AIBU refusing constant monitoring during a vbac?

[Weasleyismyking]

Just that really.
Had a horrendous birthing experience 2 years ago, where I had monitors on and in due to merconium in my waters and because of an awful midwife and very shouty doctor was strapped on my back to the bed the entire time (short 3 hour labour) before being whisked off for a CS under GA.
The thought of all the monitors this time round especially internally on the baby's head makes me cry. Midwives say I can refuse, doctors make me feel stupid for suggesting it.
Am I being stupid and unreasonable?

I'm 39 weeks pg and hoping for a successful VBAC any day now. I have issues following the monitoring stage of baby 1's birth. The short version of it was that pethadine did not agree with me, and while my mind was still very warped by that and doing nothing for the pain, I reached a point where I no longer felt right on my back and needed to change position. I was being monitored as baby was getting distressed through a long back-back labour, and the wires stopped me finding any position that would work for my body. The thought of being monitored for this birth has made my blood run cold, as it's the thought of being made to spend the whole of this labour in the state where I had most distress in my last one.

When I saw the Dr at 20 weeks I sobbed when he said I needed to be monitored (Even though I knew it was the line he'd take). Finding the right birth for me hasn't been easy. My option A is a home water birth, but after researching the risks of scar rupture, I decided that for me, I live too far from the hospital for an emergency transfer for that situation. I talked about it with my MW and I said that I thought a visit to labour ward might help change my association with that environment and make it easier to deal with. I had an hour long appointment there and was talking through things with a MW who specialises in mental health and that was incredibly helpful. Sitting calmly in a cons room means that I can prepare for and visualise this birth in a calmer state- before I could only feel stress and anger. My hospital has two units that allow for wireless monitoring that I will accept, although I still feel awkward at the thought of a monitoring band around my bump. I can still access props like birthing balls, and move around freely as I fear a back to back baby again. I also have PGP so being comfortable is hard enough without being beached up on high awkward beds and trapped within a metre of the bed.

The advice from NICE is that continuous monitoring should be OFFERED. You do not have to accept. The risk of scar rupture is very low (1:200) but serious if it occurs. Continous monitoring is a useful tool but not a complete diagnosis for rupture, and is not a subsitute for good care.

If this birth passes well, and if I decide to have a baby 3, I will be having a home water birth as I will have more confidence in a reduced risk of rupture. (A history of successful labour is associated with a lower risk)

Ultimately only you can decide the right balance of comfort and safety for you. For me, blindly accepting conventional montitoring would be the wrong approach, as the discomfort and distress I would feel in that position would compromise my body's ability to labour well. There are options out there that are worth investigating.

Check with your hospital - they may have wireless monitors which won't impact on you moving about during labour. hope you get the care, labour and birth you're hoping for.

Pasted from Mrs Mook:

The advice from NICE is that continuous monitoring should be OFFERED. You do not have to accept. The risk of scar rupture is very low (1:200) but serious if it occurs. Continous monitoring is a useful tool but not a complete diagnosis for rupture, and is not a subsitute for good care.

No, but Electronic Fetal Monitoring is the best we have got.

The whole point is about informed choice and risk. Having seen three uterine scar ruptures, I would never take the risk but then I am a mw who is very pro an active monitored birth. It really is possible.

Intermittent monitoring even if undertaken every 15 mins as NICE recommends, does not provide the same overall info as a CTG.

Have a word with your local Supervisor of Midwives for support, information and a plan. They can be contacted via the maternity unit.

OP I almost feel I shouldn't contribute to this thread as I have no experience even of being pg, let alone birth.

....But I will stick my oar in to say that whatever the rights and wrongs of CM, your HCPs sound seriously unhelpful and unsympathetic. Someone dismissing your concerns after you have had one 'horrrendous' experience sounds unacceptable, to me.

Perhaps you should do what PPs have suggested and contact the supervisor of midwives to find out what alternatives there are, like wireless monitoring etc?

revolting I'm grateful for any thoughts, your feelings are just as relevant and appreciated.

