Doulas Unhinged
Birth and parenting deserve more than recycled advice and outdated expectations. This podcast exposes the hidden influences shaping modern birth and parenthood- unpacking hospital culture, trauma, identity shifts, and the stories we're rarely encouraged to tell out loud.
Each episode challenges assumptions, amplifies lived experiences, and offers evidence- backed conversations that help you reclaim your voice, your choices, and your narrative.
If you've ever felt like the mainstream version of birth and parenting doesn't fit- you're not alone, and you're in the right place.
Doulas Unhinged
Ep 37: NST Explained
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On this episode Alex and Lacey discuss the diagnostic testing often referred to as an NST (Non- stress Test). They explain what is being measured, what it might mean and how accurate the test actually is. Dive in for another episode of Doulas Unhinged.
Risk of PPH in otherwise unmedicated birth is between 1.5-3%.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11239210/
Discuss aminoinfusion
NST
Recommended frequently
Welcome to Doolas Unhinged, the podcast where we tell the unfiltered truths and disrupt the accepted view of modern birth and parenting.
SPEAKER_00We're your hosts Alex Shaw and Lacey Morgan, here to cut through the noise, share the stories no one else will, and empower you with real talk that's equal parts honest, funny, and unapologetic. Let's get Unhinged.
SPEAKER_03How are you?
SPEAKER_00Lovely. How are you?
SPEAKER_03I'm good. I wonder if anything will pick up me eating.
SPEAKER_00I mean, I can hear it.
SPEAKER_01You can hear it? No, you can't.
SPEAKER_00I can hear I can hear the crinkle of the wrappers.
SPEAKER_01I'm gonna take it off. Less editing the better.
SPEAKER_00No kidding. The less editing the better.
SPEAKER_01As I say this, Lacey's the one that edits. Not even the one that edits.
SPEAKER_00What's going on? Uh I had a birth um last week, maybe. I don't exactly remember when it was. There goes the dinging of the phone, always.
SPEAKER_02Michael.
SPEAKER_00Um let's turn that noisemaker off. Um, anyway, and so first time mom really wanted an unmedicated birth. She really wanted an unmedicated birth. Um and you know, she started kind of in the morning, like, you know, feeling something, something, something. And throughout the day, it seemed like it was getting more intense. Um first time moms can be tricky though, right? Because you don't know what their grit is, right? Like, I I think sometimes it can be hard to read somebody. Um, you know, and she was saying things like, this is getting really intense, like these are the worst period cramps ever. Dad was reporting that he was talking to her and she was crying. And then like I got on the phone with her and she was totally fine. You know, like in my perception, totally fine, right? And some people are like that, where like they will lose it with their safe person, but otherwise they're not going to show their hand, right?
SPEAKER_01Absolutely, yep.
SPEAKER_00Um, and so I'm like, I still think that this is early labor. This really seems like early labor, like, you know, she's not really breathing through them, you know, like she was breathing through them, but she wasn't like struggling to breathe through them, and she was still talking in between them, and you know, like all things that we would look for. And uh he he was at work and he was like, Should I be going home? And I was like, I mean, you can, but I really think that this is still early labor.
SPEAKER_03So last four days, so exactly, right?
SPEAKER_00Exactly. Um, so you know, I was like, Why don't you like wait until lunchtime to see how things are going? Um, and probably around two o'clock, he was saying that she was starting to say those things that moms say, like, I need to go to the hospital, I want to get an epidural, like I want the drugs, whatever. And we were like, okay, like you should probably be heading home now. I was like, after talking to her, like she was in the backyard, uh, cleaning up the backyard, and I was like, it's probably still early labor if she's doing other things in between, right? Um, but because she was presenting so controlled, I was like, you know, like go home, don't go home, like whatever. Both Jackie and I were like, you know, it's probably a good idea for you to think about it. Like maybe if you were there, she would be able to surrender to the process, right? Um, and so I think he ended up going home around like I think I don't think he got home until five. We talked to him about like going home somewhere in the two o'clock hour. Um, but I don't think he ended up going home until five. But by the time he got home, she was like, We're getting in the car, like we're going now. And so um by the time they were in the car, the contractions were anywhere between like two to three minutes apart. And I was like, This is great, could be transition, could also be baby's position, like time will tell. Right. Because if you think about it like this was a 12-hour labor, maybe right, like from the time early contraction started to now could have been early labor, yeah. Exactly, right? And so, like with with those first-time moms, right? Like they they cannot you cannot know, yeah, right, whether it's gonna go really fast or you know, whether it's going to like just be babies funky position. And so I always try to be balanced, right? Like, could be this, could be that. Um, you know, and and so they were going into the hospital, and um I guess she stopped in the bathroom and he said, a whole bunch of stuff came out. Can you head over? I was like, Yeah, I'll head over. And so then they get into triage and they're asking about the um her plans for um comfort measures, you know, medication, whatever. And uh she says that she wants um she wants an epidural. She said, give me all the drugs. And the nurse said, Oh good, I like that. Which pissed the dad off because you know, he's like, This is not the plan, and we want to feel supported, right?
