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

[Anonymous]

Anonymous wrote:"

Anonymous wrote:if you want to avoid fetal distress don't get induced with pitocin and don't get an epidural in the first place
also the attached monitors are not always accurate; get monitored with a fetal doppler

"
This is a really stupid statement. Sometimes you don't have a choice. I had to have pitocin because my water broke and 24 hours later i wasn't dilated at all. Sometimes you're 2 weeks overdue. Sometimes there are other reasons induction needs to happen. And telling women to avoid epidurals is a mixed statement at best. There's evidence that shows that epidurals can DECREASE the risk of c-section because the woman can relax and push better. Studies have gone both ways on this.

I don't think her statement was all that stupid. It was probably an overgeneralization, but I get what she's saying. Pitocin can be a runaway train that can lead to other things that lead to other things that ultimately end up in a c-section.

I'm actually more partial to epidurals than pitocin. Epidurals can lead to dangerous decels, but more often than not, they're recoverable. I do agree that epidurals can help women relax and promote fetal descent. But I've seen where it's lead to failure to progress and where the mom has absolutely no sensation to push and you know where that leads.

BTW, I'm a Labor and Delivery nurse.

[Anonymous]

To answer the OP's question, decels can be interpreted different ways by different providers. I've seen cases where women were sent to the OR for what I considered to be a 'recoverable' decel.

NICHD is the body that determines the definitions for decels and they are always revising (at least seem to be) what such and such decel means and what the interventions should be. Unfortunately, as laboring women, we are not trained in this area and don't have much of a choice when a doc recommends a c-section. If I weren't an L and D nurse, I'd listen to my doc too.

But being informed and seeing what I've seen, I've decided to go with a midwife for my first baby. BTW, I've seen a few cases where the midwife didn't intervene quickly enough and a doctor had to make the c-section call, but all in all, I feel better with a midwife.

[Anonymous]

Okay, original OP here, (baby is going to 1 yo soon! How fast it all goes by!) Curious -- my baby hr dropped to 40 bpm. I think I heard a nurse mention it was at 40 bpm for almost 5 mins. Do you think that was a recoverable, or is that really low? I'm just asking out of curiosity.

FWIW, I completely agree that pitocin led to the c-section. Pitocin made it too painful for me to go w/o an epidural. The epidural caused the first serious decel in the baby. The baby also seemed unable to handle the pitocin, once they increased the amount of pit back up, the baby had the 2nd (and the one that made the OB decide it was time for the c/s) decel.

[Anonymous]

I have yet to hear the birth story of anyone that got pitocin and didn't end up w/ a C/S. I'm not horribly opposed to a C/S but I am very very loathe to get induced because it really tends to result in the worst situations it sounds like. Of course sometimes you have to, but other times, the OB is looking to do it only a couple days after the due date and the baby's just not "ready" yet.

[Anonymous]

Anonymous wrote:I have yet to hear the birth story of anyone that got pitocin and didn't end up w/ a C/S. I'm not horribly opposed to a C/S but I am very very loathe to get induced because it really tends to result in the worst situations it sounds like. Of course sometimes you have to, but other times, the OB is looking to do it only a couple days after the due date and the baby's just not "ready" yet.

i had pitocin and delivered vaginally.

[Anonymous]

Anonymous wrote:Okay, original OP here, (baby is going to 1 yo soon! How fast it all goes by!) Curious -- my baby hr dropped to 40 bpm. I think I heard a nurse mention it was at 40 bpm for almost 5 mins. Do you think that was a recoverable, or is that really low? I'm just asking out of curiosity.

FWIW, I completely agree that pitocin led to the c-section. Pitocin made it too painful for me to go w/o an epidural. The epidural caused the first serious decel in the baby. The baby also seemed unable to handle the pitocin, once they increased the amount of pit back up, the baby had the 2nd (and the one that made the OB decide it was time for the c/s) decel.

L and D nurse here again. 40 bpm for 5 minutes? She had to be exagerrating. There's no way anyone would wait a whole 5 minutes if the FHR went down that low. If you got a CS for that, please rest assured, in that case, it was for a GOOD reason. Again, I highly doubt it was for 5 minutes, but it's a pretty low FHR. Anything more than 20-30 seconds requires an intervention like turning to left side, increased fluids, oxygen and turning off pitocin.

