Hospital requires me to have continuous foetal monitoring, but I want to stay active

[HappyAsEyeAm]

I had DD by EMCS after a 3 day labour, she was back to back with her chin up and I didn't get past 7 cm. Turns out her cord was wrapped round her legs and neck.

I am 33 weeks now and have had my VBAC session, Midwife said that if I choose VBAC, they will have to give me continuous foetal monitoring due to the previous CS and the risk of rupture. During my last labour, I had episodes of CFM, and I had to lay on my back for this throughout the monitoring, as otherwise the trace was being lost. I also laboured in the water with a bit of G&A for a few hours and I loved it.

This time around, if I am to go for VBAC, the thought of not being able to go in the water (it has been ruled out completely for me) and being on my back is enough for me to chose ELCS. The midwife at my VBAC appointment ahs put down that I should be as active as possible, and that I can ask that I or DH holds the monitoring belt (or whatever its called!) in place, but I know from last time that if the midwife I am assigned says that I have to lie down on the bed for monitoring because otherwise the trace will be lost, there will be no discussion about it. And that is such a dreadful proposition, I would rather have ELCS and be done with it.

What am I to do?

I had this and just put up with it but ds was my first so didn't have a previous CS to consider.

Stay ay home as long as you can possibly manage, have bath at home.
I had VBAC with CFM but I was able to stand up, sit on ball, rock around etc. I kept losing the trace too, and after a while they had a look at the readings I'd had so far, were satisfied with what they saw and let me take it off for a while. I was meant to put it back on half an hour later, but there wasnt time, I was standing up for most of the labour, and only ended up back on the bed for the last few minutes.
My advice would be to stay at home for as long as you can possibly manage, have a bath at home for your water relief, and just be as upright and active as you can manage when you get to hospital.

It's part of why I've been thinking about having another ELCS too.

I was due for vbac with Dd, after emcs with Ds. I was unhappy with the idea of cfm, and brought this up with community midwife, then hospital midwife, then consultant. I had been going to pg yoga and had done a lot of reading and research into vbac. If convinced the various medical folk that i was reasonably clued up, and we agreed upon 20

Thanks Rasing - I agree with staying at home for as long as possible. But with a 3 day latent stage last time, I honestly thought that when I went into hospital after 36 hours that I was well on my way. Contractions every 5 minutes, excalating pain that the TENS hasd stopped getting near - to be told that I was only 1 cm dilated.

Went home for another 24 hours before the pain got too much, and went back to hospital to be told that I was 3 1/2 cm dilated. It took me another 10 hours to get to 7 cm!

So I have no idea whether I will be able to stay at home long enough without pain relief for things to progress as quickly as they need to.

Mins monitoring every hour.

As it happened, i had am uterine rupture and a crash section, but this is beside then point. By indicating that if had really thought about then risks associated either vbac, the hospital were happy to support my desire not to be continuously monitored.

Oooops, little hand tapped screen and if posted too soon, but my two posts above, eitherd side of happy's should read continously.

There was meconium in my waters and the MWs wanted me on the bed and on the trace but I was so blasted on G and A that I just completely ignored them! At one point I looked up and realised there was a third MW in the room, she had been drafted in to hold the trace thingy to my belly, and boy did she look grumpy about it. I was pretty oblivious until they pretty much insisted I go on the bed for the pushing stage.

You can just say no, they can't physically hold you down.

Have you done your own research into the pros and cons of CFM? The hospital can't force you into having it, if you feel it will impede your positioning etc. They may suggest it but can't require it.

Bikerunski, you were very lucky to have survived with a healthy baby. I would have thought that given that experience you would be supporting continuous monitoring.
With my 2nd child I was monitored and had an emerg cs as lost her heart rate.Born with apgar 0 but quickly resucsitated.If I had not been monitored she would have been a stillbirth.

You can sometimes get a good trace if you are standing/mobile. Your mw should be patient enough to encourage and assist with this, IMO. You may have to assist occasionally with holding the transducer if she needs to do something else. It is fairly easy to be monitored if you choose the birthing ball. Another option is the use of a fetal scalp clip. It is quite invasive and whilst restricting mobility in terms of how far from the ctg you go, will enable you to move/stand/rock/get on all 4s/ whatever!