SPEAKER_03And so I'm like your job easier. Oh good, I like that, you know?
SPEAKER_00Exactly, right? Like, yeah, that's what you should do is get the drugs because it makes it an easier patient for the nurse that day, right? I was like, listen, bro, you can ask for a new nurse, uh-huh, right? But also I knew that like check-in takes forever, you need a bag of IV fluid, when is anesthesiology gonna get there? Right. So, like, I knew that I'd have time to get to them. Um, you know, but she was saying to him, like, this is a lot worse than she expected. And I was like, listen, if she's eight centimeters, it's transition, it's not getting more intense than that. All she has to do is ride the wave. Yeah, and I was like, if she cannot get the epidural, chances are it's gonna go real quick from there, right? If you get the epidural, it's probably gonna slow things down.
SPEAKER_0310 hours later.
SPEAKER_00Correct. Um, but I was like, but if she's like three or four centimeters dilated, she should definitely get the epidural. She's saying things like that, then an epidural is a very good idea for her.
SPEAKER_04Yeah.
SPEAKER_00Um and so um she gets checked, she's eight centimeters dilated.
SPEAKER_01Love it. God, I love it.
SPEAKER_00Right. Um, so I get there and the nurse is like going through what is her preference for after the baby's born. Right? Do you want hat B? Do you want vitamin K, erythromycin? And I go, postpartum pitocin because she failed to ask about that. And the nurse looks at me and goes, That's optional. I didn't think that was optional. I didn't know that that was optional.
SPEAKER_03Oh my god. And I was like, You are in the system. This is you, the system that you are working for. You probably should know that everything's an option.
SPEAKER_00I'm like, of course it's optional. I said, every everything is optional. That you're recommending is optional. Everything is optional. I said, you know, there are hospitals around here that manage the care based on what they're seeing.
SPEAKER_02Yes.
SPEAKER_00Right? Like if a patient doesn't want Pitocin postpartum, they can monitor for bleeding and respond accordingly. Yeah. And she was like, Well, I didn't know that that was an option. Oh my how old was she? Um, probably in her fifties, maybe late 50s, early 60s. That's interesting. Um, yeah. And and it wasn't she she didn't present like she was trying to be a jerk, right? But she just was. I mean, I was like, Is that worse though? Well, I was like, I couldn't tell if she was being for real. Oh my god. I'm like, is this like is this you being passive aggressive or like do you actually not know that it's an option? Um either one is not good. Moms gets to the point where she her water breaks, she was going to consent to have her water broken because I I do think like if there's a time to break your water, transition is the time.
SPEAKER_04Totally. Right?
SPEAKER_00Like if you're gonna elect to do that, um, transition's a great time. And sometimes I think having your water broken during transition almost supports the intensity, right? Because that bulging bag in your vagina can be very annoying.
SPEAKER_03Yeah.
SPEAKER_00And having that pressure removed, like while it brings the baby down more, it does. I I feel like it feels better to have that bag of water broken. Um, so you know, I said, Do you do you have any interest in having your water broken? Your eight centimeters, like, you know, it could help to shift the sensations. And she was like, Yeah, I think I I think I do want to have it broken. Doctor came in to break it, it broke like literally as the doctor walked in the room, which was perfect. Love that.
SPEAKER_02I love that so much. Yeah.
SPEAKER_00And so the doctor just stood there. I, Alex, I have never seen a doctor sit on their hands the way that this doctor did. Like, just stood there, hands in her pockets, watching. They had the sheet over mom's knees while she's pushing, like, not even observing what's happening, just sitting in the room. Yeah. But then the hospital floor was so busy that day that that doctor was called into a different room. And there was another physician who was on the floor, not associated with their practice. So maybe the hospitalist, I don't know.
SPEAKER_02Okay.
SPEAKER_00Um, who was finishing up a different delivery and basically they were like handing off care to this other person.
SPEAKER_02Okay.
SPEAKER_00Um, because you know, this is a first-time mom. She's gonna push forever. Like the, you know, doctor from their practice would probably make it back, right? Yeah. So everybody kind of leaves the room, and the nurse is like, just keep doing what you're doing. You're doing great. Like, I'm seeing mom is, you know, making progress. And the nurse brings me a hot container of soapy water and some uh like pads or whatever, she like whatever cloths. Um, and she's like, if you want to do uh counterpressure, you can do that. And so I'm like, okay, right. So I get these warm compresses and I'm doing the counterpressure. I can feel baby moving under my hand.
