Subject: Evidence of fetal distress in labor

Definition:  Abnormal FHT’s are defined as anything persistently under 120 or over 160 beats per minute, deep decelerations with slow recovery, late decelerations, and lack of variability in heart rate.

POLICY: The birth attendant will provide assessment and appropriate intervention in the event of fetal distress. 

GUIDELINES: 1. Bradycardia persistently less than 120 beats per minute or recurring decelerations from baseline requires immediate referral to physician.  Persistent is defined as decelerations >10 minutes without variability or >30 minutes with good variability.

2. A shorter observation period prior to transfer may be indicated in the presence of severe decelerations.

3. Tachycardia persistently more than 160 beats per minute requires an immediate referral to a physician.  Persistent is defined as accelerations <170 for >30 minutes with good variability, >170 for >10 minutes, over 180 at anytime, or not reassuring with no other reason for concern including:

a)   Presence of meconium

b)   Maternal hyperthermia

c)   Maternal well being

d)   Adequate labor progress

PROCEDURE:  Upon recognition of fetal distress the birth attendant will, as time permits:

a)   Change maternal position to facilitate improvement in fetal status

b)   Administer 100% oxygen at 10 liters per minute via face mask to mother

c)   Continue to monitor fetal heart tones

d)   Start an intravenous infusion of 1000cc Lactated Ringers

e)   Notify physician immediately – report shall include:

a.   Description of FHT pattern, baseline rate, variability, and any decelerations.

b.   Cervical dilation and estimated delivery time

c.   Extenuating circumstances (weeks gestation, maternal meds, etc.)

f)    If physician deems transport necessary, prepare client for transfer to hospital

Absence of audible FHTs could indicate fetal death

a)   Ask client if fetal movement has been noted in the last 24 hours

b)   Palpate vigorously to elicit fetal movement

c)   Ask client what she thinks is happening

d)   Notify midwife, midwife will inform client of possibility of death of baby and inability to detect FHTs

If the midwife thinks that the baby has died she will:

a)   Inform the client of the possibility

b)   Recommend immediate transport to the hospital for consultation