A c-section for a 40 FHR longer than 60 seconds would seriously be considered and appropriately so (IMHO).

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have yet to hear the birth story of anyone that got pitocin and didn't end up w/ a C/S. I'm not horribly opposed to a C/S but I am very very loathe to get induced because it really tends to result in the worst situations it sounds like. Of course sometimes you have to, but other times, the OB is looking to do it only a couple days after the due date and the baby's just not "ready" yet.

i had pitocin and delivered vaginally.

I've definitely seen many vaginals with pitocin, but I just think it's associated with more sections. Put it this way, I barely see any sections that don't involve pitocin. The exceptions would be dangerously high blood pressures or active herpes. Other than that, pitocin is a common denominator.

[Anonymous]

Anonymous wrote:L and D nurse here again. 40 bpm for 5 minutes? She had to be exagerrating. There's no way anyone would wait a whole 5 minutes if the FHR went down that low. If you got a CS for that, please rest assured, in that case, it was for a GOOD reason. Again, I highly doubt it was for 5 minutes, but it's a pretty low FHR. Anything more than 20-30 seconds requires an intervention like turning to left side, increased fluids, oxygen and turning off pitocin.

A c-section for a 40 FHR longer than 60 seconds would seriously be considered and appropriately so (IMHO).

OP again, thank you so much for your opinion. There was a med student in the room with me, and it was so interesting to hear my L & D nurse explain things to her. Made me want to change careers to nursing, actually.

I probably misheard the "5 min" part. I was pretty out of it at that point. Anyway, baby is fine and healthy, so I don't mind the c/s at all, though I am a bit relieved to hear that my c/s was for a good reason.

[Anonymous]

I know several people who've had pitocin and delivered vaginally. And, again, it's not like most people who get pitocin are just doing it for fun. We're either way overdue or have other reasons (low amniotic fluid). Also, L&D nurse, wouldn't breech position be one of the more common reasons for c-section without pitocin? More often than herpes or high bp?

[Anonymous]

I had a natural childbirth but have some insight on this, filed under the category "something I'll do differently next time."

I was doing fine all day in labor and then went to the pushing stage. I was pushing in a position that was really comfortable to me, which happened to be on my hands and knees. I had only been pushing for 20 minutes, but my doctor (who is actually quite friendly to natural childbirth) suggested that I could probably push more effectively in a different position (yes, the sitting back position). So he asked me to sit back against the bed with my legs splayed (held by a nurse and my husband). He encouraged me to try it, and if I didn't like it, I could move back between contractions.

I trusted him, so I did it, but I HATED that position immediately. It also took a lot of energy to get into that position and, even though I hated it, I didn't want to burn more energy flipping around again. (Sounds crazy until you realize what an athletic event giving birth can be). Anyway, about 10 more minutes of pushing, and my doc gave me oxygen. Started directing my pushing (because I felt like I couldn't get "traction" in that position, I was probably wimping out a bit). A few pushes later, he gently suggested that baby needed to come out soon, so we'd do one more push and if no luck, then we should talk about an episiotomy.

So I shot the baby out on the next push, tearing myself from rooter to tooter in the process for a 6 lb baby boy. He was sunny side up.

I'm pretty convinced that the way I was pushing -- the way that felt natural to me -- on my hands and knees, was the way I was "supposed" to be pushing (for me). My gut told me that, my body felt terrible in the other position, etc. Researching the issue after my birth has uncovered lots of information suggesting that baby's heart rate has a lot to do with positioning. I think if I'd have stayed put, on hands and knees, I would have saved myself a tear and reduced the stress / heart decels on my baby.

There were no issues at all until I changed into that bad position.

Fortunately, I didn't have an episiotomy or any harm to baby or real lasting harm to me (other than a rough recovery). I still had my natural childbirth so all's well and all. But it's worth thinking about.