SPEAKER_03Yeah.
SPEAKER_00Right.
SPEAKER_03Oh my gosh.
SPEAKER_00And so I know the level of progress that we're making, but the medical staff seems to be completely oblivious. So now she's pushing, and we're seeing like, you know, that dime size bit of baby's head with the pushes, and then a couple pushes later, we're seeing like that teardrop bit of baby's head, probably like I don't know, two square inches of baby's head. This is the point where a physician should be in the room, right? Because baby's head is now visible between contractions. Yeah. Nobody. Oh my god. Nobody, right? Babies, like we're getting close to ring of fire, like we're getting close to crowning. No one's in the room. Now I'm looking for like who is coming, like, what is happening here? Doctor comes in the room, is not even like in her stuff, right? They like to put on their little sheet and their gloves and whatever, and um, and like literally, mom just like pops baby's head right out, like doctor barely has gloves on. Um, you know, and everybody is like chuckling at how quickly this baby came for this first time, mom, except the doctor, who is furious. She's like, You understand that this is an infectious uh material, like this this could be whatever she was saying, right? Was like that the blood could, you know, be infected and now is all over her, right? So she is pissed that she didn't have her coverings on. Oh, yeah.
SPEAKER_03Um it might have been to her advantage to put a pep in her step when she got in the room and saw baby's head. Oh, like that visible at the paraneamp, you know, like at the vaginal entrance.
SPEAKER_00Oh my god. Yeah, so that was a little gross to me, was like, okay, like it happened, and and I get it, but also like that's not much we need to do, yeah. Right, it's too late.
SPEAKER_03Like, calm down.
SPEAKER_00And don't make the family feel bad.
SPEAKER_03Feel bad about pushing her baby up, right? Like you do, mm-hmm.
SPEAKER_00Yeah, so that happened. I wasn't a super fan of that, and then um, and then what? Oh, well, then like baby is coming, and this doctor is shoving her hands inside of this mom's vagina, which was just shocking to me. She ended up with a third-degree tear, and I am 100% sure that this was because of the doctor, like shoving her hands in as if she needed to pull this baby out, who very readily was coming all by itself. Um, yeah, not a huge fan of that. And then uh the doctor comes in and is now educating the patient on why it is important to have postpartum pitocin running, which it is running full like fully open at this point, and she is educating the patient. Like, I'm like, I don't know if they didn't teach you this in med school, but the time to consent a patient is before you do the intervention.
SPEAKER_01Oh my god.
SPEAKER_00Right, because it wasn't about the patient, it was about me.
SPEAKER_01Yeah, yeah.
SPEAKER_00Right? She was trying to educate me, the dumdula, about the fact that Pitocin is required because it's life-saving and da-da-da-da-da. I'm like, okay, like I don't actually need this education. I know the risks and benefits of Pitocin. I know that Pitocin can be life-saving, but I also know that the entire planet was fully populated before Pitocin was ever invented, right? So, does it help some women? Yes. Is it necessary for all women? Arguably no.
SPEAKER_03Yeah.
SPEAKER_00Right?
SPEAKER_03Yeah, yes. Also, uh, it's the patient's decision.
SPEAKER_00Right.
SPEAKER_03Regardless of her level of the patient's level of education, we tell people all the time, you don't need a reason. I mean, in that in that scenario, like, you know.
SPEAKER_00Listen, I I think that in a typical hospital birth where you have a bunch of interventions, you should do Pitocin, probably. Yeah. Right? Like, I'm not here to make medical recommendations because that's not my job. But from my logic and my knowledge of the risks of the other interventions, I think Pitocin is a really good idea. Yeah. When you do all the other things. But when you roll in eight centimeters, they didn't do a single thing to you. The chances that you're going to hemorrhage are pretty low. Do we know the stats? Uh, we're gonna have to look them up because I don't know off the top of my head what the actual risk is in a completely unaugmented birth, but it's low. So uh then I joke to them because they had done the mock subbustion, the sacral fanning, uh, and love it. They like, you know, they did it pretty religiously. And uh I was like, man, these mock subbustion births cannot be trusted, right? Like you just like they are shifting how I do uh in so many ways. Yes, right, and um the ob goes there's no research to show that that actually works. All that it does is make you hungry, it doesn't actually flip breech babies. Oh, what? And I was like, Okay, well, we're not talking about breech babies, we're talking about sacral fanning. And I've been doing this for more than a decade. Yeah, and I'll tell you that in the last year that I've had clients using the sacral fanning for moxabustion, I'm seeing a difference to the point that it is absolutely shifting the way that I support families. And she goes, Well, maybe you should do a research study on that.
SPEAKER_03Oh my god.
