For some time now, the expression fetal distress has been widely used and also discussed by various specialists in the field as well as advocates of humanized childbirth. But what exactly is fetal distress, and to what extent is an emergency cesarean section truly necessary?
Controversies aside, fetal distress1 is characterized by a situation in which the baby is not well inside the womb. This can happen for several distinct reasons, but it has often been used as a pretext and, in some cases, even to convince a mother to have her child by cesarean section, even if the mother’s preference is otherwise. However, the term fetal distress is almost never clearly explained.
The reason for a sudden cesarean birth being solely fetal distress should be questioned, but in some cases, just hearing the term “fetal distress” is enough to make the pregnant woman panic. But which cases should actually be faced as fetal distress? What real risks truly call for an emergency cesarean?
Can a true case of fetal distress end with a normal delivery? To determine this, some factors and tests need to be conducted before reaching any conclusion. The fetus must be monitored very carefully. Assessments should include the baby’s activity, oxygenation, and the presence of meconium in the amniotic fluid2.
What are the Concrete Factors for Fetal Distress?
We’ve already seen here that nuchal cord (the umbilical cord wrapped around the baby’s neck) is totally a myth in relation to normal delivery. No matter how many times the cord is wrapped around the baby’s neck, oxygen will continue to pass through, since the baby receives all nutrients, including oxygen, via the umbilical cord. The only exception is a true knot. Since nuchal cord has already been debunked as a cause of fetal distress, let’s look at some other factors commonly believed to indicate fetal distress:
Decelerating fetal heartbeats – Usually, the compression of contractions on the umbilical cord can temporarily decrease the fetal heart rate during the peak of contraction. This commonly happens during active labor. However, there are cases where this can start happening even before 35 weeks, during practice contractions.
Decreased oxygenation for the baby is an aggravating factor at the time of delivery3. However, even if exams point to it, absolute certainty comes from a blood test from inside the umbilical cord, which can definitively detect this lack of oxygenation. This lack of oxygenation should be taken very seriously, as it is a strong indicator of acute fetal distress.
Cardiotocography done at the maternity hospital
Presence of meconium in the amniotic fluid – Normally, when the baby is ready to be born but labor does not occur, the baby is more likely to pass stool (meconium). Since the baby swallows this fluid containing meconium, there is a risk of infection. Meconium is detected after the amniotic sac breaks, and the presence of a greenish color in the fluid is a clear sign. However, the presence of meconium does not stop the mother from having a normal delivery at all.
Cardiac changes in the baby and mother – If, even without contractions, the baby has alterations in heart rate, this is also considered fetal distress. However, it is not a direct indication for emergency cesarean; everything depends on the overall condition of both the baby and the mother as labor approaches.
Maternal blood pressure changes – If blood pressure is very high, the option for a cesarean should be discussed with the doctor. Of course, factors such as the risk of pre-eclampsia and HELLP syndrome should be ruled out before diagnosing hypertensive disorders of pregnancy (DHEG).
Decreased fetal movements – This is not an indicator of fetal distress. As pregnancy progresses, the space inside the uterus decreases, so fetal movements may become less frequent, but the baby’s activity and vitality must always be monitored by the doctor.
These episodes do not prevent a normal delivery. Stimuli such as sounds should also not be ignored by the baby. Many maternity hospitals use a horn sound method to “wake” the baby and observe their reaction to external noise and touch. Another sign of fetal distress is the absence of amniotic fluid for more than 48 hours and lack of labor even after induction. In these cases, a cesarean is the safest choice.
Most cases of fetal distress, such as reduced heart rate or low fetal oxygen, are detected via Doppler ultrasound, cardiotocography, and doctor-performed exams, but absolute certainty is only possible after the birth. In summary, every case is unique and should be evaluated by a specialist on an individual basis. If you wish to have a normal delivery, talk to your doctor. Not every case of fetal distress is an indication for cesarean; the doctor must consider all factors and the pregnant woman’s medical history to determine if a vaginal delivery is viable at that time. The most important thing is that everything goes well and both mother and child are 100% healthy and that common sense prevails on both sides, from both the doctor and the birthing mother.
Blogger’s note: My first delivery was a cesarean on my doctor’s recommendation due to ruptured membranes and suspicion of infection, even though it took the doctor two days to perform the delivery. I wonder–could they have induced labor instead of doing a cesarean? I’ll never know, but honestly? What matters is that in the end everything turned out well. If you want to have a normal or natural birth, guidance and good information make all the difference.
See also: From Positive Test to Melissa’s Birth Story – Risk of Pre-Eclampsia
Photos: Pablo Alcolea
