Monitoring your baby before labor
While you are pregnant, your health care provider may do tests to check your baby's health. The tests may be done at any time while you are pregnant.
Pregnancy care - Animation
It's always important to take good care of your health, but never more so than when you're pregnant. You're not only caring for your own body, you're also nurturing and growing a new human being. Let's talk about pregnancy care. During the nine or so months of your pregnancy, you'll see a lot of your ob/gyn. In fact, you should visit your doctor once a month during the first seven months of your pregnancy. Then you should see your doctor once every 2 or 3 weeks until your ninth month, and finally every week until you deliver. You might also see your regular doctor, a nurse midwife, or, if you have any complications, a perinatologist who specializes in high-risk pregnancies. That might sound like a lot of visits, but the goal is to keep a close eye on both you and your growing baby. Your doctor will check your baby's heart rate, and measure how quickly you're gaining weight. You'll likely have at least one ultrasound, where you can actually get to see your baby and find out the gender, unless you want it to be a surprise. Throughout your pregnancy, your doctor will monitor you for any health problems, such as high blood pressure or diabetes. At your regular prenatal visits, your doctor can give you advice about what to eat and how much to exercise. You can also ask about all those weird symptoms you've been having, like morning sickness, food cravings, and the constant urge to use the bathroom. There are a few things you need to do while you're pregnant to make sure you and your baby are healthy. First, you have to take 400 micrograms of folic acid every day. Folic acid is especially important right before you get pregnant, and during the first trimester of your pregnancy because it helps your baby's brain and spinal cord form. Taking folic acid can help prevent birth defects like spina bifida. One thing you need to avoid is alcohol. When you're craving a glass of wine or beer, have some sparkling water, grape juice, or ginger ale instead. Alcohol can be very dangerous for your baby. Also don't take any medicines without talking to your doctor first. That includes over-the-counter medicines like aspirin and cold relievers. Caffeine is okay, but only in moderation. Limit yourself to one cup of coffee, instead of your regular two or three. Don't smoke and stay away from anyone who is smoking. Cigarette smoke deprives your baby of oxygen. It can stunt your child's growth, and lead to birth defects such as a cleft lip or palate. If you're pregnant and you haven't seen a doctor yet, now is the time to call. The sooner you get prenatal care, the more likely that your baby will be born healthy. Let your doctor know if you have a condition like diabetes, seizures, or high blood pressure, or if you've been exposed to a sexually transmitted infection, chemicals, or radiation. Get medical help right away during your pregnancy if you have a fever, painful urination, vaginal bleeding, or severe stomach pain. Call if your water breaks, or you're not feeling your baby moving and it's near the end of your pregnancy.
Tests you may Need Before Labor
Tests may be needed for women who:
- Have a high-risk pregnancy
- Have a health condition, such as diabetes
- Have had complications in a prior pregnancy
- Have a pregnancy that lasts longer than 40 weeks (overdue)
The tests may be done more than once so the provider can track the progress of the baby over time. They will help the provider find problems or things that are not normal (abnormal). Talk to your provider about your tests and the results.
Non-stress Test (NST)
A healthy baby's heart rate will rise from time to time. During the non-stress test (NST), your provider will watch to see if the baby's heart rate goes faster while resting or moving. You will receive no medicines for this test.
If the baby's heart rate does not go up on its own, you may be asked to rub your hand over your belly. This may wake up a sleepy baby. A device may also be used to send a noise into your belly. It will not cause any pain.
You will be hooked up to a fetal monitor, which is a heart monitor for your baby. If the baby's heart rate goes up from time to time, the test results will most likely be normal. NST results that are reactive mean that the baby's heart rate went up normally.
Non-reactive results mean that the baby's heart rate did not go up enough. If the heart rate does not go up enough, you may need more tests.
Another term you might hear for this test result is a categorization of 1, 2, or 3.
- Category 1 means the result is normal.
- Category 2 means further observation or testing is necessary.
- Category 3 typically means your doctor will recommend delivery right away.
Contraction Stress Test (CST)
If the NST results are not normal, you may need a CST. This test will help the provider know how well the baby will do during labor.
Labor is stressful for a baby. Every contraction means the baby gets less blood and oxygen for a short while. For most babies this is not a problem. But some babies have a hard time. A CST shows how the baby's heart rate reacts to the stress of contractions.
A fetal monitor will be used. You will be given oxytocin (Pitocin), a hormone that makes the uterus contract. The contractions will be like the ones you will have during labor, only milder. If the baby's heart rate slows down rather than speeds up after a contraction, the baby may have problems during labor.
In some clinics, while the baby is being monitored, you may be advised to provide mild nipple stimulation. This stimulation often leads to your body releasing small amounts of oxytocin which will make the uterus contract. The baby's heart rate is monitored during the resulting contractions.
Most women feel mild discomfort during this test, but not pain.
If the results are abnormal, your doctor may admit you to the hospital to deliver the baby early.
Biophysical Profile (BPP)
A BPP is a NST with an ultrasound. If the NST results are not reactive, a BPP may be done.
The BPP looks at the baby's movement, body tone, breathing, and the results of the NST. The BPP also looks at amniotic fluid, which is the liquid that surrounds the baby in the uterus.
The BPP test results can be normal, abnormal, or unclear. If the results are unclear, you may need to repeat the test. Abnormal or unclear results may mean that the baby needs to be delivered early.
Modified Biophysical Profile (MBPP)
A MBPP is also a NST with an ultrasound. The ultrasound looks only at how much amniotic fluid there is. The MBPP test takes less time than a BPP. Your doctor may feel that the MBPP test will be enough to check the baby's health, without doing a full BPP.
In a healthy pregnancy, these tests may not be done. But you may need some of these tests if:
- You have medical problems
- You have the potential for pregnancy problems (high risk pregnancy)
- You have gone a week or more past your due date
Talk to your provider about the tests and what the results mean for you and your baby.
John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Kaimal AJ. Assessment of fetal health. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 34.