I will give the hospital a call about talking to the supervisor of midwives, I'm wondering if the woman we spoke to in the vbac clinic held this role. We left her brimming with confidence although the birth was a lot further away then than it is now!

I had no idea that so many women were forced to stay still because of monitoring. I can't see any reason why you would need to stay still with the monitor on the babies head.

Ds had a couple of little marks on his scalp after the birth where the probes had gone in but they went away really soon after birth.

The worst bit of the monitoring was getting the sticky bits off my legs.

Am sure there are wireless monitors around these days - worth investigating.

Pasted from Mrs Mook:

The advice from NICE is that continuous monitoring should be OFFERED. You do not have to accept. The risk of scar rupture is very low (1:200) but serious if it occurs. Continous monitoring is a useful tool but not a complete diagnosis for rupture, and is not a subsitute for good care.

No, but Electronic Fetal Monitoring is the best we have got.

The whole point is about informed choice and risk. Having seen three uterine scar ruptures, I would never take the risk but then I am a mw who is very pro an active monitored birth. It really is possible.

Intermittent monitoring even if undertaken every 15 mins as NICE recommends, does not provide the same overall info as a CTG.

Have a word with your local Supervisor of Midwives for support, information and a plan. They can be contacted via the maternity unit.

To be able to make that informed choice you do have to make some kind of challenge. The VBAC leaflet the Dr gave me was a waste of paper, and totally uninformative. Given that many people in the postion of a VBAC choice are likely to have undergone a difficult/ traumatic birth experience, and often including an environment of monitoring that they've already been in under very difficult circumstances, it's a huge shame that more isn't said as standard about how to make the the birth experience mentally acceptable and what facilities are availiable to help.

At one point I felt like I was being pushed into a choice of unnecessary and very incovenient surgery or reliving a personal nightmare- and I wonder how many people go through that choice unnecessarily or make the wrong choice because compromises/ choices aren't made availiable to them.

To me the mobile montioring is a compromise- it's still pushing my comfort zone and I still have troubling "what ifs" over it, but it is giving that element of best safety avaliable. As much as I'd love to have a birthing pool poised in my house ready for action at this moment, I know for where I live, the balance of risk and urgency isn't the right one that I can take. Unfortunately not all opportunities like that are consitently avaliable.

I wish in my first birth that I had been supported much more in helping to get comfortable- all it could have taken was something as simple as a birthing ball to come out of a cupboard for me to sit on next to the bed, that might not not have solved the original problem (but could have assisted) but could certainly have saved me two years of emotional baggage.

Jamie - I was quoting what the OP said in her first post about her having a 3hr labour the first time.

I'm with you in the hollow laughter camp

Back

Ah I seeeee

I personally would be happy enough for stomach belt monitor thing, but would opt out of head clip unless there was some pressing need. I was monitored with VBAC (which ended in CS anyway) but I was still able to change postion, move around a bit etc.

Having seen 3 catastrophic uterine ruptures I would say yabu.

But, that's an opinion formed from a fair few years working as a Mw on a very busy delivery suite.

Fwiw even with continuous ctg you should be able to mobilise, try various positions and use a birthing ball etc.

YANBU to feel how you feel.

However, I had continuous monitoring with my first baby as I had meconium. I had the clip on her head. That turned into an emergency and she came out not breathing and had to be resuscitated. I am not sure how they would have known there was a problem with her if I wasn't hooked up to the monitors.

I was induced with my second because of my waters going but no labour and meconium again. I was continuously monitored again but just with the straps. I was still able to move about. I was really glad I was being monitored - personally after what happened the first time I wanted them to monitor how the baby was doing. I had a 1 hour 54 minute labour with DC2, it was a lovely, quick and easy birth and I hardly noticed the straps but felt safer (for the baby) that they were there.

Lots to think about thanks everyone. The woman we spoke to at the vbac clinic is on the website list as one of their supervisors of midwives but I haven't been able to get through to them all afternoon.

The 3 hours wasn't a stealth boast by the way and there are no guarantees it'll be that quick again (it was really 5hours in total but even that's quick compared to some of the 3 dayers others experience!). Although week on hospital the other side of the birth and all the complications can be added on.