SPEAKER_00And I was like, I would, but nobody's going to fund research where um the end result is using a plant that is readily available in the backyards of people in Pennsylvania.
SPEAKER_03Yeah, nobody makes money doing that.
SPEAKER_00I was like, but if you'd like to partner with me on a research study, I'd be more than happy to partner with you. She was like, you know, you would need a control and a variable. And yes, I took science in the 90s and early 2000s, where they actually taught how to do science. Yes, I I know how the scientific method works.
SPEAKER_03God, Jessica. I don't, I'm just making up a name. Sounds like a totally Jessica thing to say.
SPEAKER_00Dude, I was like, the dad is texting Jackie on the side, and he's saying, I think Lacey's gonna kill this doctor.
SPEAKER_02Oh my god, yes. Because he always knows.
SPEAKER_00Don't come at me just because our education, experience, knowledge, wisdom, whatever is different.
SPEAKER_03Yeah.
SPEAKER_00Like your letters behind your name mean nothing to me. Yes. How old was she? Uh, that doctor was probably just about my age, a little bit older, maybe. Uh it it matters, but it doesn't.
SPEAKER_02I'm just merely curious.
SPEAKER_00When I taught in a prestigious school district, Hoity Toity, you know, people who were CEOs of companies and took their kids like skiing in Europe over the weekend, right? Like these are the level of people that I was dealing with. They'd introduce themselves as Dr. So and so, and I'd be like, it's so nice to meet you, John.
SPEAKER_02Yep.
SPEAKER_00Because here in this classroom, I'm king of the castle, right? And your degree means nothing to me, actually, is like so far outside of the realm of what I give a shit about.
SPEAKER_03Yeah. Yeah.
SPEAKER_00Right. Because I believe that your schooling probably had nothing to do with education. And so while you may be able to reset a femur, I'm the one with the knowledge of how education works. You know, like and so, like, for this OB to be like uh pompous, like there's no research on Max Sebastian. I mean, thousands of years of Chinese medicine would argue differently. Yeah, just because it's not in the green journal doesn't mean that it's not anecdotally valid, right?
SPEAKER_03Yeah, I hate that so much.
SPEAKER_00Yeah. Um, anyway, I I will say that barring that, this was such an incredibly beautiful birth. This mom was committed to the process and she wasn't afraid. And when it got real, real intense, she gritted her teeth and just kept going. And if you want an unmedicated birth, that is the attitude that you have to go to it with is like this is just a workout, it is just my muscle doing work, right? Like, this is just a buildup of lactic acid.
SPEAKER_03This is not over. It will be it, all of it will be over on top of the breaks that you get. Yeah. The rest, the true rest. I did hot yoga this morning, and uh in it it's like a bikram style hot yoga, right? And the savasana, so like you're resting half the time. And it's like, what are you doing during that rest? Like, are you fidgeting? Are you wiping the sweat from your eye? Like, can you actually just sit there and do nothing? Can you surrender to that experience? Very much like labor.
SPEAKER_04Right.
SPEAKER_03And so for the women that go unmedicated, like, can you surrender and rest during the times of rest when you are not contracting?
unknownYeah.
SPEAKER_03And then eventually it'll all be over. It's not gonna go on forever.
SPEAKER_00And that I think is the piece when you're in it, that is so hard to remember, right? Is this contraction will end, this labor will end, and it is all worth it on the other side. Right. Uh, I want to uh document for the sake of wisdom here. Um, there was a second birth that I had last week that I kind of alluded to in one of the episodes previously um recorded. Um and I I was reflecting on it and I I feel very badly that I didn't think of this in the moment. And so I want other people to know. So they had coerced the mom into breaking her bag of water at five centimeters, right? And dad was out of the room.
SPEAKER_03Yes, after dad had left. Yes.
SPEAKER_00Okay. Uh, and then you know, a few hours later, baby is having decelerations, right? And one that was very significant, seven minutes long, that's a long deceleration, well under 100 beats per minute, a significant deceleration. Um, to the point that some local hospitals would have gone into the OR in that moment.
SPEAKER_03Yeah, immediately. Yeah.
SPEAKER_00But they didn't. They waited to see if this was going to continue. Um, which, you know, I think is probably clinically sound judgment, but you never know, right? There are no guarantees. Um, I don't know why I did not suggest an amnio infusion. All right. So an amnioinfusion is where they stick a tube up into your uterus and pump saline into your uterus to give the baby that experience of having their waters back intact. It does not, it is not the same.
SPEAKER_03Yeah. Right?
SPEAKER_00It is not the same. But it can create a little bit of buoyancy. And if baby was compressing their cord in some way, could have given that buoyancy that maybe would have prevented the, you know, then subsequent yeah, it helps protect it.
