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The Nonstress Test (NST)

A nonstress test (NST) is performed in your doctor’s office or in the labor-and-delivery department of a hospital. While you’re lying down, a fetal monitor is attached to your tummy. Every time you feel your baby move, you push a button that makes a mark on a strip of monitor paper. At the same time, the monitor records baby’s heartbeat.

When baby moves, its heart rate usually goes up. The findings from the NST help your healthcare provider measure how well baby is tolerating life inside the uterus. Your doctor can decide if further action is necessary.

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 evaluated are:

• 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 occurs.

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 time period.

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 decision.

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)

• pre-eclampsia

• 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.

Labor Induction

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:

•  walking

•  eating fresh pineapple (it contains bromelain, which may help soften cervical tissues)

•  nipple stimulation

•  sexual intercourse (semen contains prostaglandins, which help soften cervical tissues)

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