Trusted Information for Healthy Pregnancies
fetal heart rate monitor
Tips for Avoiding an Unwanted C-Section
Dec 17th
Not every mother wants to avoid a C-section -- in fact, some request them -- but if you do, here are some tips for what to ask your doctor (or midwife) in the delivery room if the suggestion is made that it's time to give up on a vaginal birth and head to the operating room.
"Doctor, is this an emergency, or do we have time to talk?"
Sometimes you need a C-section to save your life, your baby's life, or both. In those cases, there's no room for discussion.
Delivery room emergencies include excessive bleeding, a breech position where the baby is headed out foot-first, or when the baby has certain heart rate problems.
"Doctor, what would happen if we waited an hour or two?"
The vast majority of the time, when your doctor or midwife tells you it's time for a C-section, it's not an emergency.
In many cases, women just need more time to labor. In fact, the No. 1 reason for a C-section is "failure to progress" during labor. If that's what we're talking about, then it's not an emergency.
"Doctor, are you sure the baby is too big for me to deliver?"
Sometimes parents are told a baby is too big to deliver vaginally. Dr. Ware Branch, medical director of women and newborns clinical program at Intermountain Healthcare in Utah, says parents should ask whether a C-section is absolutely necessary, especially if labor hasn't advanced very far.
"If it was my wife in labor and she's three or four centimeters dilated and the obstetrician says the baby's head is too big and she can't deliver him, I'd say, 'Nonsense, she hasn't really had a trial of labor, doctor.' "
"Doctor, is there something else I can try before having a C-section?"
Antunes, a spokeswoman for DONA International, which certifies doulas, says there may be options such as maneuvers like the one she used on Ste. Marie to get a slow labor moving.
"Doctor, can we talk more about the baby's heart rate?"
If you're told you need a C-section because of the baby's heart rate, try to get your doctor or midwife to be as specific as possible.
Some heart-rate problems mean a C-section is necessary immediately, but other types of heart-rate issues are not nearly as serious, and you may be able to labor longer.
"This is a very gray area," says Debbie Levy, a certified nurse midwife in Marietta, Georgia. "It takes years to learn how to read fetal heart tones, and it's not an exact science."
Levy says it can be difficult to ask these questions when the person delivering your baby says it's time for a C-section, especially since mom and dad are often exhausted.
"This is a very tough discussion to have in the delivery room," she says. "You're vulnerable, because you're talking about your baby's well-being."
But she says as long as it's not an emergency, you should have these delivery room conversations with your doctor or midwife.
"You shouldn't be afraid to speak up and say you'd like to try to labor longer," she says.
Home Fetal Heartbeat Monitors May Decieve, Experts Warn
Nov 9th
Expectant mothers may enjoy listening to their unborn babies' heartbeats, but they shouldn't rely on home fetal heart monitors to provide an accurate picture of fetal health, researchers say.
The devices may provide false reassurance in some situations, according to Dr. Abhijoy Chakladar of Princess Royal Hospital in West Sussex, England.
In the British Medical Journal, Chakladar reported a case in which a 34-year-old woman who was 38 weeks pregnant went to the emergency department because she couldn't hear her baby's heartbeat with her home fetal heart monitor.
A few days earlier, she said she had noticed that the baby was moving far less than usual. However, she reassured herself that everything was OK by listening to the monitor. A couple of days later, when she listened again, she couldn't detect anything and sought medical help.
Physicians performed an ultrasound and found no fetal heart activity. They gave the diagnosis -- intrauterine death -- but could not explain why it had happened.
All blood tests and infection screens were normal. There was no significant microbial growth from the placenta or fetus, and the fetus seemed morphologically normal, Chakladar said.
He said the stillbirth "may have been unavoidable," but listening to the fetal heart monitor "certainly delayed presentation to the hospital."
"Without training," he added, sounds heard on the monitor "could easily be misinterpreted." Likely, the mother had simply heard her own pulse or placental flow instead.
Home monitoring devices can give only a snapshot of the heart rate and "provide no indication of other important prognostic features," he said.
Medical professionals provide context that an untrained mother can't, he added. For example, midwives and obstetricians take careful histories and make experienced observations before making interpretations for a diagnosis.
But the sale and use of at-home fetal heart monitors has been on the rise, Rebecca Coombes, associate editor of BMJ, wrote in an accompanying editorial.
The devices are often sold over the Internet, making it hard for the U.K. Medicines and Healthcare Products Regulatory Agency -- which is responsible for regulating fetal monitors classified as medical devices -- to take disciplinary action.
But not all fetal heart monitors are medical-grade. Coombes said the regulated products use medical-grade ultrasound Doppler devices, which have to conform to medical standards and can cost $500 or more. But cheaper devices that do not use ultrasound retail for as little as $33.
"These are not considered medical devices," she said.
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