Fetal Distress in Labor

A baby who is compromised in labor or during delivery is in distress. The medical term for fetal stress is nonreassuring fetal status (NRFS), which describes a baby's health late in the pregnancy or during labor.

Reasons for fetal distress are varied, from cord issues to fetal anomalies, reactions to medications or the stress of labor, and other complications of labor.

Symptoms

While you may not experience physical symptoms, signs of fetal distress may include:

• Less movement of the fetus
• Abnormal fetal heart rate (too slow, too fast, or irregular)
• Meconium (fetal stool) in the amniotic fluid

Causes

NRFS can be an indicator of numerous obstetric, maternal, or fetal conditions, including:

• Anemia, or an iron deficiency
• Diabetes
• Infection
• Intrauterine growth restriction (IUGR), previously known as intrauterine growth retardation, when a baby is smaller than normal
• Maternal cardiovascular disease
• Oligohydraminos, or low amniotic fluid
• Placental abruption
• Pregnancy-induced hypertension, or high blood pressure during pregnancy
• Post-term pregnancies, or pregnancies that have progressed past 42 weeks

Diagnosis

If NRFS is detected prior to labor, you’ll likely have the following tests to diagnose the distress:

• Biophysical profile, which is an ultrasound test that checks your baby's heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid around your baby
• Nonstress test, which monitors changes in the baby's heart rate, as well as any contractions you may be having
• Contraction stress test, during which you're given a small amount of Pitocin via IV and monitored to see how your baby responds to contractions via the electronic fetal monitor

Monitoring Fetal Distress

When you are in labor, your baby may be monitored all of the time (continuous monitoring) or at set times (intermittent). Monitoring can also be done externally (outside of the body) or internally (inside of the body), or both. In general, if you're low risk, you'll likely experience external, intermittent monitoring.

Methods of Monitoring

The type of monitoring used will depend on your risk of complications, how your labor is going, and the overall policy of your OB-GYN or hospital.

The most common methods of monitoring your baby include:

• Fetal auscultation, a method used on low-risk mothers where a special stethoscope or device called a Doppler transducer is used to periodically listen to the fetal heartbeat.
• Electronic fetal monitoring, a method which uses special equipment to measure the response of the fetus’s heart rate to contractions of the uterus.

During Labor

Monitoring during labor can help your care team recognize and/or monitor the following:

• Hypoxia, when the fetus does not receive adequate oxygen
• Contractions
• High-risk deliveries
• Cerebral palsy
• Impending fetal death

The fetal monitor uses two straps that go around your abdomen. One measures the baby's heart rate, and the other measures your contractions or uterine activity.

Using the graphs of the heart rate, your doctor or midwife is looking to see if the heart rate stays within certain parameters.

• Too high may indicate that your baby has a fever or is in distress.
• Too low may mean that there is oxygen deprivation due to a number of reasons, including the baby's position or the cord becoming compressed.

The monitors will be used to tell when your baby is experiencing distress, in relation to each contraction. For example:

• Throughout the contraction
• Recovering in the break periods
• Only at the end of the contraction
• Both during and after contractions

While FHR monitoring has many benefits, a misinterpretation of the FHR monitoring results can increase the likelihood of having a cesarean section.

What Your Birth Team Can Do

When you are on the monitor, the nurses and staff are looking for telltale signs of fetal distress, which typically build rather than come out of the blue.

When these early signs are present, the staff will ask that you remain on the monitor, switching from intermittent monitoring to continuous fetal monitoring. This allows the team to watch your baby more closely.

Some of the things your birth team may try to do to help alleviate your baby's distress include:

• Increasing your oxygen
• Giving you more fluids to ensure you're hydrated
• Amnioinfusion, where sterile fluid is placed inside the uterus via a catheter to help dilute the meconium
• Changing your position, turning you from one side to another
• Cesarean delivery
• Instrumental delivery (forceps/vacuum)
• Tocolysis, a procedure to temporarily stop contractions

Be sure to ask questions about what is going on and what your options are when possible. While the words fetal distress call to mind extreme emergencies, there are many times where you do have time to ask questions, even as plans are being made to move forward with corrective techniques.

Also, keep in mind that if you have had a cesarean for fetal distress or experienced fetal distress in a previous birth, that doesn't mean that you will be likely to see it again in a future pregnancy. Talk to your practitioner and look at your birth records to see if a cause was found. This may help alleviate your fears for future births.