CFM during VBAC

[peanutdream]

Hi

Does anyone have any interesting links/stats/experiences of continuous fetal monitoring during a vbac. I understand it is standard practice so I can't really get out of it, and obviously don't want to risk the health of me or my baby unnecessarily.

I am a big active birth fan and had a long active labour (5 days) before DS1 was born by EMCS due to brow presentation and distress during and after contractions (I was monitored for the last hours but this was obviously needed and I was happy with that. I would like a shot at a VBAC but don't mind if a CS is needed due to unavoidable circumstances. I would like to be active and upright if that is what is comfortable at the time and again, I'd like to be on all fours/squatting, again, if this is what is actually comfortable at the time.

I am worried that CFM will cause a cascade of interventions and am wondering if anyone has had CFM and coped perfectly well. How did you manage it? What can I do to minimise the impact of being monitored constantly. My worry is that this birth might be entirely different if the baby is in a good position and I don't want CFM to ruin the chances of giving birth as naturally as possible.

TIA for any info...

Had CFM for VBAC, I was on the bed but on all fours most of the time. Pushing was taking longer than normal and they told me "baby is getting tired" so I knew that I had only a little while to push before they talked about a CS, so I went on my back and had feet in stirrups unfortunately. I would keep the CFM but just tell them you want to be as active as possible. They had a monitor on DS2's head as well so that contributed to my lack of movement away from bed. Good luck :)

Thanks MrsJamin, Did you have to have the monitor on DS2's head? Is that standard?

I don't have experience of VBAC, but you can ask to be monitored via doppler continuously - I am assuming a MW would be with you at all times anyway (I may be wrong) if you're VBACing, so the MW would hold the doppler on you in whatever position you are in. They might agree to do this constantly, or every 5 minutes or so perhaps?

They might well say no of course. And although something is standard practice, it doesn't mean that you have to agree to it - they can't do it without your consent.

I stated that I would be happy for;

• an initial reading to be taken when I arrived at hospital to establish a baseline, and then the equipment be removed. Competent monitoring via a doppler by MW could be used after that.
• should a MW become concerned that continuous monitoring be absolutely necessary, I would be happy for CFM to be carried out. I did not wish for it to impede my movement and position.
• if CFM is to be carried out, a qualified member of staff should be monitoring it at ALL TIMES. I did not wish for it to be a substitute for correct MW care, and I did not want to be told after something had gone wrong that the trace showed it going wrong but nothing was done.

My hospital consultant and VBAC MW were both happy with this.

As it was, I didn't get any further than the corner of my bedroom and had next to no monitoring at all.

Hi there.

I'm about to pop with my VBAC baby and will not be accepting CFM. Indeed, I'm staying as far away from it as I can, opting for a home birth.

I'd reccommend logging onto www.aims.org.uk and ordering their VBAC book which has all the statistics you could possibly be interested in!

Here's a little from their website, but strongly urge a good read of Birth After Caesarean as well, which is excellently compiled and referenced so you can read back-up studies should you require:

"Women are commonly informed that continuous electronic fetal monitoring will be necessary if there is a history of caesarean section. Numerous studies have shown that electronic fetal monitoring, whilst increasing the caesarean section rate, does not improve outcomes for mothers or babies. Providing there are no signs of anything untoward VBAC mothers should not require any additional monitoring over and above that which is normally appropriate for all mothers."

In the US it's common knowledge by now that every 5 mins with a doppler/pinard is actually more beneficial than CFM, though this may be that this requires 1:1 care and therefore a midwife that's in tune with your labour rythem and can detect when something is going wrong quicker....

But definitely read that book if you want some hard evidence on these issues!

All the very best!

Backinthebox- nice post. And great attitude to have too!

I asked to see the consultant midwife at 34 (36?) weeks to discuss my concerns, which were much the same as yours. She went through all the risks with me, mostly related to not being induced at term for me, and told me that basically YOU CAN DO WHAT YOU WANT, they cannot impose any unwanted intervention on you. Obviously they can strongly suggest things, but you don't have to agree to anything.

So we drew up a plan together stating my reluctance to induction, not wanting a cannula on admission unless necessary, no CFM as long as the midwife was happy with the baby, possibility of water during labour if all going well, etc. and it made me so much more relaxed about the whole thing. I wrote a big VBAC thread about it (look for hobnob57).

In the end, after 3 or 4 sweeps and 3 nights of contractions that disappeared during the days, my waters went at T+15. I went in and got hooked up to FM for initial assessment. DD was in distress and I got whizzed into labour ward to get prepped for an emcs (cannula, etc.). It turns out I was 8cm and was 10cm by the time I got to theatre, so got a lovely spinal, ventouse for turning, forceps delivery and dd2 was born at T+16. And it was amazing. No ongoing problems at all, and compared to my emcs I was not impaired whatsoever and could enjoy my first weeks with dd2.

