Fetal Monitoring Errors, Birth Injury, and Hypoxic Ischemic Encephalopathy (HIE)

In this video, our on-site labor and delivery nurse explains the importance of electrical fetal monitoring.

Transcript:
My name is Andrea Shea and I’m a registered nurse. I’m the on-site nurse here at Michigan Cerebral Palsy Attorneys. I currently review medical records. When I receive the medical records, it takes me weeks, sometimes months, to go through, review, and look for potential mistakes that may have occurred in the labor and/or delivery period.

During my obstetrical nursing training, I was required to become certified in electronic fetal monitoring. Electronic fetal monitoring is essentially the window into the unborn baby’s world. It allows nurses and doctors to see how the baby is tolerating labor, specifically contractions. Electronic fetal monitoring measures two very important bits of data, if you will. Number one, it’s measuring the baby’s heart rate and, number two, it’s tracing, or measuring the mom’s uterine contractions. When doctors and nurses are monitoring a patient, it’s very important that they use the standard language and standard description when communicating findings with one another, as well as when documenting findings.

When a mother comes in to a labor a delivery unit to be assessed for labor, or if she’s in labor, the nurse is going to attach some monitors to her abdomen. The electronic fetal monitors have two different monitors that are required. The first is called an ultrasound and that measures the baby’s heart rate and it does require a bit of gel and it is usually placed right where the nurse can feel the baby’s back. The second one is called a “toco.” It has a little bit of a knob on it and that’s put lower on the belly typically, and that measures the uterine contractions.

During a contraction, the blood flow is temporarily cutoff. As that muscle gets tight and contracts, the blood flow stops and then once that uterus relaxes and that muscle relaxes, the blood flow goes back to the baby. In a naturally occurring labor those contractions typically happen every 3-4 minutes, and that’s safe. Contractions that occur every 3-4 minutes are safe for babies; that allows the babies time to catch their breath and to get oxygen again. A way to think about contractions and oxygenation, if you think about swimming. When we swim in a lake or a pool and we’re about to go under water we take a big, deep breath and we hold it for a period of time and when we need more air, we come back up out of the water and we take another deep breath. The baby can tolerate temporarily not receiving oxygen, as long as it can have a period of rest where it can get oxygen.

When a mom is in labor and she’s attached to this machine and the nurses and doctors are interpreting these findings, they’re using these findings to guide the management of the care of that mom and the baby. The electronic fetal monitor is the most important tool utilized by doctors and nurses during the labor and delivery. If that tool is misused, misinterpreted, those finding are not communicated properly or documented accurately, it can have a devastating effect. Consequences can result in a permanent, preventable, birth injury.

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