What happens during a contraction stress test?

I am 38W3D and just came back from the midwife.  The baby is still measuring 3 weeks behind and she had planned to start an induction, but the baby had gained enough weight that we were able to avoid that again.  Last Monday u/s measured the baby at 34 weeks weighing 5lb 3ounces.  Today the baby measured 35 weeks and weighed around 5lb 14ounces.  She's still behind, but growing!

Monday I have to go to the hospital for an OCT contraction stress test.  I've had the non stress test, biophysical profile, and AFI check every week since I was 34 weeks along.  I have not had a contraction stress test before.  Is it safe to the baby?  Any information you have about it would be appreciated.  Thanks!

[specialteacher]

I appreciate your comments.  I couldn't find a lot about it on the internet.  I guess if they are rarely performed that's why.  So far all of the other tests have came back fine.  The baby scored 9/10 on the biophysical profile this morning, but that's been her lowest score so far.  She is measuring small, but is gaining weight and seems healthy.  Thanks again for the insight!

[peekawho]

They aren't often done anymore.  I can't even remember the last time I participated in one, or even heard of one being done.  Perhaps many years ago?

Anyway, you'll be hooked up to an IV and given low doses of Pitocin to induce some contractions.  When you've had 3 in ten minutes, they'll discontinue the Pitocin and look at the monitor tracing.  There are certain responses in the fetal heart rate to contractions that can indicate intolerance to contractions, and your baby is usually delivered either then or within 24 hours or so.

But like I said...I haven't seen it or heard of it in many, many years.  If NSTs are ok, biophysical profiles are ok, and AFI's are ok...the CST isn't likely to add anything useful.  

But I suppose in some areas of the country they might still be done.  

The risks to the baby are mainly of uterine hyperstimulation---too many contractions for the baby to tolerate.  This does not happen often, and usually the contractions stop once the Pitocin is discontinued.  

[anxiousmomtobe?]

I have a nst tomorrow, what  exactly will they do?  I know I will have an us.....

I'm not really gaining any weight, but my belly is bigger every week when they measure.....  I think the girlie is just fine, but always open to what the experts say.

[peekawho]

That's exactly correct about the NST.

Specialteacher:

The only reason I can think why a CST would be done, is that they're actually hoping it will put you into labor.  It might, if your cervix is really ripe.  

But...at 38+3 with fetal growth concerns, there really isn't a lot of reason to putz around with your pregnancy.  There is not a lot of advantage and plenty of risk in continuing your pregnancy much longer.   But that's just my opinion.  Why the CST when its pretty blatantly obvious you should be delivered in the next week?  

[specialteacher]

When I have the nst I am strapped to a fetal monitor and push a button each time I feel the baby move.  Each time she moves her heartrate should rise.  You can actually hear it beat faster on the test.  I keep having NSTs everytime I go to the midwife.  It takes about 30 minutes.  Good luck to you!

[peekawho]

I bet they're hoping you'll go in to labor from the test.  Either that, or when you're there, they'll say "oh, keep the Pit going", which is another way to sneak in an induction without exactly calling it that!

[specialteacher]

I don't know.  Last week the midwife really talked like I would be induced today.  She did check my cervix . I think it was 1cm dilated and 60% effaced both last week and today.  The only change she noted was that the baby's head had dropped considerably.  

I went to my appointment with bags packed, but was sent home and told to come back Monday for the CST.

[specialteacher]

We'll see!  Thanks again for sharing your knowledge.

[rubyolivia]

Babies move even when they sleep! :) When i was on the monitor, it automatically showed baby's hb, a line for each contraction and then a line that showed little dots each time Max moved. I never had to push the button. Though I don't know if that was exactly considered an NST....I was just there b/c I was haivng contractions. I'm sure all will go fine!

[anxiousmomtobe?]

What if the baby is asleep and won't move around?  Now I'm stressed.  She seems to be the most active in the car or in the pool.....

[anxiousmomtobe?]

Okay I am feeling a little relieved, will arrive with a reasonably full tummy and drink some juice.  

She is so active in the car it hurts.  Last night I could actually feel her toes pushing out on the left side.  Made my husband feel it as he was sceptical.  How such a supposedly little baby can make such a ruckus in there.....

Another question, are these kick counts everyone seems to be talking about typical?  My doc has never asked me to do kick counts.....

[anxiousmomtobe?]

Just wanted to say I hope things go well and your wee one continues to gain weight and arrives here healthy.

[specialteacher]

Thank you!  She is growing so we are staying positive!

[peekawho]

Then they will have to do your test in the car!

Seriously, we have ways to wake up the baby.  Try to eat something shortly before the NST, and we often give the mom a glass of juice or ice water if the baby seems sleepy.  

[specialteacher]

About the kick counts. . .I didn't have to start doing them until around 35 weeks when my fluid got low.  I just write down when the baby moves and what time it happened.  She is supposed to move at least 10 times a day.  So far it hasn't been a big deal. I think some doctors require kick counts and others just say to make sure you notice the baby is moving consistently.  If my fluid hadn't dropped I don't think I would have had to do them everyday.

[peekawho]

Some (many) docs don't do them.  They were all the rage a couple of years ago, but you hear less and less about kick counts these days.  

There was a post a couple of months ago about them, somewhere here.  

[anxiousmomtobe?]

I'm already neurotic, I can't imagine if I had to sit and count kicks, she's moving on and off throughout the day, so I assume she's fine.

Special, do they know why your baby is on the small side?

[specialteacher]

I don't think they know why she is so small.  At first my uterus/fundal height was measuring right on target each week, but I wasn't gaining much weight.  I had only gained about 9 pounds by 34 weeks.  This led them to check my fluid level which was low.  I got my fluid level back up to normal but still didn't gain any weight so they checked the baby's size and she was 2 weeks behind and my fundal height was behind too. Now the baby is 3 weeks behind but she is gaining weight and so am I.  

Sometimes I wonder just how accurate my due date is because my pregnancy was dated with an u/s instead of LMP.  I got pregnant immediately after a m/c and I wonder if I just have my dates mixed up.

[AnnieBrooke]

Excuse me, I didn't want to GIVE the baby problems by yanking him out early.  I wanted the baby no matter what (LOL).

[AnnieBrooke]

I got a contraction stress test, and it was certainly because they wanted to start the labor but I was telling them I preferred to wait until labor began naturally.  Their way to try to start things going.  They kept me at it for hours, and finally sent me home.  The doc came in and said, "Well, we could send you home or we could induce you.  What would you like?"  I was only at 37 weeks then and really p.o.ed by then too.  They were nervous because of my IVF, donor egg and age -- were more interested in delivering me safely even if it was only at 37 weeks than in letting things take their course.  As it happened, the CST did not start labor, I went home, and then at 39 weeks and 1 day labor began naturally.  I should have more sympathy for their point of view, but I didn't want a baby who had problems because he had been yanked out untimely.

[peekawho]

Annie...LOL!  Now the truth comes out!  

[AnnieBrooke]

  Oops, you're on to me.  Throw them back if they are too little.  :)