Good luck. Try to see your consultant MW to put your mind at ease.

Gosh it just goes to show how everybody has such a different experience.
Here's mine:

VBAC after planned CS for breech DD1, straight forward pregnancy, baby in good position etc.

Went into hospital, at 3pm I was checked and found to be 2cm dilated. Put on monitor, was a pain in the bum because every contraction made me move, and so I kept losing the trace anyway. So did an hour of on/off monitoring, then MW said she was happy with the readings, baby was fine and contractions were good and I could take it off for a while.
Never got put back on...

Never got another VE

Never got the cannula

Baby was born at 5pm. No interventions. Gas and Air.

During antenatal MW appointments I was reassured that the CFM would not interfere with labour at all, I needn't be on the bed, I would still be mobile (although in the vicinity of the machine) and being mobile would still be encouraged. And this all came to pass.

Tip: stay at home as long as you can bear it.
Tip: If they are happy with your labour, ask if you can come off it for a while.

Good luck for a successful VBAC

Thanks everyone for this! Incredibly helpful to read, much appreciated! Thanks carlyvita for the link and the book recommendation - will order now. It sounds like it could be ok after all particularly going in with good attitudes like these - I love your statements Backinthebox. And thanks banjaxed, will look for that thread.

I am going for a VBAC I had an EMCS with DS for the same reason as you. I have had a vaginal birth before though.
I was told at my 16 week appointment, there was no chance of a Homebirth, waterbirth as I would be monitored throughout labour.
Not happy about this myself really, so intend to discuss it again in a few weeks with Consultant again. I don't fancy a homebirth, and am not really too upset about the waterbirth issue, but the constant monitoring annoys me a little. With DS I was hooked up to a monitor like yourself for quite a while and it really limited my movement, I was in fact told to stay on back, which at the time as there was a problem I didn't really mind. But if there isn't any signs of a problem this time, I think being ordered to stay on my back will annoy me, as it isn't for me the easiest position in labour.

nunnie my sentiments exactly. how annoying to be told where to lie/stand etc. i am going with the idea that they are in fact my medical servants (in the words of mary cronk - another great link from a thread on here somewhere) so they can't actually start telling me where to stand/lie as that is just stoopid. here

the thing is as well though, is you don't want to piss the people off who will be helping you in a crisis .

I agree peanutdream, I may well just be quietly annoyed. Will discuss it though at the next Cons appointment just to see if there is any way it can be altered slightly so I can move about a bit and keep reasonably active, but if they say not really, then I will accept and be quietly annoyed

Not much time to post but I just had a VBAC, ended up only being in hospital for an hour before started pushing, but my doula relayed my birth plan to midwife so I did not have a cannula, did not have CFM - the midwife held the monitor onto my belly for the whole time to monitor the baby. Just because it's standard doesn't mean you have to agree, you are not bound by their hospital policy. But it really does depend as well onthe midwife, when we first went in a different midwife was apparently insistent that I go on the monitor (I don't remember) but I was busy having contractions, trying to go to the loo (kept rushing back for gas and air without having had time to actually do a wee). Then she went off shift and the new midwife was fine and just accepted what we wanted. Best of luck and make sure your birth partner understands and will back up your wishes to argue for you as its very difficult to do when in labour!

1st vbac - I had constant monitoring with the doppler and was made to lie on my back for most of the three hours until he was born, including the pushing stage - not happy.
2nd vbac - she came too quickly for any monitoring, we barely got my knickers off in time!
3rd vbac - again had constant monitoring with a doppler but I refused to stay on the bed and did wander about the room a lot so must have had long cables? Also, we disconnected/reconnected it ourselves for going to the loo. I gave birth on allfours.

I have scan read through and add that we didn't have a midwife with us constantly for any of the 3 vbacs, in fact dh had to run and find someone each time I reached the pushing stage.

dd1 was an elective section for breech rather than a long/difficult labour/dstressed baby.

I also had VBAC after EMC because induction that failed to progress and fetal distress. I read a great book which others may have mentioned called the VBAC handbook. It's definitely good to do loads of research and be very clear with midwives and consultant about what you want. I decided I def did not want continuous monitoring as I felt it would send me down the same road as first labour and that it was not necessary or effective in detecting problems. I did have to be very insistent even though I had agreed with my consultant before hand, no CFM! The SHO on duty tried to tell me I had to have it but I stood my ground and agreed to an initial trace and if there were no problems with that I could go to intermitent. I would echo what others have said about staying at home as long as possible, doing your research and having a birth partner who can fight your corner. Good luck!

