and less than or equal to ten minutes)
Obstetrical nurses and obstetricians are trained to determine what pattern or combination of patterns indicate a nonreassuring or ominous fetal heart rate tracing. When a fetal heart rate tracing is nonreassuring or ominous, there is a problem with the fetus which requires immediate attention by the obstetrician. Time is of the utmost importance
Importantly, a fetus which exhibits an abnormal fetal heart rate pattern, whether because of cord prolapse or some other condition, is not destined for permanent injury. In fact, depending on the response by the obstetrician and the obstetrical nursing staff, a fetus with an abnormal fetal heart rate pattern may suffer no injury whatsoever. In many situations the health care providers can perform basic maneuvers or interventions to a laboring mother that help to relieve any stress to the fetus. Examples of such interventions include turning the mother on her right side, supplemental oxygen or administration of fluids. In some instances these interventions do not resolve the problem, and immediate examination by the OB-GYN becomes critical.
Our first task when evaluating the cause of death or injury to a fetus or newborn baby is to obtain and evaluate the fetal heart rate tracings. Photocopied, hard-copy fetal heart monitor strips are becoming a thing of the past. Today, fetal heart monitor tracings produced by hospitals during our investigation of birth injury lawsuits are more often than not created and maintained electronically. Also, the fetal heart monitor tracings are electronically synced with notes entered by the obstetrical nurses. This feature of the record allows us to evaluate precisely what events transpired in the delivery room in response to the obstetrical emergency, and when. For example ,the notes should describe what if any interventions were provided to the laboring mother during the course of fetal distress. The nursing notes should also indicate when residents or obstetricians were notified of abnormal fetal heart rate patterns or present in the labor and delivery room to perform an examination of mother and child.
With years of experience representing families struggling with the pain of having a child who suffered an avoidable birth injury during labor or delivery, our attorneys are skilled at interpreting the fetal heart monitor tracings and other critical records describing important events during the delivery period. We can identify abnormal fetal heart rate patterns which may represent moments of profound fetal distress that threatened the safety of the baby, yet went unheeded by the obstetrical staff. Regrettably, we often learn after reviewing the notes of the obstetricians and obstetrical nurses that obvious signs of an obstetrical emergency, such as signs of fetal distress, were ignored or an emergency C-section, though desperately needed, needlessly delayed.
When trusted with the task of investigating potential medical negligence in the management of obstetrical emergencies, we apply experience, hard-work, and focus. In the end, we strive to uncover the truth that will allow us to speak with a strong voice for those who must face the devastating effects of birth injury or the wrongful death of a child.