Fetal Distress

Fetal distress is a term used to describe a condition where a baby is not receiving enough oxygen during labour and delivery.

During normal labour, the contractions temporarily interrupt the oxygen delivered to the baby. A healthy, term baby will typically have sufficient capacity to tolerate these brief interruptions in oxygen supply.

There are, however, various complications that may occur during labour that may interrupt or decrease the oxygen supply to the baby’s brain causing fetal distress, such as:

• Umbilical cord compression – caused by, for example, the cord kinking, being tightly wrapped around baby’s neck, or proceeding down the birth canal ahead of the baby;
• Uterine rupture;
• Placental abruption; and
• Abnormal contraction pattern (too many contractions, contractions lasting too long, or not enough resting time between contractions), especially if labour has been induced or augmented.

A baby will typically show signs of inadequate oxygen supply with changes in their heart rate. This is why there is so much emphasis on monitoring the baby’s heart rate during labour and delivery – it is the only way of monitoring fetal wellbeing during the process of labour.

Some babies may be more vulnerable to the stress of labour than others and require closer monitoring of their heart rate pattern, such as

• Babies whose growth has been less than expected during pregnancy;
• Babies with lower or higher volumes of amniotic fluid;
• Pregnancies with more than one baby;
• Pregnancies involving high blood pressure;
• Pregnancies involving diabetes; and
• Preterm or post term babies.

A baby may also show signs of stress by releasing meconium (or poo) before they are born. A pregnant woman may pass greenish or brown stained fluid vaginally when this happens or this may be seen when a baby is delivered.

Fetal distress, typically shown as changes in the baby’s heart rate pattern, is a warning sign that there is not enough oxygen reaching the baby’s brain. The longer this continues, the higher the risk of the baby suffering from a brain injury, called an hypoxic ischemic brain injury.

The risks of brain injury to the baby increase if the baby’s heart rate is not carefully monitored during labour and delivery and if early changes in the baby’s heart rate pattern are not responded to in a timely and appropriate way.

In response to changes in the fetal heart rate, the attending nurse should communicate these changes to the responsible health care provider (the obstetrician, family physician or midwife) who must assess the changes in the heart rate pattern in relation to the progress of the labour and any risk factors that may be present, in order to determine whether continuing with vaginal delivery is reasonably safe.  If not, delivery of the baby should be expedited.

In assessing how to proceed, the health care provider may obtain more information about fetal well-being by doing scalp stimulation (tickling the baby’s head to elicit an increase in the baby’s heart rate) or doing scalp pH or lactate sampling which is a blood test to assess oxygenation of the baby’s blood.

There are also interventions to alleviate fetal distress which include:

• Changing the pregnant woman’s position to alleviate cord compression; and
• Administration of medication to relax the uterus and/or stopping any medication used to augment labour, if there is an abnormal contraction pattern.

If these interventions do not, or are not reasonably expected to, improve the fetal distress, expedited delivery is important to avoid the risk of brain injury.  Expedited delivery can be accomplished in the following ways:

• Episiotomy;
• Forceps extraction;
• Vacuum assisted delivery; and
• Urgent caesarean section.

The safest method of expediting labour depends on the circumstances of each individual delivery including any risk factors that may be present, the progress of the labour, the skills of the treating health care provider as well as the available resources in the hospital.

When early warning signs of potential fetal distress are promptly diagnosed and responded to, damage to a baby’s brain can be avoided. If you have concerns about whether there were early warning signs of potential fetal distress during your labour or whether or not your baby’s brain injury could have been avoided, then please contact us – we would like to help. We have a team of experienced lawyers and medical specialists who can review the medical care you and your baby received and help answer your questions.  We will provide you with the information and advice you need to make informed decisions about your child’s future and ensure your child’s rights are protected.  Rest assured – the consultation is confidential and free of charge.