Fetal heart rate monitoring helps prevent birth injuries

In my career as a Texas medical malpractice attorney, I have handled many cases involving birth injuries. One of the important pieces of evidence that we look at to investigate why a baby was born with a brain injury or other birth injury is the electronic fetal heart rate monitoring strip.

Continuous fetal heart rate monitoring is the most commonly used obstetric procedure in the United States. According to recent studies about 84% of mothers in labor and delivery units nationwide receive electronic fetal heart rate monitoring.

For most patients, the labor and delivery nurse attaches two sensors to a belt and then places the belt over the mother’s abdomen. One sensor measures the fetal heart rate, while the other identifies contractions. For some patients, though, an electrode is attached directly to the baby’s head, while it is still in the womb.

The sensors are connected into a fetal heart rate monitoring machine, which produces a continuous line, or tracing, of fetal heart rate activity, and another continuous line that shows contractions. These lines are displayed on real-time on an electronic screen, and are printed on paper in what is called a fetal heart rate (FHR) tracing.

A 2013 study found that electronic fetal heart rate monitoring may reduce brain injuries, cerebral palsy, and neonatal conditions. In case after case that I have handled, OB/GYN and maternal fetal medicine (perinatology) experts have testified that when the FHR tracing shows a serious problem, the standard of care requires the OB/GYN to perform an emergency C-Section, and any delays can lead to a baby being born with a serious brain injury.

To help standardize how doctors and nurses describe FHR tracings, the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine, and other groups developed three categories to describe the interpretation of an electronic fetal heart rate strip.

Category I

This type of fetal heart rate (FHR) tracing is normal and shows that the baby is not having any challenges in receiving oxygen.

Category I tracings have a baseline heart rate of between 110-160 beats per minute, moderate variability (irregular up-and-down bumps or fluctuations in the fetal heart rate baseline of 6-25 beats per minute), no late or variable decelerations (drops in the fetal heart rate either after a contraction or randomly), and possible accelerations (temporary jumps or increases in the baseline heart rate).

Generally speaking, accelerations are good, reassuring signs, and some type of decelerations are bad signs.

Category II

These FHR tracings are in between normal and abnormal.

While there are many factors that come into play when monitoring the fetal heart rate, most experts agree that reduced fetal heart rate variability is the most reliable sign that the baby is in distress (fetal distress) or has been compromised.

Category II FHR tracing factors include: bradycardia (low heart rate of below 110 beats per minute for at least 10 minutes) with variability (fluctuations in the fetal heart rate baseline), tachycardia (high heart rate of over 160-180 beats per minute), minimal variability (very few, small fluctuations in the fetal heart rate baseline), no variability with no recurrent decelerations (no drops in the heart rate), marked variability (high degrees of variability of the heart rate), absence of induced accelerations (increases of the heart rate from the baseline) even after fetal stimulation, recurrent variable decelerations with minimal or moderate baseline variability, prolonged decelerations (drops of in the fetal heart rate) lasting more than two minutes but less than 10 minutes, recurrent late decelerations (drops in the fetal heart rate after a contraction) with moderate variability, variable decelerations with other characteristics like a slow return to baseline or overshooting the baseline.

Category III

These abnormal FHR tracings show that the fetus is at a high-risk of having insufficient or absent oxygen, as well as possible acidemia (an acidic blood pH).

Category III tracings may have no baseline variability, or may show recurring late decelerations (drops in the fetal heart rate after a contraction, which can indicate a problem with the functioning of the placenta), variable decelerations, bradycardia (low heart rate), or a sinusoidal pattern (the tracing looks like a sine wave).

If the OB/GYN or labor and delivery nursing staff cannot get a good result from attempts to resuscitate the baby, there should be an immediate delivery by C-Section. Research has shown that Category III FHR tracings are associated with brain damage and other neurologic abnormalities, so emergency delivery of the baby is crucial to minimize the risk.

We are here to help

If you are concerned about the quality of care that you and your baby received during labor and delivery, we are here to help. Painter Law Firm’s medical malpractice lawyers have experience in representing babies and families who have serious injuries from negligent prenatal, OB/GYN, and labor and delivery care.

Call us at 281-580-8800 for a free consultation about your potential case.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. Attorney Robert Painter devotes his practice to representing patients who have been injured by the negligence of doctors, hospitals, and nurses. Through the course of his career as a medical malpractice lawyer, he has handled a variety of birth injury cases where babies were born with serious brain injuries or cerebral palsy, caused by in attentive physician and nursing care.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.