SPEAKER_03A little extra cushion, because even during those contractions, baby is feeling them, right? So it's not only about compressing the cord, but also how how baby is tolerating contractions in general. Right. So re air quote inflating with saline can help protect baby.
SPEAKER_00So I want the listeners to know that if ever you have a broken bag of water, whether spontaneous or um artificially broken, uh, if baby's heart rate is starting to reflect stress, an intervention that you might request that is rarely ever, I've never seen a physician offer.
SPEAKER_03I have. I have. And if I go back in my notes, I'm pretty sure I could detail how many. It's I have off the top of my head, quite a few.
SPEAKER_00Interesting. Yeah, I've never seen it. Well, and you primarily went to the one local hospital that the OBs do kind of seem more like midwives, right? So could be that that facility is more prone to doing that.
SPEAKER_04Yeah.
SPEAKER_00Um, whereas the ones that I, you know, had prior to us working together where I had primarily gone, like they wouldn't do that. I mean, they would do it if asked, probably, maybe. Yeah. Um, but anyway, so and it's called an amnioinfusion where they stick a tube into the uterus and put the saline in. Um, obviously, there's a risk of infection anytime you stick something in your vagina, um, but it's kind of a relatively benign intervention. Your physician could certainly counsel you on risks and benefits of that. But um, yeah, so I felt bad that I didn't in the moment think of that. Um anyway, that's all. We're only human. I know this, I but I want to be perfect. I want to be a perfect human.
SPEAKER_03You are not per none of us are perfect, and what a high, like it's a high expectation to have is perfection, right? And there's so much beauty in being messy and you know, not perfect. You're we're all like, and this is what a great experience right now. Like you get to share on the podcast, like, you know, I should have done this. Like, I wish I did it, and I'm feeling a certain way about it. And so it's a growing opportunity for you. Like, if you were perfect all the time, would you ever grow? Would you ever change and evolve? No, because you would be this amazing perfect person, which like we all think you are anyway, but we're all just human.
SPEAKER_00Uh in reflecting on it, I, you know, I was like, okay, well, I don't need to be the gatekeeper of this information to only present, you know, when it uh when I'm there, right? Like I other people should know that this is an option. So there you go. It's an option. If your baby's heart rate is uh, you know, reflecting any kind of level two tracings might not be a bad thing to consider. Yeah. Uh so today we were gonna talk about non-stress tests.
SPEAKER_03Sure, let's go there. Non-stress tests, NST.
SPEAKER_00Yep. Uh, which in the beginning of my career was like something that people went to once in a while. Now it seems like people are uh recommended to go all the time.
SPEAKER_03All the time. It's for like every, yeah, almost I feel like it's almost every pregnancy. They're like, oh, past my due date, I'm gonna go to NST, or oh, I'm approaching 39 and 42 NST.
SPEAKER_00Right? Yep. Um, so a non-stress test is a test where you go to a facility, whether it's the MFM or your OB office, and they put the belly bands around you uh just like they do at the hospital. And they are going to have a monitor for the contractions and a monitor for the baby's heart rate. It's called a non-stress test because uh they are not stressing the baby to see a response. They are just seeing what the baby is doing while hanging out in there. Um, so they're looking for um what is the baby's baseline heart rate? Like where is the baby basically? Um, so usually I think they're between like 110 to 160, I think is kind of like average for babies. Um, and in a 20-minute period, they are looking for spikes of at least 15 beats per minute that last at least 15 seconds. Um uh and they want to see that at least two times in a 20-minute period. But here's where it gets tricky babies have sleep cycles, right? That typically last between 20 to 40 minutes, but sometimes up to 50 minutes. If you quote unquote fail in the first 20 minutes, they will extend another 20 minutes. But what if your baby's sleep cycle is 50 minutes long? Right? Then they're gonna flag you. And what do they do when they flag you?
SPEAKER_02They're like induction.
SPEAKER_00Sometimes. Sometimes.
SPEAKER_03Um then it becomes a medical need.
SPEAKER_00Maybe. But if you look at the research, the research actually shows that while it is a good snapshot of what the baby is doing right now, it is not indicative of fetal distress. And so which makes sense, right? Some people would argue that further testing is required, but we are seeing a very um um CYA response to a non quote unquote non-reactive NST as go to the hospital and they're gonna continue to monitor, and while you're there, we might as well induce you. Yeah. Um, is a very common response that we're seeing around here. Um I would say that you know, from my research and from my experience, the recommendation should probably be to go for a biophysical profile, which is a more in-depth um study into what's going on with the baby.
SPEAKER_03Yeah. You want to explain what a biophysical profile is?
SPEAKER_00I think we'll save that for a different day. Um, but it looks at more factors, right? Fluid level and baby's movement, baby's attempts at respiration, things like that.
