Electronic fetal monitoring provides critical information about a baby’s wellbeing during labor. When nurses and physicians fail to properly interpret fetal heart rate patterns—or ignore warning signs that the baby is in distress—the consequences can be devastating. Missed monitoring errors are among the most common causes of preventable birth injuries in Illinois hospitals.
The Purpose of Electronic Fetal Monitoring
Electronic fetal monitoring (EFM) continuously tracks the baby’s heart rate and the mother’s contractions throughout labor. This technology allows medical providers to assess how well the baby is tolerating the stress of labor and to identify signs that intervention may be necessary.
The fetal heart rate strip produces a paper or electronic tracing that shows:
- Baseline fetal heart rate – The average heart rate over a 10-minute period (normal: 110-160 beats per minute)
- Variability – Normal fluctuations in heart rate that indicate a healthy nervous system
- Accelerations – Temporary increases in heart rate, which are reassuring
- Decelerations – Drops in heart rate that may indicate fetal distress
- Contraction pattern – Frequency, duration, and intensity of uterine contractions
NICHD Categories: Understanding Fetal Heart Rate Patterns
The National Institute of Child Health and Human Development (NICHD), in collaboration with ACOG, established a three-tier classification system for fetal heart rate patterns:
Category I (Normal)
These patterns are strongly predictive of normal fetal acid-base status and include:
- Baseline rate 110-160 bpm
- Moderate variability
- Accelerations present (may or may not be present)
- No late or variable decelerations
Category II (Indeterminate)
These patterns are not predictive of abnormal fetal acid-base status but require continued monitoring and evaluation. They include any patterns not meeting Category I or III criteria.
Category III (Abnormal)
These patterns are predictive of abnormal fetal acid-base status and require immediate evaluation and intervention:
- Absent variability with recurrent late decelerations
- Absent variability with recurrent variable decelerations
- Absent variability with bradycardia
- Sinusoidal pattern
When Category III patterns appear, the baby is likely experiencing oxygen deprivation that can cause permanent brain damage within minutes. Immediate action—including emergency cesarean delivery—may be required.
Common Fetal Monitoring Errors
Birth injury cases frequently involve one or more of these monitoring failures:
Failure to Recognize Abnormal Patterns
Nurses and physicians must be trained to recognize concerning fetal heart rate patterns. Common failures include:
- Misidentifying late decelerations as variable decelerations
- Failing to recognize absent or minimal variability
- Dismissing concerning patterns as “artifact” or equipment malfunction
- Not recognizing the significance of Category III patterns
Failure to Communicate Concerns
When nurses identify concerning patterns, they must notify physicians promptly. Communication failures include:
- Delayed notification to the attending physician
- Failure to use chain of command when physician doesn’t respond
- Inadequate documentation of concerns and notifications
- Not conveying urgency appropriately
Failure to Act on Abnormal Patterns
Even when patterns are recognized and communicated, providers sometimes fail to take appropriate action:
- Waiting to see if patterns improve on their own
- Delaying cesarean delivery hoping for vaginal birth
- Continuing Pitocin despite worsening patterns
- Not calling for emergency help
Equipment and Technical Failures
- Monitor not functioning properly and not replaced
- Tracing not visible at nurses’ station
- Gaps in monitoring during critical periods
- Picking up maternal heart rate instead of fetal heart rate
Specific Warning Signs Often Missed
Late Decelerations
Late decelerations begin after the peak of a contraction and return to baseline after the contraction ends. They indicate uteroplacental insufficiency—the placenta is not delivering adequate oxygen during contractions. Recurrent late decelerations with absent variability require immediate intervention.
Variable Decelerations
Variable decelerations are abrupt drops in heart rate that may indicate umbilical cord compression. When severe, prolonged, or accompanied by absent variability, they signal danger.
Prolonged Bradycardia
A sustained heart rate below 110 bpm lasting more than 10 minutes constitutes prolonged bradycardia—an emergency requiring immediate evaluation and often emergency delivery.
Absent Variability
Normal fetal heart rate varies by 6-25 beats per minute. When this variability is absent (fluctuation less than 5 bpm), combined with other concerning patterns, it strongly suggests fetal hypoxia.
Tachycardia
A sustained heart rate above 160 bpm may indicate maternal fever, infection, or fetal distress. While tachycardia alone doesn’t require immediate delivery, combined with other concerning findings it adds urgency.
Consequences of Monitoring Errors
When medical providers fail to recognize and respond to fetal distress, babies suffer oxygen deprivation that can cause:
- Hypoxic-ischemic encephalopathy (HIE) – Brain damage from oxygen deprivation
- Cerebral palsy – Permanent motor impairment
- Intellectual disability – Cognitive impairments affecting learning and functioning
- Seizure disorders – Epilepsy requiring lifelong medication
- Death – Prolonged oxygen deprivation can be fatal
Nursing Standards for Fetal Monitoring
Professional nursing organizations establish standards for fetal monitoring that nurses must follow:
- Continuous monitoring for high-risk patients
- Regular assessment and documentation of patterns (typically every 15-30 minutes in active labor, more frequently during pushing)
- Prompt notification of physician for concerning patterns
- Use of chain of command when concerns are not addressed
- Documentation of all assessments, notifications, and responses
Proving a Fetal Monitoring Malpractice Case
Fetal monitoring cases require expert analysis of the heart rate strips and medical records:
Strip interpretation – Obstetric experts review the monitoring strips to identify when concerning patterns developed and how providers should have responded.
Timeline reconstruction – Comparing nursing notes, physician notes, and the strips to determine when providers were notified and what actions they took.
Causation analysis – Neonatology and neurology experts establish that earlier intervention would have prevented or reduced brain damage.
Under the Illinois Medical Malpractice Act (735 ILCS 5/2-622), these cases require a certificate of merit from a qualified physician before filing.
Preserve the Evidence
Fetal monitoring strips are critical evidence in birth injury cases. Parents should:
- Request complete copies of all medical records including fetal monitoring strips
- Act promptly, as hospitals may overwrite electronic records
- Contact an attorney who can send a preservation letter to prevent evidence destruction
Contact an Illinois Fetal Monitoring Attorney
If your child suffered brain damage and you believe fetal monitoring errors may have played a role, contact Phillips Law Offices for a free case evaluation. We work with obstetric nursing and physician experts who specialize in fetal heart rate interpretation to determine whether monitoring failures caused your child’s injuries.
Call Phillips Law Offices at (312) 598-0917. We handle birth injury cases on contingency—you pay nothing unless we recover compensation for your family.