anyone "refused" to have continual monitoring for their VBAC attempt? Confused and emotional!!

[basilbrush]

My son's birth was pretty scary, I was going for a HB but transferred after 17 hours of proper labour on midwife's advice for slow progress. (was 6 cms) Placenta abrupted on way to hospital in car, was zoomed into emergency theatre and DS, although small at 5lbs as placenta had been failing for some weeks, was OK, thank god.

I have been told that the chance of a repeat abruption is very small but DH and I are going for a hospital birth this time just in case. I am 33 weeks and was scanned last week to check on baby's size and will be again at 36 weeks. At moment, baby is bigger than DS was at same scan which is good sign.

I have read up on VBAC and know that my best chance is to keep mobile, find positions that suit me, etc etc. I want to be in the midwife led unit which is literally down the corridor from the cons led unit in the hospital so if there is a problem, I can be transferred in two seconds.

However, consultant told me last week that because I've had a C section I have to be in the CLU, strapped to foetal monitor throughout my labour, with IV drip in hand and nil by mouth in case I need surgery. I think this will radically reduce my chances of success.

She got grumpy and said that my only option is to sign a legal waiver saying I don't want continual monitoring if I want to be in the MLU and gave me a lecture about how intermittant checks every 15 mins still leave plenty of time for my baby to die...

I am very torn. Should I sign the waiver or should I just accept that my DS did almost die and I should just do what I'm told?

HELP!

[ImightbeLulumama]

contact www.aims.org.uk

it has been shown that CFM does not actually improve outcome.

there are other signs of abruption and rupture other than on the CTG and if your DS is thriving in utero, your placenta is not failing now

you do not have to consent to anything that you have made an informed decision to decline

what you cannot do, is make an informed choice when you have terrified

i had a VBAC, i did have cfm, but was encouraged to be mobile, i did not have a canula, nor nil by mouth, and MWs left us to it until my waters broke.

[yurt1]

Don't worry too much. I had a VBA2C. I was told the same sort of thing (and in fact did need a section) but it was all very laid back and I wasn't given continual monitoring (in fact could have done with it, but still). I wasn't strapped to a monitor at all initially, then just had regular checks. I was able to be up and active and would have been allowed a bath if I'd wanted.

I certainly wasn't nil by mouth even though it was always quite likely I was going to end up a section.

[laura032004]

I planned a HB, and would therefore have refused CFM, as it wouldn't have been an option. However, my waters broke on the Sunday pm, and I ended up having to go into hospital as labour hadn't started by the Friday morning.

I was induced, and they wanted me nil by mouth whilst I was receiving the induction drugs. They turned them off overnight and let me eat / drink freely until they started them again I ate when I wanted though in reality.

Had CFM, with lots of breaks for the loo. Was very active, birthing ball, walking etc, which did wreck the CFM trace a bit, but they weren't worried so long as they got it once in a while.

Had a cannula due to the induction drugs & IV antibiotics for Gp B strep. Would have refused otherwise.

It's your choice at the end of the day. I know I was taking a big risk planning a HB, as had anything gone wrong, we were at least 30 mins from hospital, once an ambulance had got to us. However, it was a risk I was prepared to take once I weighed it up.

Even with CFM, the trace was often bad for ages, and when DS2 looked dodgy on the trace, it took them ages to call in other docs etc to look at it.

[lackaDAISYcal]

Oh you poor thing . I'm reading up on VBAC stuff at the minute and agree that being mobile is the best position to be in for a successful VBAC. I'm sorry your conultant is making you feel like this. Can you ask for a second opinion and talk to a consultant who is more in favour of a natural labour?

Have they actually quantified the risks for you? or just scaremongering you? the reason I ask is that my MW was bleating to me about chance of uterine rupture, but this is still only 0.5%, and as I'm sure someone else will tell you, is actually lesss than the chance of a cord proplapse in a normal pregnancy and birth.

I'm not sure about your previous placental abruption though, as nothing I've read talks about this as one of the maternal/foetal outcomes.

I hope someone else comes along who can help you.

[basilbrush]

Thanks DAISY

Would you believe this is Forth Park I am talking about? Have just been reading about it's award winning policies on that other thread!! I kid you not, they said to my face last week that NO VBAC are EVER ADMITTED TO MLU as they are too high risk!!!