SPEAKER_02Going on the list.
SPEAKER_00Yeah. So uh here's where I really struggle with NSTs. They have a very high false positive rate. Anywhere between 50 to 75 percent uh false positives, right? So it's frequently going to flag issues that are actually not issues, yeah. Right? Some places that I read it was like a 90% false positive rate. Yeah, ridiculous, right? And ACOG even says that uh there's low confidence in this as a surveillance um system for predicting outcomes. So why why because I think that from the OB lens, where they have uh invisible patient, right? You are never going to lose a lawsuit when you do all the things, the things that you did.
SPEAKER_03Yeah, yeah.
SPEAKER_00Right? You're really you're you're going to find yourself in a lawsuit and with trouble when you didn't do the things. Why didn't you set like standard sit on your hands, right? Standard of care is um decided by the group, not by the research necessarily, right? And so um what is it, consensus-based recommendations is what they're called. So because a lot of us do it, everyone should do it, right? Um but the idea that like routine use will prevent stillbirths has not been supported by research. What are your thoughts?
SPEAKER_02Um thinking about so many things.
SPEAKER_03Um the mother's experience during So you get a false positive, right?
SPEAKER_00Like something's wrong. Now what? How does that impact impact the mom?
SPEAKER_03Absolutely. Anxiety, stress, her heart, her heart rate's going up, her blood pressure's going up.
SPEAKER_00Right, they send you to the hospital, and then at the hospital you've got a high blood pressure reading, and now all of a sudden they're like, Oh, you're probably pre-clampsic, pre-eclamptic. We better just induce this baby. Yeah.
SPEAKER_02Like I know.
SPEAKER_00Yeah.
SPEAKER_03And and even just waiting for someone to interpret it, like I think majority, I don't know, I don't know if I want to say this, maybe not majority, but a a lot, a good number of our clients don't uh necessarily like being a hot in a hospital setting. They're having babies in there anyway, right? And so just being in a hospital setting trick like triggers them. Like, so it's just like an even wait. So it's like being in there and then waiting for someone to interpret the NST. It's like a combo effect, you know?
SPEAKER_00Yeah, absolutely. And and I would say that even if they told you that information, we're looking for babies' heart rate to accelerate by 15 beats per minute, and we're looking for that to last for 15 seconds, then you could look by yourself and feel better about what you're seeing. Yeah. I would say that um, from the research that I did, there are um conditions that might benefit from NSTs, right? Um, people who have type 1 or type 2 diabetes, people who it appears baby has fetal growth restriction, um, people who have either chronic or gestational hypertension. Um, they might benefit from having NSTs. It it could what I read was that the predictive value increases in people with those conditions. Where there's insufficient evidence is routine NSTs for things like advanced maternal age. Right? Until 40 years old, there's no good evidence that's that shows that these individuals should be subject subjected to more testing. Um trying to think what else I read that was really interesting about it. Uh, you know, I think uh also we go back to this idea of relative risk versus absolute risk with this, just as we do with other interventions. Um, like they will say, oh, like, you know, your condition might double or triple the risk of losing this baby or having this baby um be stillborn. Um, but when you look at the absolute baseline risk of stillbirth in a term pregnancy is like two out of a thousand. Right. And if we triple that risk, it becomes six out of a thousand, which is still really, really small. Yeah, minus like nine hundred four out of a thousand babies will be fine.
SPEAKER_03Very small.
SPEAKER_00Yeah. So I think you know, like uh something that I think is important for people to know when they're going into uh an NST is that this is a screening test, not a diagnostic test. Like it is throwing casting a wide net, right? A screening test is designed so that it if you cast a an overly inclusive net, you're going to catch all of the babies, right? And limit the number of babies that are missed. So it's really just supposed to um highlight, like, hey, there could be something. This an NST by itself should not be used to determine an induction.
SPEAKER_03Yeah, I agree.
SPEAKER_00Right. Uh yeah, like with a uh a high false positive rating, right? Like of 75 to 90 percent, because again, the research that I read was kind of all over the place. Um that means that out of 10 babies, eight or nine of them are going to be who flag the are totally fine. Are totally fine.
SPEAKER_03Yeah.
SPEAKER_00Right. Um so yeah.
SPEAKER_03How do we how do we help clients navigate those conversations with their providers when they're recommending an NST? Like, hey, you're you know, approaching your due date or you're past your due date, NST, right?
SPEAKER_00Um I think that it has to come from like a place of can we have a deeper conversation? Like, has the surveillance of an NST actually been proven to mitigate the risks? Right? Like I understand that there's a consensus opinion here that it is better, but what does the research actually show? Um, you know, and what are my risk factors that make this warranted? And what research is there to show that me being 36 is actually a risk factor?
