How serious is a drop in fetal heart rate during labor?

[Anonymous]

I'm curious, it seems quite often during labor, the OB will determine that the baby's heart rate is dropping too fast (maybe when mom is in this position, or during a contraction, etc etc) and then the OB says that for safety, a C/S is needed.

Three of my co-workers (the last three pregnancies that I know of!) all have had this happen at various hospitals in the area. I was watching A Baby Story, and I noticed that it happens quite a bit on that show too.

I can't help but feel that this is used as an excuse for the OB to get the baby out and head home. I know this is a horrible attitude to have towards my healthcare providers, but I just find it hard to believe that something so serious could happen so commonly. It seems to me this is just a consequence of constant fetal monitoring and is used as a scare tactic by the doctors to get a C/S. I can't imagine that in the throes of childbirth I'd have the energy to argue and I'm sure that my husband will want to listen to the doctor.

Unfortunately, my insurance doesn't cover midwives/birthing centers, so I'm using Foxhall/Sibley -- not very natural childbirth friendly places. So, I was wondering, does anyone know how serious a drop in heart rate is? If during birth, the doctor brings this up and says we need to a C/S, is it possible to hold off, or is that being irresponsible? Does anyone have any other resources?

[Anonymous]

There was a really good thread on Mothering.com about fetal distress recently. A few kind birth professionals broke out all the different types of decelerations, possible causes and areas of concern. It was very informative.

Obviously this is something they're trained to do -- this is not a time to play doctor (or midwife) yourself. And so it's important to have a provider you really trust. When they look you in the eye and say that it's time to do X, even though you had your heart set on Y, you want to believe that there's evidence-based medicine behind it, and not just knee-jerk CYA.

[Anonymous]

OK, found the thread: http://www.mothering.com/discussions/showthread.php?p=14109588

[Anonymous]

I know this is not what you asked -- but I saw you said your insurance won't cover midwives or birth centers -- and if that's what you would prefer, have you, like, triple checked? Insurance companies often tell you they don't cover midwives because midwives don't necessarily show up in the same slots OBs do in their database and the phone reps aren't used to finding midwives. I had better luck calling midwife practices, getting their provider numbers, and then calling my insurance and asking re the specific provider numbers. Most insurance companies DO cover hospital-based midwives, because they're dramatically cheaper than OBs. Many, but fewer, cover midwives at birth centers; only a few cover homebirth midwives.

I agree with the PP that at the point where your medical provider is saying, "the baby's heartrate is decelerating, we need to do xyz," you're not in a good position to argue, no matter how strongly you feel about natural birth (and believe me, I feel strongly about natural birth!) There's just not really time in the middle of labor to gather facts and get second opinions and second guess things. I think the best you can do is try to find a care provider whose priorities and decision-making you trust, in advance. Sorry, I know that's not helpful if you really are stuck with Foxhall and not happy about it... Good luck to you!

[Anonymous]

OP I heard that FTP (failure to progress) is the more commonly used excuse to perform a c-section for questionable medical reasons. Some hospitals are now requiring reviews of c-sections to address this. There were stats that the c-section rate skyrockets on Christmas Eve.

My ob/gyn was not c-section oriented at all. I did have decels but she quickly had me change positions (up on all fours..dignified no but it did the trick). I did not have epidural so I could move into this position for a while. If you have a heavy epidural, can't feel your legs then you have fewer positioning alternatives. Pit can create stronger and more irregular contractions so fetal heart issues are more common in inductions or when drugs are used to speed things up.

Natural reasons can be a cord around the baby's neck. Cord accidents while rare can be tragic. I agree you need to be careful about which ob/gyn you choose and in this town it is hard to find someone who gives anything more than lip service to natural birth.

[Anonymous]

My DS had serious heart decelerations during labor and was closely monitored for almost 8 hours. I was on oxygen for the last 4 of those hours. Initially we monitored via external monitors, but eventually they had to do internal fetal monitoring. His heart rate was not reacting properly to the contractions and I was definitely headed towards a c-section. Long story short, for other reasons, I ended up delivering DS vaginally and he was born perfectly healthy with no reason for why his heart rate was acting up -- cord was not around his neck.

I was glad I did not end up with a c-section this time, but not knowing the outcome, I would have a c-section in a heart beat. At the end of the day, I'd much rather have a healthy mom and baby than risk waiting too long and something actually being wrong. OB's have seen the consequences of waiting and I don't err them in being cautious when the indicators are there suggesting that something might be problematic. I am very fortunate that my OB ended up being very natural birth oriented and really helped me avoid a c-section, but I wouldn't have hesitated at all had she said that we needed to get the baby out now.