[Anonymous]

By the way, this is PP here. There are many things that can cause a heart decel, and positioning is just one of them. I'd encourage anyone to have a care provider they can trust to know the difference between dangerous and not so dangerous. My doc actually tried a number of things and at no point mentioned c section. However, I still feel like his pushing me into a different position contributed. (However, I have to own responsibility for actually doing it -- nobody forced me!).

[Anonymous]

Anonymous wrote:By the way, this is PP here. There are many things that can cause a heart decel, and positioning is just one of them. I'd encourage anyone to have a care provider they can trust to know the difference between dangerous and not so dangerous. My doc actually tried a number of things and at no point mentioned c section. However, I still feel like his pushing me into a different position contributed. (However, I have to own responsibility for actually doing it -- nobody forced me!).

This is why it's important to carefully interview your care provider. Women who are interested in natural childbirth will ask a general question like "can I use any position I want?" and the good docs will usually say, sure, it's your body and whatever makes you comfortable. However, they don't do births on hands and knees and they don't really come out and say that, because they are just used to asking a woman to flip over right before the birth. Instead, you might ask the doctor "how often to you catch a baby when the mom is on hands and knees?" "have you done any of those births in the past year?" Questions like that get much more specific, and hopefully give you a much great idea of their individual experience.

PP - I don't really think you are responsible at all. You trusted your doc (who is probably a pretty decent doc, just unskilled/unfamiliar with this one thing) and when you are at that point in labor, no woman feels up to negotiating with the doctor. I have witnessed countless women do whatever her doc recommends, regardless of how committed she was prior to that moment to using a different technique or position. That's just the nature of birth - in those moments you aren't thinking so rationally any more, and just tend to do what you are told.

[Anonymous]

i agree there are circumstances where pitocin might be needed, but i think it's important to acknowledge that there's wide variation among providers about when that would be. some providers are comfortable with a woman waiting up to 48 hours for labor to begin after water breaking, whereas others want to induce with pitocin right away after water breaks. some providers induce at 42 weeks while others are comfortable waiting longer assuming the baby is healthy. so to imply that pitocin is "needed" at 2 weeks overdue or 24 hours after water breaking isn't really accurate, since not all providers would follow this protocol, and since babies can be born just fine with protocols other than these.

Anonymous wrote:"

Anonymous wrote:if you want to avoid fetal distress don't get induced with pitocin and don't get an epidural in the first place
also the attached monitors are not always accurate; get monitored with a fetal doppler

"
This is a really stupid statement. Sometimes you don't have a choice. I had to have pitocin because my water broke and 24 hours later i wasn't dilated at all. Sometimes you're 2 weeks overdue. Sometimes there are other reasons induction needs to happen. And telling women to avoid epidurals is a mixed statement at best. There's evidence that shows that epidurals can DECREASE the risk of c-section because the woman can relax and push better. Studies have gone both ways on this.

[Anonymous]

i think the definition of "way overdue" varies widely. for some providers, "way overdue" is 41 weeks, for others it's 42, for others there's no such thing because as long as the baby is healthy they are okay to wait for the baby to come on its own. also there is a lot of controversy over induction for low amniotic fluid and whether this is necessary as often as it occurs. for example this:

Low amniotic fluid no risk to normal birth
http://www.obgyn.net/newsheadlines/womens_health-Obstetrics-20030306-34.asp

and
Isolated Oligohydramnios at Term: Is Induction Indicated?
http://www.jfponline.com/pages.asp?aid=1847&UID=

There's also debate about breech birth being an automatic indication for cesarean birth. Several countries (including Israel and Canada) have done studies finding that outcomes can be as good or better with vaginal birth than with cesarean birth, for breech babies under certain circumstances.
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/04/AR2010010402755.html

I guess my point of all this is that the reasons for using various interventions are often highly controversial, and something that is "needed" according to one provider or woman may not be perceived as such by another.

Anonymous wrote:I know several people who've had pitocin and delivered vaginally. And, again, it's not like most people who get pitocin are just doing it for fun. We're either way overdue or have other reasons (low amniotic fluid). Also, L&D nurse, wouldn't breech position be one of the more common reasons for c-section without pitocin? More often than herpes or high bp?

