Weeks 2, 3, and 4: Enjoyable but Amazingly Busy...

Yes, yes, I know. I haven't even thought about this blog for the last several weeks. I have had so much readings and assignments to accomplish that by the time I finish them, I just want to fall asleep. And that's what I usually do. lol.

Since I was a midwifery student and doula for five years, I'm very familiar with all that we're learning. Occasionally I learn something new. It's nice to actually know what we're learning, but there's still so many assignments that it's hard to stay on top of.

Clinicals have been the best part. I had my labor and delivery clinicals two weeks ago and got to see a Cesarean section (yay!) which is something I've been desperately wanting to see. I was amazed at how long it takes to get the baby out (since it was a non-emergent Cesarean) and how much tugging, pulling, and force was put into it. A Cesarean section is MAJOR abdominal surgery! And then for the next six weeks, you're not allowed to lift anything heavier than your baby! So the moral of the story is, unless it is a medical necessity, try to avoid a Cesarean at all costs! (Disclaimer: Obviously, there are times where a Cesarean is necessary and needed and it saves lives but it is major surgery). 

Anyway, I just wanted to quickly go over different fetal heart tone patterns with relation to contractions.

When a mom is in labor at the hospital, two transducers are placed on her stomach - one to monitor the baby's heart rate and the other to record contractions. Then, the nurse evaluates the baby's heart rate in relation to the contractions. There is a quick, easy pneumonic we learned to help us remember different heart rate patterns and what they mean:

VEAL CHOP.

The way the pneumonic works, you place the words vertically and compare the letters, like this:

V    C
E    H
A    O
L    P

So the "V" goes with the "C," the "E" goes with the "H," and so on.

V stands for "variability." We want some variability in the baby's heart rate to show that baby is responsive to contractions, but marked variability (where the heart rate varies suddenly by more than 15 beats per minute) is not a good sign. And that's where the "C" comes in. C stands for "cord compression." So when the baby is experiencing marked variability in the heart rate, it is from the cord being compressed. Just in case you're wondering, this is bad. The first thing that needs to be done is have the mom change positions. This should hopefully fix the problem, but if not, an emergency Cesarean section will probably need to be performed.

E stands for "early decelerations." This is where the baby's heart rate decreases at the beginning of the contraction but then is back to baseline by the end of the contraction. This is caused by the H - "head compression." When the baby is entering the birth canal, its head gets pressed and molded which is a lot of pressure. This pressure causes a vagal response which will decrease the baby's heart rate. Despite how horrific this sounds, it's actually normal and considered benign. In fact, I've always viewed it as a somewhat good sign - something's happening and the baby's descending!

A is "accelerations." Accelerations are abrupt increases in the heart rate by at least 15 beats per minute that last for at least 15 seconds. They can indicate fetal stress, pain, activity, annoyance, and more. The "O" they correspond to in VEAL CHOP just means "okay!" In other words, it's not too terrible to see sudden accelerations. In fact, accelerations means the baby is responsive to labor.

The last one is L - late decelerations. Late decelerations can be pretty bad since they mean the placenta isn't oxygenating the baby well. It corresponds to the P, meaning placental insufficiency. However, it can be caused by the mom being in the wrong position (like on her back), having hypotension (which decreases perfusion to the placenta), having strong uterine contractions (which makes the uterus slightly ischemic), etc. When late decelerations are seen, the first action is to change the mom's position in case it's just a positional problem. Then, decrease pitocin (if it's being given) and give oxygen. This will usually fix the problem.

One pattern midwives, doctors, and nurses really don't like to see is this one:

It's a prolonged deceleration. Not only did the baby's heart rate decrease with the contraction, it stayed low for four minutes. A normal baby's heart rate is 110-160 and this baby was happily plugging along at 160 when the contraction came and his heart rate plummeted to the 80s. Not good! The heart rate recovered but then jumped to the 180s for two minutes which is not good either. I took one look at this fetal heart recording and squirmed. This baby is not doing well...

There are many more fetal heart rate variations which make birth health care providers nervous but these are some of the main ones.

....Until next week (if I remember and don't fall asleep...)

(And because I had a very stressful day, I'm going to post funny birth pictures so I can laugh and de-stress)