Fetal Scalp Stimulation

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There is a debate at our facility regarding fetal scalp stimulation (FSC)during a decel. I had always been taught that it was bad to do when the baby was not at a normal baseline. The problem is some of the people are doing it when the FHR is down and not coming back up (after normal intrauterine resuscitation has been tried and other causes ruled out).

I couldn't find any authoritative references on this situation, only doing FSC when at baseline for reassurance.

I appreciate any citations you can provide.

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Specializes in many.

AWHONN conference in 2004 had a seminar titled "WHY ARE YOU TICKLING MY HEAD WHEN I CAN'T EVEN MAINTAIN MY BASELINE?". Also, Michelle Murray's most recent info advises against, and several anecdotal links can be found from Google using "fetal scalp stim + decel" as search term.

Hope that helps.:D

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

As stated above, check with AWHONN and Michelle Murray's literature. There is plenty out there that supports NOT doing scalp stim in the presence of late decelerations. You can only possibly make things worse at this point, messing what few reserves the fetus has left......

Bottom line: (and it's really common sense if we think about it): If you are having repeated lates and a flat baseline, you are in trouble already....the time for scalp stim has come and gone.

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Specializes in L&D.

Scalp stim is not a resuscitation measure, it is a test to determine if the baby has any reserve. The deceleration is evidence that the baby is under stress already. Attempting a scalp stim during a deceleration only stresses the baby more. Between decelerations, it may give you an idea of whether or not the baby is acidotic.

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I agree with all of the above.

I just need the evidence based articles to prove it to our docs. You know a nurse needs to have proof of what they say versus a doc who's spoken word is law. Just kidding, somewhat. It does get annoying though, that the docs only believe you if you have the paper in hand.

I do not currently have an active AWHONN membership so my access to that one is limited. If you find any journal articles I would appreciate it.

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Specializes in LTC, Home Health, L&D, Nsy, PP.
Scalp stim is not a resuscitation measure, it is a test to determine if the baby has any reserve. The deceleration is evidence that the baby is under stress already. Attempting a scalp stim during a deceleration only stresses the baby more. Between decelerations, it may give you an idea of whether or not the baby is acidotic.

This is actually in our policy. We were even sent a memo to the effect that we shouldn't be charting scalp stimulation as an intervention, but ONLY as an assessment tool.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Michelle Murrays' works are widely publicized and available. I recommend a search under her name or look for her books on barnesandnoble.com. Her fetal heart monitor classes are a must, as well. Her work is very well-documented and respected.

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If scalp stim elicits an accel,that is a reassuring sign of a non-acidotic fetus. Much like a reactive nst. It doesn't bring up the hr duringa decel. It may even provide some vagal stim, thus compounding the problem. I see physicians do it ALL of the time.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Ours have long-since stopped this practice in the face of dire/ominous tracings. Thank goodness.

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