Fetal heart rate monitoring is the primary tool for detecting when a baby is in distress during labor. Failure to properly monitor or respond to warning signs is a leading cause of preventable birth injuries.

Understanding Fetal Monitoring

Electronic fetal monitoring (EFM) tracks the baby's heart rate and the mother's contractions throughout labor. This continuous surveillance reveals how the baby is tolerating labor.

What Monitors Show

  • Baseline heart rate—normal is 110-160 beats per minute
  • Variability—normal fluctuations indicating healthy brain function
  • Accelerations—heart rate increases, a reassuring sign
  • Decelerations—heart rate decreases, may indicate distress
  • Contraction patterns—timing and intensity

Warning Signs of Fetal Distress

Late Decelerations

Late decelerations occur when heart rate drops after a contraction peaks. This pattern indicates the baby isn't getting enough oxygen and is one of the most concerning findings.

Variable Decelerations

Variable decelerations are abrupt drops in heart rate, often caused by umbilical cord compression. Severe or prolonged variable decelerations require intervention.

Prolonged Decelerations

Heart rate dropping below 100 bpm for more than 2-3 minutes is an emergency requiring immediate action.

Minimal or Absent Variability

Lack of normal heart rate fluctuation may indicate:

  • Fetal sleep (temporary)
  • Medication effects
  • Brain compromise from oxygen deprivation (concerning)

Tachycardia

Sustained heart rate above 160 bpm may indicate:

  • Maternal fever
  • Infection
  • Fetal distress

Types of Monitoring Errors

Failure to Monitor

  • Not applying monitors appropriately
  • Monitors disconnected or providing poor tracings
  • Gaps in monitoring during critical periods

Failure to Observe

  • Nurses not watching monitors
  • Understaffing leaving patients unattended
  • Distractions preventing proper surveillance

Failure to Interpret

  • Not recognizing concerning patterns
  • Misreading the strips
  • Inadequate training on interpretation

Failure to Communicate

  • Not escalating concerns to physicians
  • Delayed notification of warning signs
  • Poor handoff communication between shifts

Failure to Act

  • Recognizing distress but not intervening
  • Waiting too long to call for help
  • Not performing appropriate interventions

Appropriate Responses to Distress

When fetal distress is detected, standard interventions include:

Intrauterine Resuscitation

  • Repositioning mother
  • Administering oxygen
  • IV fluid bolus
  • Stopping Pitocin if in use

Investigation

  • Checking for cord prolapse
  • Assessing for placental abruption
  • Evaluating labor progress

Delivery Decision

If distress doesn't resolve quickly:

  • Urgent vaginal delivery if imminent
  • Emergency cesarean section if vaginal delivery not possible

Proving Monitoring Negligence

Key Evidence

  • Fetal monitoring strips—the actual tracings showing heart rate patterns
  • Nursing notes—documentation of observations and actions
  • Timing records—when distress appeared, when action was taken
  • Staffing records—nurse-to-patient ratios

Expert Review

Obstetric and nursing experts analyze:

  • What the strips showed and when
  • Whether patterns were properly interpreted
  • Whether response was timely and appropriate
  • Whether earlier intervention would have prevented injury

Injuries from Monitoring Failures

Undetected or ignored fetal distress can cause:

  • Cerebral palsy—from prolonged oxygen deprivation
  • Hypoxic-ischemic encephalopathy (HIE)—brain damage
  • Developmental delays
  • Seizure disorders
  • Death—stillbirth or neonatal death

Hospital Liability

Hospitals may be liable for:

  • Inadequate staffing—not enough nurses to monitor patients
  • Poor training—staff unable to interpret strips correctly
  • System failures—monitors not functioning, alarms disabled
  • Protocol violations—not following monitoring standards

Conclusion

Fetal monitoring exists to detect problems before they cause injury. When healthcare providers fail to monitor properly, misinterpret warning signs, or delay response to fetal distress, they may be liable for resulting birth injuries. These cases require expert analysis of fetal monitoring strips and medical response timelines.