Why So Many of My Birmingham Clients Have These Tests

If you’ve been sent for a non-stress test (NST) or a biophysical profile (BPP), you are in good company. Many of my Birmingham, Alabama clients have had one of these tests over the years, and a handful of recent questions and experiences brought the topic to mind. Different reasons. Very different outcomes.

Some had these tests after risk factors showed up at a prenatal appointment. Some noticed their baby wasn’t moving as much as usual, which is always a good reason to request a test. Others go in every week because of their own health history.

For some moms, the results are reassuring and they go home. For others, the results can lead to more monitoring or a recommendation to have their baby a little sooner.

If you’re already carrying some anxiety about labor and delivery, a surprise trip for monitoring can stir up a lot. As a birth and postpartum doula, I’ve seen how much calmer moms feel when they know what to expect. So let’s walk through what these tests are, why they’re done, and what the results might mean for you and your baby.

What Is a Non-Stress Test (NST)?

A non-stress test (NST) is a way of checking your baby’s well-being by observing how the baby’s heart rate responds to his or her own movements. Just as our heart rate increases when we are active, we expect the baby’s heart rate to increase in response to movement. This test can be performed after the 28th week of pregnancy. Although most consider it a non-invasive test, you should understand what to expect and speak up if you are uncomfortable with any of the aspects of the test.

What If My Baby Doesn’t Pass the Non-Stress Test?

A reactive non-stress test result means your baby’s heart rate speeds up at least twice in about 20 minutes. That’s the result everyone is hoping for. A nonreactive result means those heart rate bumps didn’t show up during the test.

Take a breath. A nonreactive non-stress test very often just means your baby is asleep. (Babies have no respect for appointment times.) Your nurse may keep the monitor on longer, offer you something to eat or drink, or use a small buzzer on your belly to gently wake your baby up. If the result is still nonreactive, the next step is usually a biophysical profile to get a fuller picture.

What Is a Biophysical Profile (BPP)?

A biophysical profile (BPP) is an ultrasound test that evaluates several aspects of the baby’s health. The BPP is typically used after the 32nd week of pregnancy, and it may be performed in conjunction with an NST. Each aspect of the baby’s health is given a score. If your baby receives a low score, your provider may recommend more testing or an early delivery. (See below on scoring.) As with the NST, the BPP s considered a non-invasive test, but you should understand what to expect and speak up if you are uncomfortable with any of the aspects of the test.

Why Would I Need a Biophysical Profile or Non-Stress Test?

Your provider might recommend a biophysical profile and/or non-stress test for a lot of reasons. Usually it comes down to wanting a closer look at how your baby is doing when something about the pregnancy calls for extra care. Some of the most common reasons include:

• Your baby is moving less than usual
• High blood pressure or preeclampsia
• Diabetes, either before pregnancy or gestational diabetes that needs medication
• Other health conditions, like thyroid, kidney, or autoimmune disease
• Questions about your baby’s growth or the amount of amniotic fluid
• Carrying twins or more
• A previous stillbirth
• Going past your due date (often starting around 41 weeks)
• Your age (some providers start testing at 35 or 40)

Some moms have these tests only once, when a question comes up. Others have weekly non-stress tests, or even twice-weekly testing, for the rest of a high-risk pregnancy. Being scheduled for regular monitoring doesn’t mean something is wrong. It means your care team wants to keep a close eye on things.

Decreased Fetal Movement: When to Get Checked

This is the one I want every mom to hear. You know your baby. By the third trimester, most moms have a feel for their baby’s patterns: the busy times, the sleepy times, the hiccups at 2am. I recommend my clients start counting kicks in the third trimester, so you have data to back you up if you feel like something is off.

If your baby is moving less than usual, or something just doesn’t feel right, call your provider or head to labor and delivery. Don’t wait until tomorrow, and don’t worry about bothering anyone. The nurses would much rather check on a healthy baby than have you sit at home worrying.

What to Expect During a Non-Stress Test or Biophysical Profile

You might have these tests in your doctor’s office or at the hospital. If you go to the hospital, you may be given a hospital gown and asked to change. If you prefer to stay in your own clothes, however, just say so. The provider will need to be able to access your belly, but that shouldn’t require you to wear a gown if you’re uncomfortable.

During the Non-Stress Test

For the non-stress test, you’ll be asked to lie back in the bed and have two stretchy belts placed around your abdomen. Each belt has a sensor, one for your baby’s heart rate and one to record any uterine contractions you may be having. A nurse will apply ultrasound gel to the sensors before placing them on your belly with the belts. These belts connect to a computer monitor, which will record a tracing of your baby’s heart rate. You may also get a button to indicate when you feel the baby’s movement.

How Long Does a Non-Stress Test Take?

A non-stress test will typically last around 20 to 30 minutes, though it may take longer if the baby is sleeping or nonreactive (meaning the baby’s movements don’t raise his or her heart rate).

During the Biophysical Profile Ultrasound

The BPP involves an ultrasound test. The ultrasound technician or provider who performs the test will ask you to lie back, apply gel to your belly, and scan various parts of your abdomen to check the different aspects of your baby’s health. This is not as thorough as the anatomy scan ultrasound you may have had earlier in pregnancy. In particular, your provider will probably be looking at the baby’s lungs (to assess their respiratory, or practice breathing, movements), limbs (to assess muscle tone and movement), and the spaces around the baby that constitute pockets of amniotic fluid. The ultrasound portion of a biophysical profile usually takes up to 30 minutes, depending on how quickly your baby shows off.