I had a VBAC after an elective for a breech baby.

The consultant said I would need CFM, that I would need to come into the hospital earlier than if it was not a VBAC, as well as a couple of other things which I can't even remember now if I'm honest.

So, I wrote in my birth plan that I didn't want CFM, didn't want interventions, wanted as natural as possible etc, and the midwife was pretty good about sticking to it.

I did end up with CFM after I got to about 8cms though because ds2's heart rate was dropping. I don't remember agreeing to it, but I must have done, I was totally off my face on G&A. DS2 was delivered with forceps in the end, but my experience was postive over all, especially as they had been eyeing me up for an emergency CS.

I would have preferred not to have had the CFM and been free to move about, but at the time, my feelings about it were not as strong as they had been beforehand and I guess I felt it was best to trust the midwives.

i hope it goes well for you!

Thanks again for all of this. Really helpful. Happily my partner is very good at fighting my corner - we did an active birth weekend together which just seemed to colour his whole outlook on the birth being about helping my body do what its supposed to which was great... He was awesome with the consultant who wanted to do the EMCS when they realised DS was brow presentation - really made her explain and asked for five minutes so we could make a decision etc etc

That is interesting mawbroon about them saying to get to hospital sooner than normal as I want to stay at home as long as possible. So I don't really get it as I won't be monitored at home will I, so why the monitoring in the hospital? I suppose once you're at hospital you are more likely to be in more established labour so more risk? Anyway... thanks for all advice - shall start getting informed and then see what midwives/consultant says. Thanks :)

can they turn the volume down on the monitor? the heartbeat gave me the heebie jeebies although when DS was really starting to struggle it was helpful to see/know as I knew I had to breathe really deeply to get lots of oxygen to him and his heart rate did improve until the end when he was obviously getting really compressed in a funny way...

Ha, yes it is interesting that the consultant told me to get to the hospital sooner rather than later, but when I called the midwives when labour started, they were all for me staying home longer!!

I also have a bicornuate uterus, which apparently in itself poses a rupture risk, so perhaps that coupled with VBAC made the consultant twitchy!!

Not sure about the volume tbh. I am very vague about most of what happened after I got out of the birthing pool (because of the lowered heart rate) because I was so off my face on G&A

I must say that once the labour process was well underway, they could have asked me to do pretty much anything and I would have agreed, so it is important that your DH fights for what you are wanting there and then, rather than sticking to what you agreed beforehand. Does that make sense?

Mawbroon, I have been told the same by my Consultant, but I don't usually wait too long I progress quite quickly and with DD I was pushing within 15 minutes of arriving and I arrived pushing with DS. Hopefully the same this time round then I won't have to be strapped to the bed.

'important that your DH fights for what you are wanting there and then, rather than sticking to what you agreed beforehand'

that's a good point actually. when you are actually there and it is all happening, it could all be very different...

when i was labouring with ds for four days before i actually went in, they kept saying to wait wait wait until contractions were 3 minutes apart and like clockwork... they were three, four, five and six minutes apart for ever it seemed although now it is clear that it was probably because of ds's head! i suppose it depends what midwives too... you just don't know what will happen do you as if the baby was in a good position and contractions were 3 minutes apart, I am worried I would have it on the way!

I talked through the VBAC Handbook with my consultant today and had highlighted the CFM bit; quoted above. He happened to know Mr Murphy the author of the article (a close colleague) the research was done 20 years ago and was not carried out on pregnant women and so the comments were quoted out of context. Mr Murphy is now very anti-VBAC.
It is lovely to hear that people can have positive VBACs though even with CFM, thank you.

Oh that's a shame :( It's so hard to find out what is the most sensible and safe course of action isn't it :(

Anti VBAC all together? Does he think all post- c sections should be c sections then?

That is his line, however, my consultant has a 90% successful VBAC rate which is fantastic but as he explained under some duress - I took my husband who is a barrister who happens to also do some medical negligence work, along with me. My consultant's insurance premiums are £150k a year. If any thing goes wrong in labour and a child is brain damaged that child will require at least 5 million pounds worth of care over their life. One can see why an obstetrician would choose to avoid that kind of risk and plan a repeat section...

I must say I dont think that is very helpful sugarsnap when the OP is hoping for a successful VBAC.

There is no reason why anything should go wrong, every consultant I saw was Pro VBAC and I ended up with a straight forward, easy delivery as baby was in a great position. Was a hugely positive experience and CFM did not interfere with me being mobile the whole time. I was standing up with my arms hanging round DH neck when my waters went and about 5 minutes later baby was born. And not a wire or strap in sight at that point!

Best of luck to you OP.