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During normal labor the fetal heart rate drops during contractions. This is considered to be a normal fetal reflex.

The article by Pamela Warrick on Tanner Roberts’ birth describes an increase in fetal heart rate during contractions--a change I don’t believe has previously been observed or reported.

Could you please clarify this discrepancy so as to allay anxiety among laboring patients and their significant others who might observe the fetal heart rate decelerations associated with contractions and, based on the implications of this article, think them abnormal.

DR. MARVIN N. SCHWARTZ

Encino

Warrick replies: While it is true that the stress of a contraction can cause a deceleration of the fetal heart rate during some phases of the contraction, that decrease is routinely accompanied by a very noticeable increase in rate. For observers of labor, that increase in heart rate toward the end of the contraction period may appear quite dramatic, as measured and broadcast by the fetal monitor. So, it is normal for the fetal heart rate to experience both decreases and increases over the course of the uterine contraction.