Fetal Heart Monitoring: How Mistakes Happen in Labor and Delivery

Fetal Heart Monitoring: How Mistakes Happen in Labor and Delivery

By Giles Manley, M.D.
CP Family Network Medical Director

Parents should learn how to read Electronic Fetal Monitoring results so that they'll know when to request medical intervention.Electronic fetal heart monitoring is used in nearly all hospital births in the U.S. The technology has been around for decades. But medical records of brain-injured infants I review each week frequently show that although fetal monitoring was showing the baby was experiencing high levels of distress while still in the womb, nurses or doctors failed to take appropriate action.


What is Electronic Fetal Monitoring?

Electronic Fetal Monitoring (EFM) involves hooking the laboring mother up to a machine that records the baby’s heart rate. Changes to the heart rate, which are indicated on a graph called a tracing that is printed out by the monitor, can indicate that a baby is being deprived of oxygen for some reason, such as the cord wrapped around its neck. If the tracings show unusually high or prolonged stress, it may be critical to take the baby by C-section to avoid brain injury from lack of oxygen.


Why do Mistakes Occur?

Medical best practices are clear about how to interpret tracings and when to take action. But preventable mistakes still happen. There are several reasons for this:

  • Different medical and nursing school programs use different terminology to describe tracings. The American College of OB/GYN is taking steps to prevent this, but old terms have a way of hanging around and can affect communications among people trained differently.
  • Nurses delay alerting doctors to signs of worrisome tracings. They may hesitate to “bother” the doctor, or they may keep trying other techniques, such as turning a laboring mother to her left side or suggesting she squat, to try to alter the situation.
  • A doctor’s order for an emergency C-section isn’t carried out within 30 minutes because of staffing or facility issues or simple miscommunication.

These situations, and others like them, are why I tell parents to learn enough about EFM to know when they ought to be insisting that a doctor be called or that the baby be taken by C-section. It is far better to start insisting on a C-section that later isn’t needed (if tracings return to normal), than to need one and not get it done in time.


Tips for Expectant Parents

In an effort to prevent possible birth injuries, I recommend parents:

  • Tell your labor and delivery team you want to be informed about any evidence that oxygen levels to your baby have dropped and what action is being considered.
  • Confirm that an obstetrician and anesthesiologist are in-house and available to respond in an emergency situation.
  • Know the chain of command in the hospital so that if you feel your concerns are being ignored, you know who to call for a second opinion and intervention. The chain is initiated by getting the charge nurse or nurse manager involved immediately.
  • Encourage expectant couples you know, especially those with high-risk pregnancies, to learn about EFM.

As a board-certified obstetrician for more than 20 years, I know how important it is that parents take an active role in labor and delivery decisions. Learning about fetal heart monitoring should be a part of every expectant parent’s birthing education. To read more about EFM, see my blog Expectant Parents: Pay Attention to Fetal Monitoring During Labor.


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