For decades, the term “fetal distress” has been used to describe cases in which an unborn child appears to be doing poorly. The reason why the child is in “distress,” however, has always been somewhat unclear. While “fetal distress” may be linked to abnormal heart rates and oxygen deprivation, the phrase doesn’t actually refer to a well-defined medical condition.
What Is Fetal Distress?
As a cursory search through the National Library of Medicine shows, the term “fetal distress” is rarely used in medical literature. In fact, the nation’s leading obstetric authority, the American College of Obstetricians and Gynecologists, has long held that the phrase carries a nonspecific meaning, at least when the term is being used in the delivery room.
Outside of medical journals and peer-reviewed papers, you’ll find numerous references to “fetal distress” in health articles written for a popular audience, but explanations of the condition leave much to the imagination. Take the definition at BabyCentre, a UK-based pregnancy blog, as a characteristic example: fetal distress occurs when “a baby is unwell during pregnancy, or isn’t coping well with the demands of labour.” It should be obvious that there’s nothing specific, or particularly medical, about this explanation.
Fetal distress “remains mostly in the eye of the beholder,” writes Dr. Jeffrey P. Phelan, a contributor to ObGyn.net. In his 2011 piece on the subject, Phelan polled 22 obstetricians on a simple question: what does “fetal distress” mean in your hospital? While most of the doctors referred to an abnormally-slow fetal heart rate as the condition’s tell-tale sign, the majority were at a loss to provide a specific clinical definition. In fact, several of the obstetricians said that “fetal distress” was a diagnosis they had stopped using because it lacked a specific interpretation.
Fetal Distress & Birth Asphyxia
In some sources, like Merck Manual, you’ll find suggestions that “fetal distress” is synonymous with “birth asphyxia,” itself a poorly-defined condition in which an infant is deprived of oxygen for some reason during delivery. Obstetricians sometimes use the terms “fetal distress” and “birth asphyxia” in a similar way, as interchangeable names for the same condition. But both diagnoses have been soundly rejected by the nation’s premier physicians.
In a 2005 opinion statement, the American College of Obstetricians and Gynecologists (ACOG) expressed serious concerns over the continued use of the term “fetal distress” by practicing obstetricians. ACOG, the nation’s leading membership organization for birth specialists, noted that, as a diagnosis in the delivery room, the phrase “fetal distress” was both “imprecise and nonspecific” – a label more likely to create confusion among members of a birth team than suggest practical treatment options. Birth asphyxia, on the other hand, should be thrown out altogether as a diagnosis, ACOG says.
Even more importantly, the use of a term like “distress” could inspire far more invasive treatment measures than are actually necessary. As the Committee on Obstetric Practice at ACOG writes, the word “distress” can imply extreme danger, which “may result in inappropriate actions, such as an unnecessarily urgent delivery under general anesthesia.”
Nonreassuring Fetal Status
As a replacement diagnosis, ACOG suggested that physicians use the term “nonreassuring fetal status,” and explain their characterization using objective diagnostic readings, such as the results of fetal heart rate monitoring.
The point of ACOG’s switch in terminology is not that “nonreassuring fetal status” is a concrete medical condition. Without detailed explanation, nonreassuring fetal status is no more specific than “fetal distress.” Just like “fetal distress,” “nonreassuring fetal status” acknowledges that something may be wrong – that the unborn child’s vital signs are worrisome – but falls short of explaining causal factors or suggesting any concrete interventions.
As ACOG explains, a degree of “imprecision” is built right into the definition of “nonreassuring fetal status.” Instead of saying that a fetus is unwell and may be in jeopardy, ACOG’s preferred nomenclature suggests only that a doctor is troubled by their own interpretation of test results. That is a far cry from saying that an infant is in “distress.” In fact, a diagnosis of “nonreassuring fetal status” during delivery is perfectly consistent with “the delivery of a vigorous neonate,” the experts at ACOG say.