Fetal Distress

This article discusses fetal distress – why a baby may become distressed before birth and the likely consequences of fetal distress.

What is Fetal Distress?

‘Fetal distress’ is a general term (sometimes labelled a “syndrome”) which implies that the baby is not getting enough oxygen while in the womb. Most commonly, the term is used during labour. Fetal hypoxia (reduced oxygen) is it’s more accurate name.

Why would the baby become distressed?

During labour the muscles of the mother’s womb contract every few minutes and, as a result of this, there is a decreased flow of blood taking oxygen to the baby. Most babies withstand this amazingly well – towards the end of pregnancy they lay down fat stores, which can be converted into energy as necessary and they also have glycogen reserves in the heart, to ensure a good energy supply in labour.

This safety net does not always exist against foetal distress, for example:

• Prematurity – a baby born before 34-36 weeks has not had the chance to lay down fat and glycogen stores
• Reduced growth in pregnancy – a baby who has been poorly nourished in the womb, due to smoking for example, will have less reserves to help them through labour
• Long labour – even a healthy, strong baby will have reduced reserves at the end of a long labour
• Multiple births – there is increased demand from the placenta and blood supply, making twins and triplets more vulnerable in pregnancy and labour.

With the increasing use of technology, the signs of fetal distress are sometimes picked up in labour, and then acted upon, only to find that the baby at birth is perfectly robust and healthy. There are therefore many ‘false positives’ which leads to unnecessary interventions; however, if the midwives and doctors suspect that your baby is not coping with labour, they will inevitably act on the side of caution!

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What does fetal distress involve?

Babies in the womb receive their oxygen and nutrients via the umbilical cord. This travels from the placenta to the baby, where it enters at the umbilicus (tummy button) and passes into the main circulation of the developing baby.

Likewise the baby’s waste products are removed from the baby, through the vessels of the umbilical cord, to the placenta where they are diffused across to mum’s circulation for her to get rid of them.

This system relies upon:

• A good supply of oxygen to the placenta
• Which in turn relies upon mother having healthy lungs, heart and blood vessels and being in an environment which is clean and well oxygenated
• The placenta being healthy and functioning
• The blood vessels in the umbilical cord being healthy to allow a good blood flow through them.
• The baby having a normal heart and blood vessels.

If any of these factors are reduced or missing then there will be a reduced oxygen and nutrient supply to the baby, which may lead to fetal distress.

Signs and Symptoms of Fetal distress:

• Either in pregnancy, which would be picked up through reduced fetal movements (kicks)
• Or in labour, when it would usually be detected through changes to the baby’s heart rate.
• The baby may move their bowels while still in the womb, causing the fluid around baby to become green/brown stained – called meconium
• If the blood gases of the baby were analysed they would show reduced oxygenation of the blood.

Risks and complications of fetal distress

If the baby has reduced movements and you report this to your LMC, the health professional caring for you will monitor the baby’s heart rate by cardiotocograph, or CTG.

If this shows signs of distress, such as an increase or decrease outside of the normal range of 110 -160 beats per minute, or dips in the heart rate (and you are not in labour) you may need to have your labour induced or, if necessary, have an emergency caesarean section.

If you are in labour the midwives and doctors will try to deliver your baby as soon as possible – through encouragement of your pushing, an assisted birth or, if necessary, an emergency caesarean section.

If a reduced oxygen supply to your baby went undetected, this could lead to permanent damage to the vital organs of the body, such as the brain. Ultimately your baby needs oxygen to survive and after a period of time your baby would run out of reserves and die. This is an extremely rare, but tragic event.

What can I do to prevent fetal distress?

Most importantly, count / keep an eye on your baby’s movements every day!

Imagine a well toddler, running around and then taking regular rests in between – this is perfectly normal!

However, if that toddler were to lie still on the sofa for a long time when they did not usually nap, you would be suspicious and wonder if they were poorly….

If your baby has reduced movements at any stage of your pregnancy – contact your LMC immediately.

Please note that it is not normal for your baby to slow down the number of kicks towards the end of pregnancy – the movements change due to lack of space, but should never slow down.

Things you can do to help your baby stay healthy:

• Eat well in pregnancy to ensure good nutrition for your baby to lay down reserves for labour.
• Eat small nutritious snacks in early labour and keep well hydrated in labour (sip water throughout) to ensure that you are well nourished and hydrated – which in turn will improve the quality of the blood supply to your baby.
• Do not lie on your back in late pregnancy or labour – your womb and baby will squash the major blood vessels in your abdomen, reducing baby’s blood supply and making you feel faint.
• Keep breathing slowly and deeply during contractions (this is sometimes not as easy as it sounds!). Your baby needs an oxygen supply, which they can only get via mum until they are born!

Please remember that the vast majority of babies in New Zealand are robust and healthy and withstand labour amazingly well!

Useful Articles

For information on what to expect during a Normal Birth click here

For more information on Assisted Birth see our informative Kiwi Families article.

You may want to read more about Caesarean Section just in case this becomes a necessity for you; our article Caesarean in Detail will certainly make you feel well prepared.