There are many things that nurses and providers look at when we watch your baby’s heart rate during labor. It is important to monitor what your baby’s heart rate is doing to make sure that your baby isn’t in distress and is tolerating the contractions.
This information is a quick overview about your baby’s heart rate to help you understand why we do certain things while you’re in labor. It’s good to know the basics so there are no surprises. This isn’t meant to make you a professional. Interpreting baby’s heart rate takes a lot of practice to fully understand.
How Do We Monitor Your Baby?
The most common way of monitoring baby’s heart rate is by using electronic fetal monitoring. We hook you up to two round monitors, one that monitors the heart rate and one that monitors your contractions.
We look at a lot of different things to determine if your baby is tolerating labor. We look at how close your contractions are, what baby’s heart rate average is, and if the heart rate increases or decreases.
The Associate of Women’s Health, Obstetrics, and Neonatal Nurses (AWHONN) gives us the most up to date information on fetal monitoring and how to interpret your baby’s heart rate. You can check them out here if you want a more in depth detail of what it all means.
You’ll have to excuse my drawing out of the heart rate and contractions. I don’t want to mess with HIPPA or copyright issues!
What Am I Looking At?
The top line is baby’s heart rate. The second line is mom’s heart rate. The bottom line is the contraction pattern.
From one dark line to the next dark line is one minute. Each box and light line is ten seconds. When you time the contractions, you start from the beginning of one contraction to the beginning of the next. The contraction monitor doesn’t tell us how strong the contractions are, but how often you’re having them and how long they last.
What We Like to See
We like to see a lot of squiggling in baby’s heart rate. That means baby is well oxygenated and doing well. This is called variability.
We also like to see baby’s heart rate go up for a little bit. We call this an acceleration. That also means you have a happy baby that is tolerating labor.
When Baby’s Heart Rate Drops
There are four different types of drops in your baby’s heart rate.
- When the baby’s heart rate drops with the contraction, that means that your baby’s head is getting squeezed. This is normal when labor is progressing and is not concerning. Those are called early decelerations and look like this:
- When the baby’s heart rate drops after a contraction, that means the baby doesn’t like the contraction. Those are called late decelerations and look like this:
- When the baby’s heart rate drops quickly and comes right back up it means the cord is getting pinched somewhere. Those are called variable decelerations and look like this:
- When the baby’s heart rate drops from the average beats per minute for longer than a few minutes it means baby is possibly in distress. Those are called prolonged decelerations and look like this:
What Makes Us Concerned
Late decelerations and prolonged decelerations will make us concerned for your baby. Those are usually indicators that baby is not getting an adequate amount of oxygen and is getting stressed.
Variable decelerations can sometimes be concerning depending on how often they’re happening and how low the heart rate gets.
How Do We Fix Drops In Heart Rate?
There are a few things that we do if your baby’s heart rate is concerning.
- We may put an oxygen mask on your face. This will boost the amount of oxygen to your baby.
- We will help you change your position to see if baby’s heart rate improves. Sometimes if you’re positioned a certain way the cord is getting pinched or the placenta isn’t getting enough blood flow to it. Switching positions may help fix that. We may flip you to your left side, right side, or even on all fours.
- If your blood pressure has dropped due to an epidural, sometimes baby’s heart rate will drop because a decrease in blood flow to the placenta.There are some medicines we can give to help bring your blood pressure up.
- Worse case scenario would be a Cesarean section. Typically an emergent C-Section happens when baby’s heart rate has dropped low for a long period of time and nothing is bringing it back up. Those baby’s are in serious distress and need to be born. Having late decelerations with every contraction for a long period of time could also indicate a need to deliver the baby by C-section.
If you think you see something concerning while you’re in labor, don’t panic. Your nurse is watching your baby’s heart rate at all times. There are most likely monitors all over the unit with your baby’s heart rate so we can see them wherever we are.
Like I mentioned earlier, reading and interpreting baby’s heart rate takes a lot of practice. This is not meant to make you a professional at it or to freak you out with any dip in the baby’s heart rate. My goal is that this helps you better understand what all those lines mean and why the heck we keep switching you from your left side to your right or put oxygen on your face.