The previous poster who said that continuous monitoring is only recommended has a valid point. You do not have to have to have it.

The supervisor or midwives at my hospital told me that the reason for continuous fetal monitoring is that it gives better quality information about the wellbeing of the baby and enables faster intervention if signs appear to suggest that the baby is in trouble. It depends how you feel about that, I guess. For me, I am not concerned enough about the experience to override the potential benefits of CFM though I know it has its risks.

I had a VBAC after emergency csection and wasn't CFM. I was CFM first time when I had the csection and I was restricted to the bed. This time I wanted to be free to move around use a birthing pool and I had hopes of the birthing pool. The midwife sat with me and checked without linking me to a machine.

A recent vbac client of ours wanted a home birth specifically to avoid cfm. However, a helpful chat with supervisor of midwives has enabled her to agree a birthplan of intermittent monitoring on del suite which she prefers because it does allow for rapid action in case of trouble.(cfm isn't great at detecting rupture more than good intermittent monitoring anyway?.The most important safety device is an attentive midwife)

You can always refuse CFM and have intermittent monitoring. This means the midwife regularly listens in to the baby and her focus is on you, not a machine in the corner. Research evidence shows no better outcome for CFM over IM, just a raised c-sec rate. Primarily the CFM is there for legal reasons. Without the option of augmentation for a VBAC, I personally feel that active birth is really important to keep labour going and avoid a section.
vbacfacts.com/2009/06/24/the-role-of-interpretation-acog-refines-fetal-heart-rate-monitoring-guidelines/ might also be helpful as a neutral reference.

jaffa cake I do know how for tunate If to have a healthy baby and the OP has said she knows the risks of rupture, but is still unhappy about cfm.

The CFM was one of the reasons why I went for an ELCS after my previous EMCS. Not to do monitoring never seemed a valid option for me. Have no regrets about the ELCS.

I'm planning a vbac and am refusing CFM. I had it with my first (induced labour, immediate hyperstimulation with one dose of pessary, CFM as trace was suspicious from the outset, crash section due fetal distress/late decels).

CFM meant I was literally flat on my back for the whole labour (7 hours of continuously contracting). I couldn't roll onto my side as I lost the bloody trace...even lost the trace just lying there, with either me or DH holding it continuously...every HCP who's ever discussed CFM with me says you can remain mobile, to the length of the lead, which I think is complete and utter bullsh*t. I don't know a single woman in RL who's had CFM and been able to remain active.

This time I've done my reading and am happy with my decision to refuse CFM - I want midwives who are focused on me, to spot scar rupture signs like pain between contractions, instead of standing over the monitor for hours at a time. I strongly believe that remaining active gives me the best chance at a vbac and that CFM would almost guarantee another section (for "failure to progress" if nothing else).

I've discussed it with my consultant (v much recommended CFM but understands that I know the risks) and consultant midwife. I've actually been signed off to go to the birth centre instead of the labour ward, which means birth pool etc if I want.

The vbacfacts site is excellent btw.

I was induced so had CFM and spent none of my labour on my back, I was on my side, on a ball, on all fours and on my knees lying over the back of the bed. If the trace was lost when I changed position then the midwife repositioned the sensors to suit. Although I didn't move around much once in a position IYSWIM.

I find it odd that my experience is unusual, maybe the belt things I had particularly good elastic, or perhaps it's because the hospital I was in also has an MLU and the midwives rotate so are a bit more willing to help you get into alternative positions, or maybe it's because I screamed blue murder every time my back touched the bed because it really hurt meaning they had no choice but to accommodate me

Anyway the point of this is that it is possible to have CFM and not be stuck on your back.

This will sound really silly, but how do you physically keep still for the entire length of labour?

My DC1 was born via ELCS as he was transverse breech, but I did have to have CFM for an hour or so after we attempted an ECV. I was lying down and keeping still but the trace was still lost countless times, much to the annoyance of the MWs. I'm looking at a VBAC in a couple of months and my community MW is trying to convince me I can have an 'active' labour whilst wearing the monitor? Unfortunately, as I've also tested positive for Group B Strep this pregnancy I need to go to hospital at the very start of labour and will be looking at spending hours being monitored as this is officially my first labour it's expected to be a long one. I'm really, really worked up and nervous about this. I don't know how I'll be able to keep myself perfectly still if I'm in pain?

