The Biophysical Profile (BPP)
A biophysical profile is done on baby to
help determine fetal health; it’s done when there is concern about
baby’s well-being. It uses a scoring system. The first four of the five
tests listed below are done with ultrasound; the fifth is done with
external fetal monitors. A score is given to each area. The five areas
• fetal breathing movements
• fetal body movements
• fetal tone
• amount of amniotic fluid
• reactive fetal heart rate (nonstress test [NST])
During the test, doctors evaluate fetal
“breathing”—the movement or expansion of the baby’s chest inside the
uterus. This score is based on the amount of fetal breathing that
Movement of the baby’s body is noted. A
normal score indicates normal body movements. An abnormal score is
applied when there are few or no body movements during the allotted
Fetal tone and posture are evaluated. It is a good sign if baby has good tone.
Evaluation of the
volume of amniotic fluid requires experience in ultrasound. A normal
test shows adequate fluid around the baby. An abnormal test indicates
little or no amniotic fluid around the baby.
Fetal heart-rate monitoring (nonstress
test) is done with external monitors. It evaluates changes in the fetal
heart rate associated with baby’s movements. The amount of change and
number of changes in the fetal heart rate can differ, depending on
who’s doing the test and their definition of normal.
An abnormal score is 0 for any of these
tests; a normal score is 2. A score of 1 is a middle score. A total
score is obtained by adding all the values together. Evaluation may
vary depending on the sophistication of the equipment used and the
expertise of the person doing the test. The higher the score, the
better the baby’s condition. A lower score may cause concern about the
well-being of the fetus.
If the score is low, a
recommendation may be made to deliver the baby. If the score is
reassuring, the test may be repeated at a later date. If results fall
between these two values, the test may be repeated the following day.
Your doctor will evaluate all the information before making any
5. Inducing Labor
There may come a point in your pregnancy
that your doctor decides to induce labor, which means labor is started
to deliver your baby. It’s a fairly common practice; each year, doctors
induce labor for about 450,000 births. In addition to inducing labor
for overdue babies, it is also used when a woman has other problems or
when baby is at risk.
When your doctor does a pelvic exam at
this point in your pregnancy, it probably also includes an evaluation
of how ready you are for induction. Indications for induction of labor
include the following:
• pregnancy 2 weeks past the due date
• baby isn’t thriving in the uterus (determined from tests)
• signs the placenta is no longer functioning as well as it should
• illness that threatens the well-being of mother-to-be or baby
• pregnancy-induced high blood pressure
• premature rupture of membranes
• bag of waters breaks but contractions don’t begin in a reasonable amount of time
• infection of the uterine membranes
The Bishop score may also be used.
It’s a method of scoring used to predict the success of inducing labor.
Scoring includes dilatation, effacement, station, consistency and
position of the cervix. A score is given for each point, then they are
added together to give a total score to help the doctor decide whether
to induce labor.
Sometimes labor should not be induced. Your healthcare provider will take into account any contraindications to inducing labor.
Ripening the Cervix for Induction
Doctors often ripen the cervix before labor is induced. Ripening the cervix means medicine is used to help the cervix soften, thin and dilate.
Various preparations are used for this
purpose. The two most common are Prepidil Gel and Cervidil. In most
cases, doctors use Prepidil Gel and Cervidil to prepare the cervix the
day before induction. Both preparations are placed in the top of the
vagina, behind the cervix. Medication is released directly onto the
cervix, which helps ripen it. This is done in the labor-and-delivery
area of the hospital, so baby can be monitored.
Research from the Centers for
Disease Control and Prevention (CDC) indicates about 25% of all
inductions are elective or medically unnecessary. If you’re considering
inducing your labor at 37 or 38 weeks for nonmedical reasons, you
greatly increase baby’s chances of having complications. Or you may end
up having a Cesarean delivery.
If your doctor induces labor, you may
first have your cervix ripened, as described above, then you will
receive oxytocin (Pitocin) through an I.V. The oxytocin starts
contractions to help you go into labor. The length of the entire
process—ripening your cervix until the birth of your baby—varies from
woman to woman.
Oxytocin is gradually increased until
contractions begin. The amount you receive is controlled by a pump, so
you can’t receive too much. While you receive oxytocin, you’re also
monitored for the baby’s reaction to labor.
It’s important to realize that being
induced does not guarantee a vaginal delivery. In many instances,
induction doesn’t work. Inducing labor may increase your chances of
having an emergency Cesarean delivery.
You may want to try some “natural” labor inducers that have been known to work for some women. They include:
• eating fresh pineapple (it contains bromelain, which may help soften cervical tissues)
• nipple stimulation
• sexual intercourse (semen contains prostaglandins, which help soften cervical tissues)