Vbac and refusing continuous fetal monitoring?

[Neverme]

Has anyone done this?

I started another thread earlier about more general vbac issues, but have realised this is something I really don't want to happen, especially since previous birth DS was in a funny position and it got worse during labour, so I'm sure moving around and being upright would help.

As I understand it the only reason the medics would want to do continual fetal monitoring is because of the risk of scar rupture but that is minute, right?

Am wondering if I could agree to having say 15 minutes of monitoring an hour or something as a compromise

[newyearsday]

Yes, that's why they do CFM. The risk is 0.5% (I'm sure I read somewhere it was 0.2%?). Incidentally it's the same risk level that first time mums have for cord prolapse but no-one gets hauled in front of an obstetrician to hear that one!

If you don't want it, be assertive and tell them you don't want it. You could request intermittent monitoring every 15mins (with a hand held monitor).

I don't want CFM either, I'm aiming for a HBAC.

[hzgreen]

Hi Neverme i'm in a similar situation to you, i'm going for a vbac but am sure being strapped up up the machine will slow or halt my labour, i had CFM with te DS so know how restricting it really is.
When i first mentioned this to my consultant at about 12 weeks pg she said that i had to be CFM'd, there was no discussion. so at 20 weeks i spoke to the community midwife and requested a homebirth. luckily she was fully supportive but even if she weren't everyone is entitled to try for a homebirth. anyway to cut a looooong story short while the supervisor of midwives was fully supportive of an HB my consultant was horrified and as a result i have been offered a spot in the low risk midwife led unit (located in the hospital) and will be monitored using the a mobile monitor AND i can use the pool if it is available (something that the consultant said was out of the qustion originally).

no-one can force you to be continually monitored and if you feel strongly about it you are in a good position to negotiate. i am happy with our option of the midwife centre but would have opted for an HBAC otherwise. so i guess my advice is speak to your supervisor of midwives, know your rights and if you are immovable you can get what you want.

[Neverme]

Thank you all. Am not quite brave enough for a home birth but good luck to you guys! I suppose a good argument is that I could in theory demand the home birth where you cant do continual monitoring so why would they insist on it hospital. I think my main worry about the vbacs.is having to argue with the docs!!!

[hzgreen]

you don't actually have to have a homebirth though, you could just use that as a bargaining chip, if the doc thinks you're willing to have a homebirth he/she is likely to be more pliable about negotiating.

i was worried about having to argue with the doc too as i'm not very assertive but as it turned out i didn't have to do much arguing i was just a bit immovable on what i wanted. even before i was offered the midwife led centre i had got the consultant to agree to put in my notes that i wanted the mobile monitor, that i didn't want a canular unless necessary and that there should be no time limits on labour as long as the baby was ok. she was so concerned about getting me into hospital that she agreed to quite a lot really. so you don't have to get confrontational or anything (though it helps to have some moral support when you approach it).

it was really the suprevisor of midwives that helped me get what i want though and i would really advise talking directly to them because they can negotiate with the doc so you don't have to. their number is in the back of your mat notes book.

[SoozleQ]

I ended up opting for a home VBAC because our local maternity centre is not willing at all to allow any element of high risk women into its midwife led unit. Effing ridiculous if you ask me but that's a whole other argument.

Anyway, the midwives at my home birth attempt conducted intermittent monitoring with a handheld device. She didn't make me change position to do it and just worked round me every so often. They started noticing some minor decelerations and so upped the frequency of monitoring. I was at the pushing stage and after I'd been pushing for a while but baby just wasn't descending at all, coupled with the decelerations, we decided to transfer in.

Ended up with forceps but ultimately a healthy baby so all good.

Good luck

[Neverme]

Thank you all. Hzgreen so did you see the consultant first or the midwife supervisor? Do you just call up the mw supervisor direct or do you need a referral?
Think I'll see how things go with the consultant - apparently consultant is female and pro vbac so am hoping she won't be too difficult!

[hzgreen]

Hi Neverme, the first thing i did was to get this book:
www.amazon.co.uk/Vaginal-Birth-After-Caesarean-Handbook/dp/1905177240/ref=sr_1_1?ie=UTF8&qid=1350808207&sr=8-1&tag=mumsnet&ascsubtag=mnforum-21
which armed me with a few facts and helpedme determine where i was coming from (i really think research and knowledge is the key to getting what you want!)

then at my routine midwife appointment i mentioned my concerns re monitoring on the impact of labour and we talked about the homebirth option, she talked initially to the supervisor of midwives on my behalf who then spoke to the consultant. at my next consultant appointment i had the conversation with her about homebirth where she told me it was risky and tried hard to put me off (my midwife said she would do this), we didn't argue about it but i just kept outlining my concerns until she agreed to add in my notes about me wanting the mobile monitor, no canular and no time limit on labour as long as the baby was ok. at that point i didn't promise anything re where i would birth, i just said i would consider hospital birth under those conditions.

i have to admit that appointment shook my faith a bit, the consultant (also female and and pro vbac) said it was dangerous though she wouldn't clarify why. so after that i met with the supervisor of midwives (arranged through my midwife) who visited me at home and explained why homebirth was actually quite safe for me and the baby and that they were happy to go ahead with it but then presented me with this third option that we are going for which is to go to the midwife led centre within the hospital.

Sorry that was so long and in answer to your original question, i saw my midwife first and got the backing then saw my consultant, meeting the supervisor of midwives was arranged through my own midwife but if your midwife isn't supportive of what you want you can contact the Supervisor directly and see her.

i hopw some of that helpes and doesn't sound to scary, it has actually been rather straight forward for me but i think so much of it depends on where you live and who you see. but like i said i have never had to be confrontational just sure of my facts (re risks of rupture etc) and a bit imovable on what i want. xx

[Panzee]

My consultant said I won't need CFM if everything is going as it should. They said I can labour like anyone.