[ImightbeLulumama]

speak to supervisor of midwives at the hospital if their policy and awards are not matching your experience

[lackaDAISYcal]

I'm basilbrush. Have you asked to speak to the Director of Midwifery Services. Perhaps a meeting with her and your consultant would help to smooth things over. Also perhaps you should remind the consultant of the award that they have just won (although I suppose this is the MWL unit rather then the CLU). I'd try talking to the MW unit on Monday (you have the names from that article? try asking for the MWs involved personally) and seeing if you can set up a meeting. It seems ridiculous that they won't let you labour in the MWU if everything to date is fine with your placenta. And as you say, you are literally along the hall should you need to be transferred.

LOL starlight at saying you want a home birth

[PortAndLemon]

I sort of accidentally refused CFM with my VBAC (story here -- just because I arrived at hospital in the bolshie transition stage where no one was telling me what to do and the midwives sensibly decided to let me get on with it.

Ask your consultant if he can refer you to the research that shows that CFM produces better outcomes than intermittent monitoring (I'll be surprised if he can, because there isn't any...) or if he is making his comments about your baby dying just to scare you based on no evidence.

Mears, who is a midwife, always advises women being told they "can't" do whatever to say they want to have a homebirth as suddenly then all the objetions tend to disappear.

[lackaDAISYcal]

what a lovely birth story portandlemon, congratualtions

It's what I hope mine will be like

[basilbrush]

Thanks girls.

I am well aware of my "rights" etc (I had to be to book a HB last time !) but it's very difficult to take this decision rationally after what happened last time

DH is particular is adamant that "once bitten, twice shy", we tried to "buck the system" last time and things went very wrong. He says he doesn't care how many "rules" we have to follow this time, as long as baby is OK.

I know, I know...it won't be him strapped down having contractions....but the it's hard not to get superstitious, I totally believed in my ability to labour and birth normally last time and then had a very rare but very real obstetric emergency

BUT! that is why I am planning to labour in the hospital this time. I suppose I should be focusing on the key question: will continual monitoring improve the chances of my baby's safety?? Probably not as far as I can gather...

[mazzystar]

I was in this position just over a year ago with dd.

I would see if I could get a more sympathetic consultant. Mine was great - I had every confidence that my wishes would be respected and that she understood that I was making an informed choice. She even tovk me down to one of the labour room and we looked at the monitor together to assess how much mobility would be possible - quite a lot actually - and there is no "strapping down" required. She said that whilst monitoring and a canula were standard practice, she would ensure that my notes made it clear that she and I had discussed it and that would mean any registrars etc would lay off with the pressure.

In the end I ended up with an elective c/s. DD was late, and I had no wish to be induced with a VBAC. Even on the day I was wavering though. If I did it again I would, without hesitation, hire a doula.

You will find a way of this being ok.

[pinkyminky]

Someone advised me to ask for doppler instead of the belt. I'm going to see if that's an option for me. Having said that, my friend had a successful VBAC with CFM recently, which they later changed to the little clip monitor on baby's head, as they were a bit concerned. It all went well for her.

[cece]

I am afraid I agree with your husband. Why risk your baby for the sake of being able to be mobile.

I had constant monitoring and a drip for my second dc. Hence I was in bed the whole time. Because of the monitoring they picked up that he was in distress and could do something about it. Having lost a baby recently at 18 weeks I would not wish it on anyone. If I am lucky enough to have another full term pg then I will request continuous monitoring to ensure my child's safety. I would be quite prepared to put up with a few hours of discomfort or a cs if it meant a live and healty baby at the end of it all.

Sorry if it isn't what you want to hear but that is how I feel.

[mistermoo]

You definitely don't have to do the CFM - all the studies show NO IMPROVEMENT in outcome with CFM. Plus half the pp in hospital don't even know how to read them properly (even 2 consultants will disagree over the meaning of the same trace).
Half the time they aren't even in the bldy room (this happened to me with no.1... DH had to go around shouting down the corridors for help when heartrate dropped to 60)

Much better to get a doula... who can watch you constantly, and ask for handheld monitoring every 5 mins if it makes you feel better with doppler.

Also - don't bother with canula... is painful and unnecessary distraction for you... they claim is necessary in case you 'crash' and they can't find a vein.. but is crap. Half the time they don't even insert a big enough canula to be useful for surgery anyway and have to do again.