SPEAKER_03Yeah.
SPEAKER_00Right.
SPEAKER_03Um a lot of our clients are on board with them for the most part, would you agree?
SPEAKER_00I think that a lot of people make decisions because it is just they're being funneled through the system and they're not really educated.
SPEAKER_03And if they were told, yeah.
SPEAKER_00Right.
SPEAKER_03If they were told that if you get a red flag here, the likelihood of induction is high, they wouldn't do it.
SPEAKER_00Well, I think if they were told that 80% of the time that it finds something, it's actually wrong. Yeah. Like, why would I do that? Yeah, yeah. Um, so okay. The NST has a high negative predictive value, right? So um the probability that a person with a negative test is truly negative, right? So this means that if baby looks fine on the NST, that's like a really high level of certainty. It's a 99.8% chance. So a 99.8% chance that if baby looks good, baby is probably good. Right? Um and that is uh generally considered like good for the week. Yeah, yeah, yeah, yeah. Yeah. Uh however, there is no guarantee because again, this is not a diagnostic test, so cannot account for random spontaneous things, a blood clot forming, uh cord issue, like spontaneous potential abruption.
SPEAKER_03Yeah.
SPEAKER_00Right. But there's a 99.8% chance that if it says your baby is good, then it's probably good. Um, so this idea, I think one of the challenges that a lot of our clients face is if they elect to go past their due date, or if they're an IVF family, or if they're blah blah blah, whatever, and they're being recommended non-stress tests. Now they're being recommended twice a week, three times a week, and it becomes a burden for them, right?
SPEAKER_03That then they um are anxious about two or three times a week, and they have to take off work and they have to go and and sit there and wait for the results. And oh my, like just the entirety of the of that appointment. Right, and then up to it.
SPEAKER_00That goes back to this idea of like, is this benefiting the mom, right? Or is it having a negative impact on the mom?
SPEAKER_03And therefore benefiting the baby or not, you know, because when mom is stressed, baby knows that.
SPEAKER_00Right. You know, um, so times that NSTs might be ordered would include decreased fetal movement, um, post states pregnancies, hypertension preoclampsia, diabetes, fetal growth restriction, advanced maternal age, which we already said. There's no research to actually support that. IVF pregnancies, which there is good research to support that, uh, because IVF pregnancies are at a high Risk of placental issues, um cholestasis, uh, multiple gestations, previous stillbirth. Um, so you know, there's a lot of conditions in which this might be recommended. Um, and there are things, factors that can if affect this. Gestational age. Prior to 32 weeks gestation, a baby is unlikely to have a reactive NST. And so the standard is actually reduced to 10, uh, an increase of 10 beats per minute over 10 seconds, not 15 by 15. Um, obviously, we talked about baby's sleep could affect the results. Um, certain medications that mom is on, so she should know if that's the case. Um, the use of uh nicotine, um mother's position. So if you're in a fully reclined position, you're more likely to have a non-reactive NST than if you are uh in a semi-reclined position.
SPEAKER_02Yeah.
SPEAKER_00Um, whether or not mom has eaten uh and what her hydration looks like can affect the NST. Um, so all factors that I think should be highlighted so that you can set yourself up for success, right? You should eat and hydrate in the day before and then in the hour before your NST. You should make sure that you're not on your back.
SPEAKER_03Try not to stress, knowing that it's what 80 to 90, what what was the numbers?
SPEAKER_0280 to 90.
SPEAKER_00It depends on where you look. Um, but anywhere between um 50 to 75 or 75 to 90, depending on what research you're reading.
SPEAKER_03Like if I yeah, I would I'd go into those appointments like this means absolutely nothing.
SPEAKER_00Maybe I you know, right? Like it it could point to something, um, but also is likely to be nothing, false positive.
SPEAKER_03And so, you know, it's like, okay, well, this is supposed to give me peace of mind, but and for some it does, like we have seen it for some they want those and like they they do feel better with that, right? But continue.
SPEAKER_00I would argue that better would be for the family to understand and know how to use kick counts. Yeah, right, because noticing your baby's normal movements and noticing if they are changing significantly is uh I think uh more indicative of how baby is doing. And we know that baby's movements change at the end, as the space runs out, they do change at the end. But a a sudden drop in the baby's movement is likely to be noticed by mom over time, yeah. And if that is the case and mom's like, hey, something's wrong here, then I think it really becomes prudent to go and explore, like, let's get the test done. And that and I'm not saying like wait until your next appointment. No, right do it, wait until the next day. At any point, if you suspect that something is wrong, right? I think that it is worth going in and getting checked, right? You can go to the ER, they will send you to labor and delivery, they will do an NST right there at the hospital. And who cares if you're the crazy lady who comes in five times before she has her baby? Yeah, right. Who cares? Your job is not to manage the feelings of grown-ass adults in your life. If you think that there's something wrong, err on the side of caution and go get it checked out.
