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Tom Sharon
Early detection of any fetal distress & immediate action


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Fetal Monitoring

The key activity for the labor period is fetal monitoring. Attaching the mother-to-be to the monitor is usually one of the first actions of the labor and delivery nurse. The purpose of fetal monitoring is early detection of any fetal distress with immediate appropriate action. Fetal distress is due to a loss of umbilical cord blood flow within the uterus, and it is life-threatening to the baby. Action must be taken right away in this case. Even a few minutes lost could be catastrophic.

The nurses have to operate the monitoring equipment correctly, and they must check the readings diligently and frequently. The monitor tracks the baby's heart rate and measures the intensity and frequency of the uterine contractions. The changes in fetal heart rate just before, during, and immediately after the contractions determine whether there is any fetal distress.
 
The monitor attaches to the mother in one of two ways: externally or internally. The former requires a belt around the abdomen, and the latter necessitates inserting an electrode into the birth canal. Both attach to the same electronic device, with the internal electrode usually producing readings that are more reliable. There is a monitor screen in the birthing room where the mother stays during labor and another one at the nurses' station. The nurse can watch the monitor from either location. Therefore, the nurse does not have to be with the mother constantly during labor, but frequent hands-on assessments are required. The minimum intervals depend on how close the patient is to delivery.
 
The ongoing observation of the monitor readouts is the nurse's responsibility. The obstetrician or nurse-midwife relies on the nurse to report any signs or suspicions of distress. This is why adequate staffing is of paramount importance. Each hospital has a policy on the minimum number of qualified nurses required to maintain a safe labor and delivery unit depending on the number of beds. Managers and administrators who allow staffing at less than that number are being derelict in their duty.
 
Another area of concern is the risk of using Pitocin to induce labor, although there are times when the risk of continuing with an overdue pregnancy is considered greater. However, all too often, a few obstetricians order the drug and walk away. Careful monitoring is vital. A sudden increase in the strength and frequency of contractions could result in the passing of meconium (fetal bowel movement in the uterus). This is very dangerous to the baby's lungs because the baby is actually breathing in amniotic fluid, which has the meconium in it. If the meconium reaches the lungs, it can cause pneumonia, and that can sometimes even cause irreversible brain damage. Again, it all comes down to monitoring, which cannot be overemphasized.
 
A devastating case illustrating the consequences of a monitoring failure is the story of Baby Jane. Her mother, Nellie, was resting in the labor room with the internal fetal monitor. Contractions were intense and seven minutes apart. The monitor screen was visible in the room and at the nurses' station. Nellie was watching the monitor to assure herself that the baby was doing well with its heart rate. The line went flat with the alarm beeping because the electrode had fallen out. She waited a few moments, thinking that the nurse would come running. After ten minutes, Nellie rang the call bell. Everything had been going well up to that point, so she was not panicky -just concerned.
 
Then the concern turned to frustration when another fifteen minutes passed with no response. Nellie started yelling for the nurse. Still no one responded except for a nurse's aide, who told her that her nurse was busy with other patients and would be in shortly to reconnect the monitor. Meanwhile, Nellie had several big contractions.
 
It took a total of forty-five minutes for the nurse to come in and reinsert the electrode. The monitor alarm went off immediately, showing a severely slowed heart rate of 65 beats per minute. It should have been around 120. The nurse quickly rolled Nellie into the delivery room for an emergency cesarean section. The baby was blue at the time of birth and survived, but tragically with massive permanent brain damage. No one knew how long the condition existed because the monitor was off for forty-five minutes. Investigation revealed that there were four nurses on duty, and this unit's policy and hospital policy required a minimum of seven.
 
It is vital that expectant mothers and fathers be aware of the importance of monitoring and understand the dangers of observation failures. While I don't wish to cause any undue apprehension regarding the birthing process during the labor period, asking questions about your concerns regarding the management of the facility is the best remedy for anxiety. The potential consequences of a false sense of security are far worse than being alert and prepared.
 
The right questions to ask when arriving on the labor and delivery unit are as follows:
 
* How many nurses are on duty?
* How many nurses are required for safe care?
* What is the normal range for the baby's heart rate?
* How often will you come in to check my condition?
* What will you do if the baby's heart rate is too slow or too fast?
 
Remember that you have the right to expect the doctor to come and talk to you each time you believe the fetal monitor shows that something might be wrong.

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