You do not have to keep perfectly still at all Petunia. As you said, even being motionless, the monitor still loses the trace, I was constantly trying to reposition mine and the trace would come and go. But like thefurryone said, you can move about, sit on a ball, rock, stand, kneel etc etc. If you are in hospital from the very start, I doubt they will expect you to be constantly monitored. Perhaps you will be able to ask for intermittent monitoring like Bikerunski suggested.
My VBAC was after ELCS due to breech also, and it went well, as I said earlier, I was monitored maybe for an hour out of my 5 hours in hospital. And that was classed as CFM. While I didnt have the straps on the MW would have a listen every so often.

Good luck ladies, fingers crossed for successful VBACs.

Thank you for some reassurance! I do feel like my MW just dismisses all my worries as being silly (some of them are, some of them are serious!), so it's great to get information on here from people who've experienced this first hand.

I had thought about asking for intermittent monitoring (perhaps until the labour really gets going?), unfortunately my consultant appointment at the hospital keeps getting cancelled/ rearranged so I haven't had the chance to talk through any options.

Thanks, HappyAsEyeAm for starting this thread. Have you had any more thoughts on what sort of delivery you'll choose?

It might not be as bad as you think. Firstly, you do not have to have the CFM on until you are in "established" labour, which is something of a subjective science from what I have seen. Secondly, you can be somewhat active. It is clearly a pain in the butt as there are wires but, if you have a useful midwife and partner, they can focus on holding the monitors in place and getting the wires out of the way as you move around. Finally, once the cervix is open enough, they can replace the external monitor with a "clip" on the baby's head (not sure what the baby makes of this!) and then the trace cannot be lost. Of course, you do have a wire trailing out of your vagina but that can be quite useful to see how far the baby has come down anyway.

My wife had the above. Not saying it was a really nice labour but she definitely retained some mobility throughout (well, until we had to go to theatre for forceps as cord was around baby's neck).

Thansk for so many informative replies.

Petunia, I have decided not to have the clip on the baby's head - its too invasive for me to consider.

I have also decided not to ask for intermittent monitoring (I would not refuse it if offered) as I don't want to be responsible myself for any risk of something going wrong whilst I wasn't being monitored if the gaps in monitoring were solely my choice.

This leaves me quite at the mercy of the midwife I am allocated when I arrive at hospital (hopefully in established labour, but as I said, it took me 3 days to get to 7 cm, with very regular contractions, last time, and I thought I was in established labour 36 hours before DD was actually born).

I know from last time that if the midwife I am allocated says that I have to stay still on the bed or the trace will be lost, there will be no discussion about it, as she will tell me that this is what is required to keep me and the baby safe. And then I was stuck on the bed for hours. I am hopeful that I will be allocated a midwife who will let me try and sit up or maybe squat or whatever, with DH helping me keep it all going, but that is down to luck. The midwife at my VBAC appointment wrote on my notes that I should have "as active a birth as possible", but there is no guarantee of that and she said that I would have to discuss it with my midwife at the time.

If I knew how my slowly/quickly my labour would progress, and if I knew what my midwife's attitude to me being off the bed would be, it would be an easier decision. But I just don't know these things in advance and its making the decision so much more difficult for me. At least with a ELCS I know what I woudl be getting and could plan for it. As if labour doesn't progress quickly (as it didn't last time), I will not be allowed to be in established labour beyond dilating 1 cm/hour - I will have to have an EMCS. And if this labour is anything like the last one, I will lose all contractions when I am on my back, which will mean syntocin/epidural and the chances of an EMCS are much more likely. So I might end up with an EMCS rather than an ELCS anyway!

HappyasEyeAm it really isn't up to the midwife what position you are in. Just tell her that you won't be lying on your back because you are concerned that it will slow your contractions and that she will need to position the monitoring equipment to take account of this. The midwife if there to assist you in giving birth not dictate to you on what position that you need to be in for their convenience.

Perhaps speak to the supervisor of midwives in advance on this matter and query in advance why the advice of your VBAC midwife would be ignored by a colleague.

On a practical note, I wonder if something like a bump band would help to keep the sensors in place if the straps were a bit rubbish.