Watching this thread with interest as currently considering vbac. My cs was for breech baby and was a very calm & positive experience, with a relatively easy recovery. However now having a toddler to care for, I'm weighing up my options.

My main worries are that:

1. 30% of vbac's end as emergency sections anyway, (best chance if you've previously had normal delivery or at least dilated past 5 cm - which I didn't).
2. even if I'm promised wireless monitoring, what happens if the few units they have are already in use when I go into labour?
3. if the labour ward is busy, can they guarantee that I'll get the level of care needed to spot a uterine rupture early enough? Apparently the baby needs to be delivered within 18 mins for the best chance of a good outcome. What if the theatres are all busy with other emergencies?

Sorry OP, this is asking more questions rather than answering yours!

I had to be monitored for about five hours when I went in to have DS2 . I was told it was because my waters had broken even though they were clear. They kept me on the monitor for so long because he wouldn't stop moving and they said they couldn't get a proper reading. He was a wriggly baby throughout my whole pregnancy though. I ended up having to lie perfectly still and breath really shallowly for hours (whilst having contractions every 90 secs) so that his movements would slow down/stop just so they would take me off the damn thing.

By the time they took me off the monitor and examined me I was 1 cm dilated. I was devastated. I was in labour for another 10 hours and pushed for three and still ended up having a forceps delivery. I was monitored at different points throughout after the initial five hours and had to remain lying down on the bed again. I was t

I gave birth naturally with my first child. It was long and difficult labour but I had no epidural, no forceps and no stitches. I really do think the lack of mobility last time was the problem as when they decided to take me to theatre they sat me up to take me there and to give me the epidural and when they came to pull him out he was nearly there and came out with two tugs. This was after having pushed for three hours lying on my back when he hadn't moved anywhere.

i had intermittant monitoring
at least that way a midwife actually looked at the result
what are staffing levels like at the hospital? will anyone be looking at the screen?

I had monitor on with both and I moved around as much as I wanted. Even had on in birthing pool as they quickly pulled me out as the baby's heart rate plummeted. I dont remember being on the monitor tbh only the bit where they made me get out of the birthing pool.

Yanbu I was at a conference where a professor of midwifery was giving details of much of the latest findings on continuous monitoring. There is evidence that feotal monitoring increases c section rate in labour. There is a lot of misinterpretation of trace results. I had 2 vbac no continuous monitoring except for a 20 minute monitoring on arrival. That said I am all about trying negoiating what is important to you in labour and not getting 2 excited about the small stuff or you will be stressed.

Shelby

I had an emcs after induction, 13 hours of labour, an hour and a half of pushing.

Was very torn about trying for a VBAC or not, but a big determinant was having a toddler, and the recovery.

To cut a long story short - the same thing very nearly happened with DC2 and he had to be assisted out with ventouse. Emotionally, there was undeniably something satisfying about having experienced a VB, but I also think the whole thing was better because I felt more in control.

I'm glad I experienced it, but if I were to have a 3rd (I won't), I would lean towards an Elective CS. I found labour terribly painful.

I'd say the recovery was just as bad/worse. I had to have a blood transfusion, I had a 2nd degree tear and terrible piles (sorry TMI). I felt nearly as incapacitated for several weeks as I had after the EMCS.

None of this may be relevant - my experience is different from your because I experienced 2 labours. Just my musings.

YANBU - midwives and consultants like women on their backs with continuous monitoring for their benefit not yours. I recommend a doula or a very strong birthing partner to avoid the bullying and shouting that will happen if you try to give birth on your terms. Good luck.

YANBU
I've had 2 VBACs at home with intermittent monitoring, was monitored quite closely but could wander around doing as I pleased. My midwife gave me heads up of the early signs of rupture so I was aware of what to look up for.

Jamie it's starting to seem like more a case of 'better the devil you know' for me. But if they could guarantee a short, easy labour, no tearing & a 6 hour discharge.....

Take all the monitoring you can.

I wasn't monitored nearly enough and I had a uterine rupture during my vbac. it was horrific.