SPEAKER_03Yeah, I agree. Your your intuition is better than anything.
SPEAKER_00Yep. Yep. Um, I just I, you know, I think that at the end of the day, as families, we need to remember that this is a snapshot. It neither indicates that your baby is in distress guaranteed, nor does it guarantee that your baby is fine. Um, it really is just a snapshot. And so, you know, really like having the mother focus on what is she feeling, what is she noticing, um, that is going to be the the most impactful uh data point that you can have in how your baby is doing, in my opinion.
SPEAKER_03I agree, I agree wholeheartedly.
SPEAKER_00Yeah. Uh, and knowing that it can lead to a cascade, right? Like you get a borderline or non-reactive tracing, now you're doing prolonged monitoring, or you're being sent to the hospital for prolonged monitoring, you're being sent for a biophysical profile. They find that the water, the fluid is low-ish, which is not a scientific term, but now, like, oh, we're on the lower end of normal, still normal, but the lower end of normal. Well, you know, you're 40 and a half weeks anyway, and babies do better on the outside, and your placenta is just gonna crap out tomorrow, and like we can't promise, right? So we should probably just induce you, right? And now you're being induced because your baby was sleeping during your NST. Um, and again, I'm not saying that you shouldn't do an NST, making that very clear, right?
SPEAKER_03Because any type of medical advice.
SPEAKER_00I don't care what you do. What I care about is that you understand that this is research that has no scientific grounds to be a standard part of the protocol.
SPEAKER_03Well, and honestly, much like the um continuous fetal monitoring, right?
unknownRight.
SPEAKER_03Go check out that episode because we talked about that and and the research behind that and what it actually like what it's actually doing and leading to. Right. So if you're curious, go check that one out.
SPEAKER_00Right. You know, so I think back to your question, um, you know, for moms, part of the shared decision-making process should involve like, okay, so you're recommending an NST. Can you explain exactly what that's going to look like? Why are you recommending this?
SPEAKER_03What is it gonna show me?
SPEAKER_00Right. What specific risks are we monitoring for? Right? Um, what is my absolute risk without the surveillance? Right?
SPEAKER_03Um what are alternatives?
SPEAKER_00Sure. Um what what evidence shows the NST surveillance changes the particular outcome of my particular risk? Right. So if my risk of a stillbirth is one in a thousand, what evidence is there that an NST will change that? Yeah, right. Um and you know, I mean, uh, we always say, like, what if I decline, right? That option and brain do nothing.
SPEAKER_04Yeah.
SPEAKER_00I mean, they can't answer, right? Because they're gonna say, well, your baby might die.
unknownRight?
SPEAKER_00Like, I wish that they would stop doing that. I wish that they would stop doing that because coercive. Well, yeah, but but also I think that it it erodes the trust, right? A family then is like, well, you said that my baby might die, but then my baby didn't die. And and now we're not we're not trusting you when you later say, like, this could be really bad for your baby and your baby could die. And now they're not believing the providers because they used a fear-mongering tactic in order to get you to right. Yeah, exactly.
SPEAKER_03And then they look to the doulas when they go, should I get this site attack? Should I have this postpartum pit or methrogen because I'm possibly having a postpartum hemorrhage? They look to the doula.
SPEAKER_00Right.
SPEAKER_03You can't make a medical d decision or recommendation. But but I'm gonna make this very clear there is trust there. That's why they look to the doula, because there is trust established.
SPEAKER_00Yeah. Well, it's like that nurse manager who told me that I should be telling people just to trust the medical staff, right? That they met for seven minutes one time in their pregnancy? Come on, really? Okay, girl. Yeah. Yeah. You know, I I think that the the question that people should be left with is we routinely say that NSTs are done to prevent stillbirth, but how strong is the evidence that the testing actually accomplishes that? Right? And that is a conversation that you need to have with your provider. And is once a week sufficient? Is twice a week necessary? Is three times a week actually predictive? Right? Yeah.
SPEAKER_03Well, if you guys liked this, please share it with someone that you love. Um, leave us a review. We'd love to hear from you guys. And we'll see you next week.
SPEAKER_00See you next week. Thanks for getting unhinged with us today. We hope this conversation challenged you, validated you, or made you laugh out loud. Birth and parenting aren't meant to be perfect or polished, and neither are we.
SPEAKER_03If you love this episode, share it with someone who needs real and raw truths. Leave us a review and make sure you're subscribed so you don't miss what we're unraveling next. We're Alex Shaw and Lacey Morgan reminding you that your voice matters, your experience is valid, and you're allowed to do this your own way.
SPEAKER_00Until next time, stay unhinged.