Fetal Heart Rate Patterns

Watch out, I'm on a roll.

Yesterday I got the official "ok" from my school to take the NARM exam this August. Woohoo! Ohmygod, now I have so much to stress about. I have to get all my paperwork turned in by June 1st. For NARM, I need to get a money order for $725, take a passport photo, copy my CPR cards, and double-check every single page of the paperwork for correctness. First, though, I have to get some signed forms back from El Paso. Hurry up! For my school, I have to finish writing every last practice guideline by the first of June. I have 37 modules to finish. Can I do it?

I finished the Fetal Heart Rate Patterns module today. The actual module was fairly easy to complete, but the topic feels so complicated. It's all about the types of heart rates a baby can have before it's born. Too fast can be a problem. Too slow can be a problem. A heart rate that looks like a sine wave when it's charted can be a major problem.

The hippie dippie midwives are big on using only a fetoscope to listen to the baby's heart beat. The advantage is that there are no ultrasound waves involved and you can get a more accurate reading of the baby's position based on where you most clearly hear the heart. The reason I'm not a big fan of the fetoscope is that it requires the mother to lie still and everyone has to be quiet. It's too hard during labor. So, what I use (along with a lot of the less hippie-ish midwives) is a doppler. They're expensive, but it's so easy to hear the baby's heart beat, even during labor. Mine is waterproof, which means I can still listen to heart tones if the mom is in the birth tub.

When people find out that I'm a midwife, one of the first questions they always ask (right after, "but what if something goes WRONG!?") is how I know the baby is doing okay at a home birth. So, to clear it all up, yes, we homebirth midwives actually listen to the baby's heart tones at home. It's the same technology they have in the hospital, it's just catered to the mother's comfort instead of to the convenience of the doctors and nurses. Monitoring intermittently with a doppler at home requires a continuous presence as opposed to slapping on the monitor belt and leaving the woman alone in the hospital.

The continuous presence also notes things that may be out of the ordinary as soon as they happen. If nothing out of the ordinary happens, the continuous presence provides reassurance and encouragement to the woman in labor, her partner, and her family. It's one of the major differences between medical and midwifery care.

Oh yeah, one of the other big questions I get asked is whether we carry oxygen to home births. Well, yes, we do. If a baby's heart rate drops during labor or birth, it means they aren't getting as much oxygen as they need and it can be a serious problem if the heart rate doesn't come back up. Giving the mother oxygen (and changing her position) can make a difference in a situation like this. Oxygen can also be used directly on the baby if it has a little trouble breathing once it's born.

It's kind of amazing all the stuff midwives have to know how to do. No freaking wonder my training seems to be taking so long. But, at least I'm starting to feel like I know my stuff.