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Navigating ‘Foetal Distress’ During Labour: Empowering Your VBAC Journey
One of the most emotionally challenging moments during labour is when a care provider tells you, “Your baby is in distress.”
It’s a phrase that can feel frightening and disempowering, and for many women planning a VBAC (Vaginal Birth After Caesarean), it’s a scenario they dread, often triggering fears of another unplanned caesarean. But how do you really know what’s going on with your baby? And when should you trust that this is a genuine emergency versus a precautionary call?
Let’s explore what “foetal distress” actually means, how it’s diagnosed, and how you can stay informed and calm during these critical moments.
The term “foetal distress” is often used to describe signs that a baby might not be coping well with labour, usually based on patterns seen in foetal heart rate monitoring (via CTG or intermittent auscultation). But here’s the important part: it’s not a diagnosis – it’s an interpretation.
Foetal heart rate monitoring is subjective and as Dr Kirsten Small highlights, it is actually “foetal heart rate recording” rather than monitoring. Different care providers may interpret the same heart rate pattern in different ways. While some changes might indicate that your baby needs extra attention, not every variation in heart rate means there’s an emergency.
The truth is, you shouldn’t have to figure it all out on your own in the middle of labour, especially when you’re vulnerable, tired, and already doing lots of work. But here are some practical steps that can help you feel more confident and informed:
1. Ask for specifics, not just labels
If a care provider says your baby is in distress, ask:
Sometimes, simple things like changing your position, drinking fluids, or moving around can improve the baby’s heart rate pattern.
2. Understand the difference between ‘pathological’ and ‘non-reassuring’
Many heart rate variations are non-reassuring – meaning they’re worth watching – but not necessarily dangerous. A pathological pattern means baby is truly struggling and action may be needed quickly.
Don’t be afraid to ask:
If baby’s heart rate returns to normal, there may be no need for intervention.
In a true emergency, there will be no ambiguity – the atmosphere in the room changes instantly. You’ll likely see a rush of people enter the space: additional midwives, doctors, anaesthetists, and paediatric staff. The tone becomes serious and focused, and care providers will act quickly with clear instructions and immediate intervention. In these moments, there’s a distinct sense of urgency, and the priority shifts to getting the baby out as quickly and safely as possible. This isn’t a time for prolonged discussions or “wait and see” approaches – the clinical team will be working fast because they genuinely believe the baby’s wellbeing is at risk and needs prompt delivery.
3. Use your B.R.A.I.N.
This is a helpful decision-making tool you can use at any point during labour:
You’re allowed to ask for time.
You’re allowed to ask for more information.
You’re allowed to say no – or yes – based on what feels right for you and your baby.
4. Understand the limitations of continuous foetal monitoring (CFM)
One of the most significant factors that influences how “foetal distress” is diagnosed is the use of continuous foetal monitoring – especially in VBAC births. Many hospitals require CFM for women planning a VBAC, but is this actually evidence-based?
Dr. Kirsten Small, a retired obstetrician and researcher, has extensively studied the use of continuous electronic foetal monitoring (CTG) during labour. Through her platform Birth Small Talk, she educates parents and professionals on the realities of monitoring in labour.
Dr. Small highlights that continuous CTG monitoring has not been shown to improve outcomes for babies, but it does increase the risk of interventions – including instrumental birth and caesarean. This is especially relevant for VBAC births, where the fear of uterine rupture is often overstated, and monitoring is used as a safety net – despite no solid evidence that it provides better outcomes.
Dr Kirsten Small’s research has shown that intermittent auscultation using a handheld Doppler is not only safe, but often more effective than continuous CTG monitoring for low-risk pregnancies, including many VBAC labours. Her analysis highlights that CTG increases the likelihood of interventions without improving outcomes for babies. In contrast, intermittent auscultation allows for more mobility, less stress, and a better connection between the woman and her care provider. Dr Small points out that the quality of interpretation and timely response are what matter most – not constant surveillance. Her work challenges the widespread belief that CTG is the gold standard, particularly when the evidence does not support its routine use in healthy labours.
Dr. Small encourages people to ask:
Her work empowers women to have deeper conversations about risk, consent, and how technology is used during labour.
5. Be proactive in your VBAC preparation
VBAC births come with unique emotional layers, especially if you’re carrying fears from your previous birth. Take the time during pregnancy to:
6. Choose care providers you trust
This is one of the most important tips. If your care provider uses fear-based language, dismisses your concerns, or defaults to intervention at the first sign of uncertainty – it may be time to explore other options.
A supportive care team will:
You need to feel safe to labour – and safety includes emotional and psychological safety, not just physical.
It’s absolutely valid to want the best for your baby and want a VBAC. These are not competing goals – in fact, they go hand-in-hand.
You deserve care that respects both your wellbeing and your autonomy. If your baby genuinely needs help, you’ll likely feel that in your gut. But if you’re being rushed into decisions without clear information, pause and ask questions. Get your team around you. Trust yourself.
You’re not a passive bystander – you’re an active decision-maker in your birth experience. This is your body, your baby, your birth – and your voice matters. You deserve to be informed, involved, and respected throughout your birth.
Labour may be unpredictable, but how you’re treated and included in the process shouldn’t be.
References:
Small KA, et al. Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review. Women & Birth. 2020;33(5):411-8.
https://www.sciencedirect.com/science/article/abs/pii/S187151921930825X
Small KA, et al. The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography. Women & Birth. 2023;36(3):281-9. https://www.sciencedirect.com/science/article/abs/pii/S1871519222003225
Alfirevic Z, et al. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017;2(CD006066):1-137.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006066.pub3/pdf/CDSR/CD006066/CD006066_abstract.pdf
Monitoring Your Baby in Labour – Myths and Misconceptions. Tracy Donegan Blog.
https://blog.tracydonegan.org/blog/ctg-monitoring-in-labor-what-is-the-evidence
VBAC and the CTG. Birth Small Talk.
https://education.birthsmalltalk.com/VBAC
Birth Small Talk – Foetal monitoring information you can trust. Birth Small Talk.
https://birthsmalltalk.com/
Continuous Foetal CTG Monitoring, with Dr Kirsten Small. Birth-Ed Blog.
https://birth-ed.co.uk/blog-1/sharing-birth-stories-with-host-megan-rossiter-n9y6x-7zeyw-s5zn9-fzyfn
If you have any questions or would just like more information please don't hesitate to get in touch by clicking the button below and filling out the contact form.
Contact Vicki