How do you know if your baby is thriving inside you? What are the warning signs of fetal distress? Obstetrical Nurse Wanda Steele tells you a few things you and your healthcare provider may watch for.
Wanda Steele, RN

The question: What are the signs and symptoms of fetal distress? - Carson

The expert answers:
Hi Carson,

Unfortunately, there are very few ways to know that your fetus is in distress in utero. One thing that we do rely a lot on is the "kick count." The mother does this herself while going on with her normal daily activities. If the fetus has not accomplished at least 10 movements from after breakfast until the mid-afternoon, we ask the mother to call us. If the 10 movements have been accomplished, she does not worry about counting any further until the next day. We usually only ask mothers who have or are at risk for problems or have complained of decreased fetal movement to do this activity.

If someone calls and says that her baby has not moved ten times in the time period, then she is asked to come into the office for a Non-Stress Test (NST). The patient should have eaten recently, emptied her bladder and should drink some fluids. She is hooked up to the fetal monitor and asked to push a button each time she feels the baby move. At the same time that she does this, a small mark is made on the monitor strip. (A lot of times we find that the baby is indeed moving frequently but the mother has become so used to the movements that she did not notice it for a while.) The monitor strip is also registering the fetal heart rate and any uterine activity.

At the time of the movement we like to see a corresponding rise in the fetal heart rate of at least 15 beats above the baseline that lasts for at least 15 seconds. We need to see at least 2 of these accelerations in a ten minute time frame and the test should be no less than 20 minutes in duration. We also do not want to see any decelerations in the fetal heart rate occurring with or without movement or in response to a contraction. These are the American College of Obstetrics and Gynecology standards for this test, and the test should be evaluated by a physician.

If this test if found to be non-reassuring -- which would be noted by lack of fetal movement, lack of corresponding accelerations with movement or decelerations of the heart rate -- further testing would be ordered. This may involve an ultrasound to assess the well being of the fetus, a biophysical profile. Further monitoring would also be indicated. If these tests were not reassuring, delivery may be necessary.

Fetal distress during the labor and delivery phase can be noted similarly by observing the baby on a fetal monitor. Decelerations of the fetal heart rate occurring with a contraction can be a normal response by the baby, as long as the baby returns to baseline as the contraction is ending and the deceleration was not "too deep for too long."

If the fetal heart rate should go down and not return to baseline promptly with increased fluids, oxygen and position changes, this could indicate a problem that could mean a quick delivery is necessary.

Repetitive, subtle decelerations that occur after a contraction has begun and a return to baseline after the contraction is well over ("late decelerations") are considered an ominous sign, and the delivery is usually quick if the baby does not respond to the same measures I mentioned above.

Please bear in mind that the evaluation of a fetal monitor strip is a very complicated process, and I am just giving you a few basics here. This is not something that should be undertaken by an amateur, and should only be done by a highly-trained professional who has had specific training in the area of fetal monitoring.

The color of the amniotic fluid can also be considered a sign of fetal distress. The fluid should be clear but can be discolored. If it is green or dark brown (stained with meconium, a baby's first bowel movement), this would indicate there has been stress on the baby. Of course, who would not consider labor, in and of itself, stressful? If it is bloody, this could indicate a bleeding problem with the placenta.

There is further testing that can be done, such as a scalp pH, but that would depend on the evaluation of the situation by the physician.

Again, I ask that you consider that the evaluation of all of the things I mentioned above should be done by highly-trained professionals. It pays to be an informed patient, and I advocate your right to know what is going on wholeheartedly, but let the professionals you trust with your own and your baby's care do their jobs.

For now, eat well, take a nice walk and enjoy yourself. Your caregiver will let you know when there is a reason to be concerned.

Good luck :)

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