Cleveland Birth Injury Attorneys Explain Electronic Fetal Monitoring
Understanding the risks and benefits of electronic fetal monitoring
Electronic fetal monitoring (“EFM”) is used at various times during pregnancy and during labor and delivery. It can measure the baby’s heart rate and the strength and frequency of uterine contractions. EFM is used to make sure the baby is getting enough oxygen and is not in distress. When used properly, EFM can reduce the risk of some serious birth injuries. Unfortunately, nursing staff and physicians sometimes improperly interpret the data collected by the fetal monitor or use the monitors incorrectly. At The Eisen Law Firm, our Cleveland birth injury attorneys hold doctors and nurses accountable when they fail to properly interpret electronic fetal monitoring data or to act upon that data promptly.
There are two types of electronic fetal monitoring: external and internal.
External fetal monitoring
External monitoring can be performed with a special type of stethoscope. However, it is most often done with two flat sensors that are secured onto a pregnant woman’s belly with an elastic band. One sensor uses ultrasound technology to track the baby’s heartbeat, and the other measures the mother’s contractions. This data is printed out on a machine that is connected to the sensors. These printouts are often called the “fetal monitor strips” or just, “the strips.”
External monitoring may be used in a non-stress test, which records the baby’s heart rate while the baby is both moving and not moving; with a fetal ultrasound to detect how much amniotic fluid is present; or during a contraction stress test, which measures changes in the baby’s heart rate during contractions.
There are several reasons a physician may order external monitoring before labor, including evaluating a mother for preterm labor, checking the placenta, and monitoring mothers with high blood pressure or diabetes.
During labor, external monitoring is used almost universally. In other words, virtually every pregnant woman in labor is fitted with an external monitor during active labor. It is quite simply the standard of care.
Internal fetal monitoring
Internal monitoring is only used during labor. Internal monitoring is only possible after a woman’s cervix has dilated to at least 2 centimeters and after her amniotic sac has ruptured (after her “water has broken”). Internal monitoring will continue until the baby is delivered. Internal monitors are most frequently used when a problem is detected during external monitoring and a physician wants to further investigate the issue with a more reliable (but also more invasive) monitoring system.
How is internal monitoring done? First, a sensor is strapped to the mother’s thigh. An electrode is then placed into the uterus and attached to the baby’s head. The baby’s heartbeat will then be monitored closely. Uterine contractions may also be measured with a small tube that is placed in the uterus.
What do healthcare providers look for with electronic fetal monitoring?
Electronic fetal monitoring is used primarily to verify that the fetus is not having any problems during labor and delivery. In general, if the EFM shows a healthy, non-distressed fetus, it is likely the fetus is not experiencing any significant problem with its oxygenation. On the other hand, if the EFM strips are “bad,” that is an indication that something dangerous might be occurring. EFM is one tool that is used to help health care providers tell if something is going wrong in the delivery of a baby and to alert them to the fact that they might need to change the delivery plan.
The printouts from electronic fetal monitoring machines show two graphs, each one on a single row. On the top, the graph shows the baby’s heartbeat in beats per minute. The bottom graph depicts the mother’s contractions. During a contraction, the baby’s heartbeat drops a bit, but then should return to normal levels quickly after the contraction has ended. Any abnormalities, such as the failure of the baby’s heartbeat to return quickly to normal levels, will be displayed on the graph.
A baby’s normal heart rate is between 120 and 160 beats per minute. Some variability in the heart rate is normal. For example, short-term variability occurs when the heart rate alternates between 5 to 10 beats per minute from beat to beat. Long-term variability is a change from 6 to 25 beats per minute over a 60-second period. Variability can be determined from a careful analysis of the EFM strips.
Signs of a problem
Healthcare providers should take action if they notice any of the following:
- A heart rate of less than 110 to 120 beats per minute or greater than 160 beats per minute
- A decrease in heart rate variability
- A deceleration in heart rate (especially certain types of decelerations called “late” decelerations
- An extended length of time for the baby’s heart rate to return to normal after a contraction
These may be signs that the baby is not receiving enough oxygen. Certain nursing interventions might be undertaken in order to see whether the abnormalities on the EFM will resolve. Such interventions include intravenous fluids, repositioning the mother, and providing the mother with supplemental oxygen. However, if the abnormalities persist or are bad enough, the baby must be emergently delivered or brain damage may occur.
What issues may cause a baby’s heart rate to appear abnormal?
There are a number of reasons why a baby’s heart rate may become a cause for concern. These include:
- The umbilical cord is wrapped around the baby’s neck or will precede the baby’s exit;
- The placenta has separated from the uterine wall;
- The uterus has torn;
- The amniotic fluid levels are either too high or too low;
- The baby is breech (is in a “feet first” position”); or
- The baby is too large to come through the birth canal.
These conditions are serious and must be addressed promptly for the safety of the baby. That is why it is so important to interpret the EFM data correctly and promptly. Failure to correctly interpret EFM strips or failure to act on EFM abnormalities may result in a profoundly injured baby.
Although electronic fetal monitoring is widely used in hospitals around the country, medical professionals still make mistakes when studying the data these machines provide. Misinterpreting data can lead to serious birth injuries, which may cause a newborn to suffer permanent disability or even death.
Contact our offices today for a free consultation
The Ohio birth injury attorneys at The Eisen Law Firm are experienced in a variety of birth injury claims. We provide compassionate, aggressive representation to parents in these difficult cases. If your baby suffered a birth injury that may have been caused by a misinterpretation of electronic fetal monitoring data or other medical mistakes, call 216-687-0900 or contact us online to schedule a free consultation.