[Anonymous]

Thanks for link on mothering.com. That's was really interesting to read. I know that I'm in no way qualified to decide whether or not I may need a c/s or not, but I like reading up on the science behind it. Just makes me feel better prepared.

All the PPs are totally right that you need to find a provider you trust. I'm not there yet with Foxhall. While I've liked the doctors I've seen so far, it's kinda hard when you have no idea which doctor will actually be delivering the baby.

[Anonymous]

Such a bad idea to refuse a c-section when your doc says it is necessary. That is how you end up with a dead or severely brain damaged baby.

[Anonymous]

But the problem is a lot of times the doctor says it's necessary when it really isn't. Of course, the problem is that it's very hard for you, the patient, to know when it's truly necessary or not.

[Anonymous]

OP, as you're realizing you set yourself up for big trouble when you don't trust your care providers. What insurance do you have? I don't know of any insurance that won't cover some type of midwife. PP is correct that you need to actually call the midwife herself, since many insurance companies will say "we don't cover midwives" yet since the midwife bills under the code of an OB practice, you actually COULD get the midwife covered. Only the midwife or birth center will be able to tell you if they are covered. ALL insurance companies will say "we don't cover homebirths" yet I know many many women who have had their homebirth covered by major insurance companies.

To your original question, fetal heart variation is extremely common in labor. There is a huge range of grey where different care providers will interpret things differently. I find that the only universally agreed upon bad tracing is when there is a long, low deceleration. ie, babies heart rate drops for several minutes to somewhere well below 100. Everyone would consider that bad, yet still not everyone would consider that an indication for a cesarean unless it happens more than once or twice. Also remember that different types of drugs can cause poor fetal heart tracings as well. In a completely healthy mom and baby having an unmedicated birth, it would extremely rare that there would be true fetal distress.

Babies and placentas (and moms) are extremely resilient and can handle considerable variability during labor.

[Anonymous]

My son's heart beat dropped 3 times while I was in labor. My doctor told me that 3 times and she would have to do a c-section, but luckily the nurse covered and said that the 3rd time it was because I had begun to push. I think that it is very normal to not trust your health care provider, and I feel the same way. You don't know exactly what their intentions are and they are still human. If I were you I would prepare for what you are willing to accept, would you do a c-section at the first time of fetal distress? The second? Educate yourself on it, as it certainly may be an issue. Also something that I wish I would have been more aggressive about, when will your doctor induce you. My doctor induced me 2 days after my due date, and in retrospect I realize she did this to fit me into her calender.

[Anonymous]

It's normal for a baby's heart rate to drop when you're actually pushing--but it should normalize again between pushes. It's when it doesn't that docs get worried.

[Anonymous]

I think you should discuss this with your doctor before going into labor.

My baby's heart rate dropped during labor. It dropped most drastically during contractions, but as the labor progressed it was recovering less and less.

At first they just monitored me more closely -- and put an internal monitor on the baby. Then they had me try different positions and put me on oxygen. While this was going on, they started to caution me that I might need a c-section. They told me that if the heart rate dropped below a certain level (I think this was between contractions) then they would want to do a c-section.


We did reach the point where I did have a c-section, but this was after a few hours. The cord was tied around his neck. Everything turned out fine.

With my next pregnancy, I read an OB journal while waiting in my doctors office one day. Most of the stories were about babies who were harmed because the doctors were slow to intervene. So while many babies might be fine without intervention, no OB wants to be the one who doesn't intervene when it is required. Theories vary on how well you can discriminate between the two ahead of time.

[Anonymous]

My son's heart rate dropped to 60 during 2 contractions and that was enough to send me to the OR. The second time it happened, I had to get on all 4s, have injections, and was surrounded by 4 nurses. I was more than thankful to get my baby OUT. My son wasn't able to handle the contractions, and I trusted my OB to make the right decision. However, I never had a birth plan or had my heart set on a natural delivery. I only wanted a baby in my arms.

[Anonymous]

Our daughter's heart rate dropped at the start of the induction (decelerating at the end of every contraction) and then got worse during labor. I only labored actively for an hour before the doc called for a c-section; she was born less than 90 minutes later. It turned out that our baby had an undiagnosed congenital heart defect, requiring an immediate heart procedure on the day of birth, followed by open heart surgery a week later to save her life. She's doing fine now, and I know that odds of what happened to us are rare, but I agree with PPs that you need to trust your care providers on this. Our daughter would not have survived a longer labor and delivery process.