Refusing monitoring during induction

[knittakid]

I'm 42 weeks today, will be going for an induction tomorrow. If the gel/breaking of waters doesn't work and need syntocin, can I request to be monitored intermitently rather than continusly when having the drip?

No, clinical guidelines require constant monitoring for your baby's safety. This doesn't mean you have to lie on the bed though. You can stand up, move around, sit on a chair or ball... as long as the sensors stay strapped to you, which is where your birthing partner can help.

You really do need to be monitored continuously, for your baby's sake, but no, that doesn't mean having to lie on your back without moving. Hope it goes well!

Yes. You can download the NICE guidelines for Induction of Labour here.

Interestingly, they state in Chapter 7 that there is "no evidence" regarding the effectiveness of different forms of monitoring during induced labour, and flag this as an area that needs studying. They do then go onto say that they recommend following the Intrapartum Care guidelines and state that guidance says:
"After administration of vaginal PGE2, when contractions begin, fetal wellbeing should be assessed with continuous electronic fetal monitoring. Once the cardiotocogram is confirmed as normal, intermittent auscultation should be used unless there are clear indications for continuous electronic fetal monitoring as described in ?Intrapartum care? (NICE clinical guideline 55)."
(I've had a look in CG55, but I'm struggling to find anything that says "we recommend CFM after induction because...").

Either way, guidelines are just that - they are not legally binding. It may be standard practice to use CFM after induction, but I'm struggling to find reference to evidence that says it is beneficial to either mother or baby - if anything I'm finding references that say statistically CFM:

• increases risk of CS
• increases risk of instrumental birth
• increases requirement for pain relief
• increases chance of baby going to NICU
• increases likelihood of mother being left alone during labour
• increases immobility

If you've done your research and believe that intermittent monitoring is a better option for you and your baby then you don't have to request anything - you can tell them that you do not accept CFM and refuse to have the belt put on.

(For more tips on how to be a bolshy assertive patient, memorise these phrases by Mary Cronk )

Yes you can.

Interestingly many developed countries prefer intermittent monitoring (even the US) and anyone who has done a little research can argue that NICE advises no advantage to this hideous blanket policy.

The only advantage to CFM as I see it is certainly not for mum or baby, but rather for a hospital maternity unit that find it easier set up this way. And quite frankly, nobody is going to be working harder than you, so least they can do is get down on their knees every 5 mins!

Any guideline the hospital may have is only a guideline and it is your right to decline anything offered throughout your visit.

Sorry Tangle, not sure if I've actually added anything you haven't already said!

All the very best Knittakid for a positive labour and birth experience.

Thank you all, I had seen those references, and having been for monitoring 3 times in the past week have grown to hate those machines, it is easily understandable how a glitch here or there can cause a cascade of interventions that where not necessary, as was almost the case on Tuesday, when people were starting to panic but luckly someone suggested going away and coming back in a while to re-do it, in another machine and another room, and who knows what had been happening before, but there wasn't the least cause for concern after the second monitoring.
Anyway, I want to keep as mobile as I can and will definetly fight for that right. On a positive note, just had a show!!
Thank you all for your good wishes.

I would assume you can refuse anything you like but the NICE guidance above is interesting. I would definitely try to avoid it - from what everyone has told me my labour pains were much worse because I had to stay on my back (whenever I tried anything else they lost contact). If I have a similar situation again I will be asking vociferously for intermittent monitoring.

Hi there Knit, following Propess/Prostin its intermittent auscultation but as soon as synto starts you should have continous - some babies really hate the stuff and dont cope well with it at all, CTG would pick this up much quicker. CTG shouldn't affect your mobility as long as FH can be detected clearly, if not ask for an FSE, to maintain your freedom! A

If you end up on synto (hopefully not), please have the monitoring! Had my birth debrief yesterday and saw just how distressed my DD was. I'm so glad they were aware of this and doing all they could to get her out fast!
No monitoring would have been very dangerous.

knitakid - I really hope all went well and you're now happily enjoying your new baby :)

One of the things that concerns me re. CFM (of whatever form) is that it is only as good as the person monitoring it. In an ideal world, all women in labour would have continuity of care and 1-to-1 support so there would be someone there keeping an eye on things - on how the labour is progressing and on whatever form of monitoring is being used.

But we aren't in an ideal world and there aren't enough MWs to provide that level of care to all women. There are too many stories of women who are strapped to machines and then left to get on with it with no-one in attendance. Maybe they're linked back to a central review point - but then how many machines can one person monitor effectively? And what are the chances of them being able to do that without interference? Maybe not all of those of those women were given CFM because of induction - but presumably they were all on CFM as they were considered at risk of something so I'm not sure the cause is that relevant.

Bottom line for me is in accord with the NICE guidance - we need more research to say whether CFM actually improves things. It may be counter intuitive, but the data currently available seems to show that CFM makes things worse. Possibly because women who refuse CFM are more likely to have 1-to-1 care...

five - I'm really glad your DD is fine and that you're happy with the care you received. I'd just like to clarify that I don't think anyone was suggesting that no monitoring was a good idea, just that continuous monitoring was not obligatory and there were reasons why it might not be the best solution :)

For me continuous monitoring was vital. One night everything was fine, a few hours later a completely different story. When synto is added to the mix all sorts of things can happen.
Hopefully Op is all cuddled up wuith her new baby and all this wonn't be worth worrying about by now.

I think we might still be talking at slightly cross purposes - my experience of intermittent auscultation was the MW listening in to DD1 every 15-20 minutes during the 1st stage for at least 1 contraction to see how her heart rate was responding to the stress. Maybe I was extremely fortunate to have that level of care, but I sincerely hope that this is what would be offered to a woman who was offered CFM due to increased risk(s) but declined it.

I agree that all sorts of things can happen, but that is true regardless of what choices we make. Any choice will have a set of risks and benefits attached. CFM should pick up problems sooner and more accurately - but only if the output is monitored regularly/continuously by someone who is competent and experienced in interpreting the results. And the downside for many women is reduced mobility. Which can result in a longer and more complicated labour...

But you're right - hopefully knitakid is now cuddling away and this discussion is (at least for her), moot :)

Probably too late to be helpful, here.

But just in case, I turned down CFM with the straps around me in my 2nd induction with synt drip. Although I had them at the start, unless I reclined back on the bed they lost contact, so it was impossible for them to work correctly if I stayed mobile, and I refused to not be mobile. So I ripped them off and the midwife held the mobile heart rate monitor to my stomach instead. I was fully mobile, but she must have got very achey arms, bless her, as she held it there for a lot of the time.

Has DD2 naturally, only g&A (had previous terrible experience with epidural and resulting forceps delivery with lasting damage to me and DD1 with previous induction, so had strong motivation to stay mobile and cope with pain better next time round.)

Thanks all, had not seen this thread for a while and have been as some of you pointed out, enjoying cuddles with baby.
I ended up with the whole 'cascade of interventions', much to my dismay, and it has taken me all this time to kind of come to terms with it all.
I had excellent care but was not allowed to take the belts off once the synto was started (mec in waters, etc). but I was able to keep mobile, I'd have died if i had to stay lying down... had an epidural in the end and even then i could move my legs... the anatesthsist didn't understand!
Well, who knows what'd happen if this or that or the other, what happened happened and we are both alive and well.