[ButterflyBessie]

BasilBrush

This is one very close to my heart

I had a vba2c which culminated with an abruption at 10cms so still managed to birth through the right hole - no cfm

I then went on to have another vba2c (in hospital) where I was not monitored constantly, I birthed my 10lb 14ozer completely naturally kneeling by the bed with no episiostomy, I did tear slightly and 4 hours after dc4 was born I was back at home .

There was a slightly raised chance of a second abruption but cfm will not necessarily detect it any quicker. There is afaik a 96% chance of you not experiencing one again

Good luck, it is worth it (imho)

[whomovedmychocolate]

I was reading recently about this (preparing to do battle with yet another obstinate obstetrician) and apparently there are better outcomes with doppler checks at five minute intervals than with CFM because you are more mobile so labour takes less time which reduces the stress on the baby etc.

But it was only a small scale study. Frankly, since no-one can prove to me that CFM does more than give the midwives an opportunity to pay more attention to a machine going bing than the labouring mother, I'm not even going to entertain the possibility of using it. But it's a personal choice thing.

You don't have to sign any disclaimers btw. Any procedure including monitoring must be done with your consent, if you simply say 'no' (or in my case 'bog off') they cannot force you as to do so would be assault.

[shouldbeworking]

I shouldn't read threads like this as they really p me off.
If I were you BB I'd listen to your dh. Why do you all seem to think that hospitals want to carry out procedures just to inconvenience you or upset you and that they have no medical reason for wanting to do them. Surely the bigger picture is that you have a healthy baby and how it arrives is second to that.
You can't blame the consultant for wanting you to sign a waiver can you? The hospital have to protect themselves from possible legal action. The consultant obviously believes that what he is recommending is necessary now matter how small you believe the risk to be. If you don't agree deliver elsewhere or sign the waiver. As the mother of a sn ds I would have taken any sort of monitoring 2nd and 3rd times to avoid the same thing happening again. I ended up with healthy babies and thats all I really care about. The unnecessary monitoring would soon become a distant memory. Sadly my son's sn never will.

[VictorianSqualor]

The waiver is ridiculous, in planning for my VBA2C all my cons did was put in my notes that she had explained risks and that I understood.

Yes, there can be good reason to monitor but it should not hinder your labour nor make medical intervention more likely, which laying strapped up on a bed would.
Could you not ask your hospitsal to get hold of a radio monitor?I'm surprised they don't have one tbh, it was what my cons suggested to me so I could be mobile and get the labour i wanted yet they could get the readings they wanted.

[ImightbeLulumama]

i see your point ishouldbeworking, but as you say yourself, 'uncecessary monitoring will become a distant memory' . i am all for medical intervention when it is used for a real purpose, not just becasue it is there. there is no evidence to show that CFM improves outcome. the stats on rupture are very similar to the stats on prolapsed cord, something that could happen to any labouring mother, yet we are not told to sign waivers about that. telling a woman her baby will die if she does not do X Y or Z is insulting and takes away her ability to make an informed choice. but i can absolutely see where you are coming from.

[Jacanne]

There's an article on the AIMS site about whether continuous monitoring is actually necessary VBAC - on whose terms?. I would imagine that as long as you agree to frequent monitoring, say every half hour or so, that you should be okay (then I'm not an expert).

It is a decision that only you can make. In your position I wasn't brave enough to say "No, I'm waiting" when my pregnancy over ran by 10 days so I ended up with an elective section rather than the VBAC I wanted.

[whomovedmychocolate]

shouldbeworking - but the waiver isn't legally enforceable and the only purpose it serves is to put the frighteners on parents who (quite understandably) have enough to worry about.

[ButterflyBessie]

Shouldbeworking

The unnecessary monitoring which led to my second section is definitely, 5 years down the line, not a distant memory. That and my two vba2cs have shaped me into the person I have become today.

Unnecessary monitoring is just that unnecessary, , because of cfm I had to stay motionless on a bed and so my labour was both more painful and longer and culminated with the so called caring profession insisting I needed a section. My dc2 was born with apgars of 9 and 10 and I was left with yet another incision and pnd . The incision healed, the scarring both physical and mental is still there

I am a stronger person through my determination to achieve my vba2cs and my subsequent babies were born into a much calmer and more natural environment

Intermittent sonicaid monitoring was performed during both labours and that and the excellent care I received and my own knowledge of my body worked for me, I am well aware it doesn't work for everyone