If this is less than 7.0, we know the baby experienced some level of lack of oxygen. We can assess how hypoxic a baby is at birth by obtaining a cord ph. If the baby continues to have late decels, it will slowly become hypoxic and either die in utero if sent home this way or if not delivered vaginally in a reasonable time or by c/section could also experience lack of oxygen and be at risk for serious brain injury. This is a baby that could be in jeopardy if it is not delivered in the near future. This tells us the placenta is not functioning as well as it should. This means the baby is experiencing a brief drop in oxygen as the baby's chemoreceptors trigger a response for the baby to try to constrict peripheral blood flow back to the baby's vital organs. This means the deceleration is occurring after a contraction. Let's now say her baby has some random "late" decels. We know that there is an increased risk for stillbirth in a patient like this. However, let's say the patient is more than 1 week over due, so she is almost 42 weeks. We would never deliver a 25 week baby early for something like that. If the patient was only 25 weeks along and the decels were just occasional variable type, meaning the baby is just rolling on the cord and dropping the heart beat here and there, that is a normal variant we expect to see. The problem with this logic is that it depends on the gestational age of the baby, the type of decels, if there are contractions, bleeding, etc. How many of you feel good about that if that was your baby? I GIVE ALL MY PATIENTS EPISIOTOMIES HOW TOfor a non expert who sees their baby have a decel or two and not know how to accurately evaluate the whole picture, they may think, well, ACOG says I'm fine, my baby is moving, send me home and do nothing more. So, with that knowledge, ACOG (American Congress of Obstetrician's and Gynecologists) has said, that it is appropriate to do intermittent monitoring in labor on low risk appropriate women and that not all decelerations in the fetus warrant urgent delivery. This could even occur in utero prior to birth and have nothing to do with preterm birth or even anything going wrong during the delivery. Cerebral palsy, we know is caused from lack of oxygen at some point to an area of the brain. We know preterm birth causes many of the these cases, and since the 1970's we have gotten more aggressive at saving more and more babies at earlier gestational ages, even as early as 23 weeks, which obviously holds risk for CP (cerebral palsy). The cerebral palsy rate situation is complicated. There has also been a rise in cesarean deliveries, likely because we panic too much over certain types of decelerations in the heart beat and rush to c/section too soon. Since the 1970's, when continuous fetal monitoring came to be the standard of care, there has been no decline in the rate of cerebral palsy cases in newborns. I would like to state the reason why this issue has become complicated for some "natural" patients. If neither of the those criteria are met, further continuous monitoring is necessary. However, in this scenario, many natural patients desire intermittent monitoring which is acceptable when the baby has a reactive initial non-stress test for 30 minutes of monitoring and is not having decelerations in the heart rate during or after contractions. She had her typical birth plan and desire to go "natural." Now, first off, let me say, I fully support natural and birth plans, and such to the extent that they are safe, and that if I detect something may not be going well with your baby from monitoring and such that my patients are going to trust me and my formal education and experience to know when more monitoring or intervention is necessary. Hello again! I've once again been a huge slacker at writing, but will try to be better:) I recently had a case (a few months ago) of a patient who was very self educated so to speak in the ways of childbirth.
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