Preventing a baby from developing HIE is a matter of importance during labor and delivery. If there are no genetic, or developmental abnormalities, then the question becomes, what happened during labor and delivery which could have led to a baby receiving a reduced level of blood and oxygen, thus leading a brain injury and subsequent hypoxic ischemic encephalopathy diagnosis? Preventing HIE in this context falls in many instances on the actions, or inactions of the medical professionals in the labor and delivery room.
Why The Electronic Fetal Heart Monitor Is So Important…
The electronic fetal heart monitor is a device that is used during labor and delivery to help doctors and nurses gauge fetal wellbeing. Hospitals across the United States use the electronic fetal heart monitor to evaluate whether a baby is tolerating a vaginal delivery.
When mom presents in the delivery room, the connections for the monitor will be placed on her stomach. The monitor will display a host of readings to the medical professionals responsible for mom and baby’s care. Not only will doctors and nurses know the baby’s heart rate (normal range is between 120-160 beats per minute), it will also keep track of contraction patterns. Below are some of the readings presented on the monitor:
Baseline Heart Rate: this is the baby’s heart rate during a 10-minute period on the strip and rounded to the nearest 5 bpm reading. The baseline must be at least 2 minutes in determination. If a reading cannot be determined over a 2-minute time frame, then the baseline is said to be indeterminate.
Fetal heart rate: normal range 120-160 bpm
Bradycardia: a fetal heart rate and baseline of 110 bpm or lower
Tachycardia: a fetal heart rate and baseline above 160 bpm
Variability: rise and fall in the fetal heart rate of more than 2 cycles per minute
Absent: 0 bpm
Minimal: > 0 & ≤ 5 bpm
Moderate: 6-25 bpm
Marked > 25 bpm
Accelerations: these are short-term rises in the heart rate that go at least 15 beats per minute. This lasts for at least 15 seconds.
Decelerations: this is a decrease in the baby’s heart rate below the baseline heart rate. An early deceleration is defined as a waveform with a gradual decrease and return to baseline with time from onset of the deceleration to the lowest point of the deceleration >30 seconds.
Early Decelerations: a gradual decrease in the FHR with onset of deceleration to the bottom > 30 seconds. The bottom of the reading occurs with the top of the contraction.
Late Decelerations: a gradual decrease in the FHR with the onset of the deceleration to the bottom > 30 seconds. Onset of the deceleration occurs after the beginning of the contraction, with the bottom FHR occurring after the peak of the contraction.
Variable Decelerations: A sudden decrease in FHR of > 15 beats per minute measured from the most recently determined baseline rate.
HOW THE ELECTRONIC FETAL HEART MONITOR ASSESSES FETAL DISTRESS & HELPS PREVENT HIE
Doctors and nurses can use the reading from the electronic fetal heart monitor to determine whether a baby is continuing to hold up during a vaginal delivery. When doctors and nurses fail to properly assess the readings on the fetal heart monitor, danger to the baby can loom along with an HIE diagnosis. Fetal distress, in this context, means that the baby is no longer tolerating a vaginal delivery.
Being able to properly diagnose fetal distress allows for proper treatment. One cause of fetal distress can be a reduced/lack of blood and oxygen. This reduced level of blood and oxygen is what can lead to a brain injury and possible HIE diagnosis. A method of preventing HIE is for doctors to understand the baby’s well-being during labor and delivery.
Using An Emergency C-Section To Help Prevent HIE
When a baby is in distress, and that distress continues for too long, then the baby can suffer from reduced blood and oxygen, which can lead to a diagnosis of HIE. During development and labor and delivery, a fetus has something called fetal reserves (think of this like reserve oxygen). These reserves are in place to help with the birthing process.
With that said, fetal reserves are not unlimited. What this means is that if a fetus is in distress past the point of its reserves, then damage to the baby can occur. Doctors and nurses can use conservative methods to help when it seems that the baby is in distress. However, these conservative methods (turning mom, giving oxygen, providing a bolus, etc.….) will sometimes not resolve the fetal distress.
Doctors are expected to be ready to move to an emergency C-section when warranted to help prevent a baby from developing HIE. If doctors must move to an emergency C-section, time is of the essence because of the risk posed to baby (reduced blood and oxygen) and mother in some cases.
Why We Care
The HIE Resource Place is a website owned and operated by Boston Law Group, LLC. We are birth trauma legal professionals who help families gain an understanding into the world of HIE. This website is a continuation of our mission (more than 200k views on our YouTube educational video channel) to provide families with an avenue to learn more about their baby’s HIE condition from a medical legal standpoint.
It has been our experience that for many families, when a baby is diagnosed with HIE, there are many questions. From how did the HIE diagnosis occur, to what do we do now, families can experience fear and isolation due to “not knowing what’s next.”
Please use this website to expand your understanding of HIE from a medical legal standpoint and do not hesitate to contact us regarding your questions. If you are wondering, you only pay our legal fees if we win for you and your family. We can be reached for a free discussion and talk about your baby’s story at 1-833-4HIEHELP or 1-833-444-3435.