[newyearsday]

hzgreen I don't know how you can say you're not assertive, you stood your ground and got exactly what you want - good for you!

My experience is the same as snoozle. I tried to negotiate but the MWLU is brand new and they will not allow 'high-risk' women through their doors so I'm planning home, and I'm happy with the decision. I just kept repeating "I want a midwife-led birth" to anyone and everyone. I saw the Consultant Midwife rather than an Obstetrician and she said I'm making an informed decision and they will support me.

I also recommend the vbac handbook. Good for partners to read too.

[user12785]

I had a VBAC, refused consultant care, refused cfm, refused internal examinations, used the birthing centre and the pool, and had ds in 5 hours. I had him standing up, there wasn't even a bed in the room. I had been determined not to be hindered by cfm and being flat on my back on a bed, and it paid off. Consultant was a git, he'd put me down for another C-section without even asking me. Birthing centre midwives were amazing.

[hzgreen]

thanks Newyearsday, i'm pretty bloody minded and i think in the end i am more afraid of being herded into the operating theatre than the hideous awkwardness of arguing for something i'm entitled to!

Eglantyne at your consultant!! but your actually birth experience sounds just what i'm looking for, i hope mine goes as well but i'm getting twitchy now as i'm 40+3 and if they induce me i'll be out of the midwifery led unit...

[newyearsday]

hzgreen wow how exciting! Not long now. Hang in there. Relax and let your oxytocin flow ;0) Good luck!

PS hope your hospital don't do the syntocin drip induction on vbac mums? It horrifies me that some hospitals do.

[hzgreen]

they have been really flakey about explaining their induction methids for VBACs, it seems it depends on which consultant is working on the day! so i think i will do some research and decide my cut off point, i don't fancy the drip! i have been booked in for induction at 41+12 but am considering trying to hold off until 42+1 when my sister will be able to be an additional birth partner along with my DH, i really think i will have a better shot at a VBAC if she is there too (she is experienced in hypnobirth and is an aromatherapist) however 42+1 is a saturday will that make a difference? i'm hoping they will be so desperate to get me into the hospital by that point that they won't worry too much about the timing. we'll see. REALLY hoping for spontaneous labour soon (tonight, now!!!).

will try to relax - not sure if it comes across in my posts but relaxing and letting things happen is not a strength for me!

[Himalaya]

I took it off to go to the loo, felt much more comfortable without and just didn't put it back on. They can't force you, and you don't have to agree beforehand.

It also helped I had a doula who was continuously watching me and supporting.

[MyNameIsInigoMontoya]

I escaped monitoring (which I really wasn't keen on) for most of my VBAC because they wouldn't believe it was progressing as fast as I thought [hgrin] so I spent most of it walking round, bouncing on birthing ball etc before they eventually agreed I was going to drop soon and needed to go to delivery instead of being sent home! By the final stages though, I was knackered so actually preferred to be lying down and didn't mind them putting the monitor on for the last bit (can't say I noticed it by that point).

[halloweeneyqueeney]

I'm planning to have the monitoring but will stay mobile, its routine at the CLU to get on the bed to have it applied, then you get down to your ball or wherever you want and they tweek it there.

Also they don't do it till you're about 5cms here

And you can take it off for periods too

So its not necessarily meaning being strapped to bed for the duration at all, I don't plan on lying on my back and everyone (MW and consultant) are keen on me not doing so either

[JustFabulous]

Your baby so obviously your choice but there is a good chance I would be a mother of 2 and not three if I had refused the CFM when in labour. And those two children would possibly be motherless.

Not trying to scaremonger, and no doubt I will be shouted at for scaring you, but sometimes things go wrong and being monitored is for the safety of you and your baby.

Please reconsider.

[JustFabulous]

Just to add, I didn't find it restricting at all as the monitor is not on the whole time you labour, just when pushing iirc and since I gave birth up on the bed on my knees it didn't get in the way at all.

BTW it is a great position to give birth in.

[Panzee]

Some hospitals do insist on it being on all the time for VBAC though, that's the problem and why OP is concerned.
My consultant has said that I will be asked to be monitored now and again but will not be expected to have CFM unless there is a problem. I am more than happy with this. And sod's law will be after worrying about it I will want to lie down on my back! :o

[newyearsday]

JustFabulaous The choice isn't between CFM and no monitoring. If you decline CFM you get intermittent monitoring which happens every 15mins, and up to every 5mins during 2nd stage, so changes to the baby's heart rate will still be picked up. It also means a midwife is with you constantly (and checking your heart rate, blood pressure, etc).

My experience of CFM was 'continuous' and I hardly saw a midwife, they popped in to check the monitor and left!

[smileychicken]

I had continuous fetal monitoring but it didn't mean I had to be on a bed. I was on a birthing ball for the entire labour. Occasionally moving around meant wires got tangled but they were easily dealt with and it gave me and the staff peace of mind to let me get on with my VBAC my way and I had a very positive experience. My friend had fetal monitoring that could be used in the birthing pool.

[halloweeneyqueeney]

Panzee they cant insist, you have to give consent!

[thehairybabysmum]

There is some good guidance on the NICE website regarding CS and VBACs, also includes the stats relating to risk to mother and baby from various options.

I was monitored but didn't have to remain still or flat on bed. I did actually have a second emCS as DSs heartbeat was too fast and lots of meconium when waters broke. Healthy baby though and that is the main thing.