[Anonymous]

Anonymous wrote:

Anonymous wrote:By the way, this is PP here. There are many things that can cause a heart decel, and positioning is just one of them. I'd encourage anyone to have a care provider they can trust to know the difference between dangerous and not so dangerous. My doc actually tried a number of things and at no point mentioned c section. However, I still feel like his pushing me into a different position contributed. (However, I have to own responsibility for actually doing it -- nobody forced me!).

This is why it's important to carefully interview your care provider. Women who are interested in natural childbirth will ask a general question like "can I use any position I want?" and the good docs will usually say, sure, it's your body and whatever makes you comfortable. However, they don't do births on hands and knees and they don't really come out and say that, because they are just used to asking a woman to flip over right before the birth. Instead, you might ask the doctor "how often to you catch a baby when the mom is on hands and knees?" "have you done any of those births in the past year?" Questions like that get much more specific, and hopefully give you a much great idea of their individual experience.

PP - I don't really think you are responsible at all. You trusted your doc (who is probably a pretty decent doc, just unskilled/unfamiliar with this one thing) and when you are at that point in labor, no woman feels up to negotiating with the doctor. I have witnessed countless women do whatever her doc recommends, regardless of how committed she was prior to that moment to using a different technique or position. That's just the nature of birth - in those moments you aren't thinking so rationally any more, and just tend to do what you are told.

I think that is generally a good observation, but I feel the need to respond here about my specific situation and also to let you know that -- although I think it is unintentional and I believe you meant to be reassuring -- there is a patronizing element to your response.

Any woman who has really researched this knows that you don't just ask "how do you feel about natural childbirth" and expect a full answer. I researched this pretty well because I wanted a home birth and found THE most natural childbirth friendly provider I could, by asking not just the question you mentioned but dozens like it.

Doctor said, "I find that many women actually do end up doing better sitting up. However, if you want, I will catch your baby in any position you want." To be clear, during birth, my doctor did not direct me to flip over. I was fully aware, in good spirits, etc. He thought (and I think it is genuine) that I might do better in a different position. The truth is, I was a little bit weirded out by the sensations of pushing and was not pushing effectively so I don't necessarily blame him for asking me to try something different. I should have just waited it out and caught my groove, but instead I did decided to try it. I didn't expect it to take as much energy. Live and learn, you know? I talked to this doc after childbirth. I have no regrets, but I wanted him to know that flipping over seemed disruptive to me. I was careful not to make it a blame statement, I was ONLY telling him because he actually is a very natural childbirth friendly doc, did an amazing job of supporting me to that end (including supporting eating and drinking during labor, walking around as much as I want, minimal fetal monitoring, and more). When I said "I don't like this position!" He said "okay, let's turn back around, we'll help you." Trust me, I'm not one to get pushed around, even in the moment. There were things that the doc wanted to do (like additional cervical checks) that I did refuse and he gave no push back. I simply took advice, which anyone (even a doula) might have offered, and then regretted it.

As much as I do agree that women, in the heat of labor, get persuaded to do things they shouldn't / wouldn't otherwise, this isn't one of those cases. I'm sure you really have seen dozens of cases where the woman changes what she wanted regardless of how committed she was to something. The fact is, I was "committed" to doing whatever worked best. I was committed to not being pushed into something I didn't want. That didn't happen at all; I was a full participant. The problem is not one of the doctor being pushy. The issue is that the doc probably hadn't experienced as many births going the way mine was and was helping to the best of his training. I genuinely don't think he was afraid to catch a baby on hands and knees (for a while I was standing against the bed pushing and he actually said straight up "if you are comfortable like this we can catch the baby this way." and directed the nurse to hold the monitor on my stomach so I didn't have to worry about it moving around.

Anyway, not sure if the long explanation is needed, but there is enough distrust of the medical establishment out there without making it seem like every woman doesn't know which questions to ask, or that every doctor who makes a recommendation is doing it out of self-interest.

so, while I think you meant well, please consider that you are taking a post I wrote to help inform others and making it out like I'm just another woman "duped" by the medical establishment. Birth is a tough process, but not everyone loses their marbles. Rational decisions can still end up being not the best ones.