What Does a Biophysical Profile Measure?

The test measures the following aspects of the baby’s health:

• Muscle tone
• Respiratory movements – your baby’s practice breathing exercises
• Heart rate
• Amniotic fluid, and
• Movement.

What Do Biophysical Profile Scores Mean?

Each aspect of your baby’s health is given a score of 0 or 2. Here in Birmingham, the score is usually given out of 8 because heart rate is measured separately in the NST; however, some providers may combine all 5 aspects into a score out of 10. The table below indicates the scoring for each aspect:

Biophysical Profile Scoring
Fetal Movement	Three or more separate movements from the baby’s body or limbs in 30 minutes	0 or 2 points
Fetal Muscle Tone	One or more episodes of active extension and flexion of an arm or leg, or the opening and closing of a hand, in 30 minutes	0 or 2 points
Fetal Breathing Movements	At least one episode of continuous breathing that lasts at least 30 seconds during the 30-minute test	0 or 2 points
Amniotic Fluid Volume	At least one pocket of amniotic fluid that measures 1 cm across and 2 cm vertically	0 or 2 points *In addition to the point scoring, your provider may record the amniotic fluid index, or AFI, which is the sum of fluid measures in four quadrants.

• A score of 8 or 10 is considered reassuring.
• A score of 6/8 may call for further testing, usually within 12-24 hours.
• A score of 4/8 or lower generally indicates that delivery may be recommended, depending on gestational age and other health and risk factors.
• An amniotic fluid index (AFI) between 5 cm and 25 cm is considered healthy.

Can a Biophysical Profile Lead to Induction?

Sometimes, yes. A BPP is one of the tools your provider uses to decide whether your baby is doing well staying put, or whether it might be safer for your baby to be born soon.

If the score is reassuring, you’ll usually go home and keep your regular plan, with or without more testing scheduled. When the score is borderline, your provider may ask you to repeat the test within a day. If the score is low, or there are other concerns like low amniotic fluid, your provider may recommend induction or, in some cases, a cesarean. How soon depends on how far along you are and how you and your baby are doing overall.

I’ve had clients go in for a quick check and come home an hour later. I’ve also had clients go in worried about their baby’s movement and be advised to stay and start an induction the next day. Both are normal outcomes of the same test. It can feel like a lot when you walked in with a water bottle and your phone at 12% battery.

If your provider does recommend an induction, you still get to ask questions. A tool I love sharing in my evidence-based birth education classes is BRAIN:

• Benefits: What are the benefits of this recommendation?
• Risks: What are the risks?
• Alternatives: Are there other options, like more monitoring?
• Intuition: What is my gut telling me?
• Nothing: What happens if we wait, or do nothing for now?

Sometimes the answers make it clear that induction is the right call. Sometimes they open the door to another option. Either way, you’ll walk into labor understanding why, and feeling like you were part of the decision. That’s what preparing for birth with confidence looks like, even when the plan changes.

How to Prepare for a Biophysical Profile or Non-Stress Test (and Feel Calmer)

Monitoring in pregnancy can stir up a lot of feelings, especially if you already have some anxiety about labor and delivery. A few things can help you walk in feeling a little steadier.

Bring a few comforts. A phone charger, a snack, a water bottle, and something to do. A non-stress test can run longer if your baby is napping, and a quick hospital visit can turn into a long one. Keeping a small bag in the car during the third trimester is never a bad idea.

Bring a support person if you can. Your partner, a friend, or your doula. Having someone there to listen, ask questions, and hold the snacks makes a real difference.

Ask questions. You’re allowed to ask what your provider is looking for, what the numbers mean, and what happens next. A few good ones:

• Can I watch my baby while you do the ultrasound?
• What did the test show?
• Is this result reassuring, or do we need to do more?
• What are my options from here?
• When should I come back, and what should I watch for at home?

Speak up if something doesn’t feel settled. If you leave an appointment still uneasy, it’s okay to call back, ask for a follow-up, or get a second opinion. Sometimes a repeat test somewhere else brings the reassurance you need. Your peace of mind matters too.

Breathe. The same slow breathing you practice for labor works on a monitoring bed. Long exhale, drop your shoulders, unclench your jaw. (You’re clenching it right now, aren’t you?)

Birth Doula Support in Birmingham AL When Pregnancy Doesn’t Go As Expected

Pregnancy doesn’t always follow the plan. A routine appointment turns into a trip to the hospital. A slow afternoon turns into “let’s get you on the monitor.” When that happens, it helps to have someone in your corner who knows the tests, knows the local hospitals, and can help you sort through what you’re hearing.

As an experienced birth doula in Birmingham, AL, that’s a big part of what I do. When a client goes in for testing, we talk through the results, the questions to ask, and what to expect during labor if it ends up starting sooner than planned. And if induction becomes part of the story, I’m there for that too.

My goal is always the same. By the time you’re holding your baby, I want you to feel like you were in the driver’s seat the whole time, even when unexpected things happened.

If you’re preparing for birth in the Birmingham area, here are a few ways to get started:

• Download my free Birmingham birth guide
• Join my evidence-based childbirth education class
• Book a consult to talk about birth doula support