Declining continuous fetal monitoring with a VBAC

[RunningGuerita]

Will try to make this short.
First child: laboured on midwife led unit, quite long latent labour, used pool, tens and gas & air. Got fully dillated, pushed for 2.5hrs. Transfered to labour ward where was told baby was stuck with a deflexed head and had not descended enough to use instruments. C-section. No regrets, hang ups or anything of the sort. It was just the way it was and I did everything I could to get her out and it just wasn't happening..

Am 38+2 with my second and planning a VBAC. Will have to go straight to labour ward, which is irratating as the pool worked really well for me and I liked the midwifery led unit. The thing I am not happy about is the presumption that I will accept to have continuous fetal monitoring once in established labour.

Anyone with any experience of declining in a VBAC scenario? I have tried to speak to the supervisor of midwives with no luck.

Thanks.

I had a vbac and to be honest as much as I wanted to move around during labour and not be hooked up to a monitor I feel as much as I hated it at the time I'm glad I did it now. I think you have to weigh up your discomfort for however many hours labour takes and the safety that comes with continual monitoring of your baby.

What is it that bothers you about the monitoring?

Your first labour sounds almost exactly like my first.

With my second I dithered all pregnancy about the exit strategy - and when I got to term+5 had an elective. (which was horrible)

With my third, I spoke to my consultant, who said if I wanted to try VBA2C she was supportive, but if I wanted to decline CFM I might as well go on the MLU. Met the consultant midwife who said well if you're not having CFM you can have the pool if you like. (He was keen - first time VBA2C had been attempted on MLU). Had a brilliant birth, with a lovely doula at home with me through early labour, and gave birth with zero pain relief (no time) and only 2 stitches 40 mins after arriving at the hospital.

I know lulumama has lots of experience of VBAC (her own, plus she's a doula) so put a shout out to her. Btw I think CFM might feel reassuring for some people, so I'd see if you can think through the scenario of Labour ward positively. For me with my third I would have been happy with that just to not go through another elective.

I would persist in trying to speak to someone on MLU about it and see if they are prepared to have you. You might be surprised. Also if you make it clear that your decision re CFM is an informed one, your decision is likely to be respected. I'd really recommend a doula if you can manage it, they can do all sorts of declining on your behalf.

Good luck!

Running, I started a similar thread a couple of weeks ago and had some very helpful responses. Search under my name and something along the lines of "Hospital wants me to have continuous monitoring but I want to stay active". Good luck.

Thanks for your speedy replies.
We have a doula (the same lovely one we had last time).
My reservations about CFM are that I want and need to stay active throughout labour.
I will keep trying to speak to the hospital midwives.

I'm planning a vbac (am 38+6), am declining CFM and am booked into the midwife-led birth centre. I had to jump through a string of hoops to get this signed off - including meeting with my consultant and the consultant midwife - but had it all signed off by 33 weeks. My notes very clearly say I'm declining CFM but am fully aware of the risks of doing so. We've also having a doula this time, to help and support our wishes.

My reasons for declining CFM as a standard are two-fold:

• I'm not convinced it's the best way to spot a uterine rupture
• I want to stay active in labour and CFM will mean I'm strapped to the bed.

I had CFM with my son (induced labour, immediate hyperstimulation, flat on my back with the monitor strapped on, couldn't move as the trace would be lost, crash section due to fetal distress) and it was useful in that situation, as the hyperstimulation caused fetal distress that the CFM picked up. But it was a horrible horrible labour, and I am doing what I can to avoid a repeat of it. I think CFM will increase my chance of a repeat EMCS hugely, as I won't be able to move around and use gravity or the pool.

I'll revise my plan if anything comes up in labour (eg meconium stained waters) but am currently happy with my decision. I have agreed to have a cannula sited on admission though, so that an emergency situation can be dealt with faster (the birth centre is also one floor away from the labour ward, should an emergency arise).

You can decline anything though, so if you don't want CFM just decline it on the day/night (though I know from experience this is easier said than done!).

I had CFM with my VBAC. To be honest it was a pain, got in the way and meant that I couldn't get in a comfortable position. In the end I asked for an epidural - if I couldn't move around I though I might as well be pain free and save my energy for the pushing stage (off topic but you might want to check how long the hospital will let you push for - I was limited to 1 hour but managed to extend it for 30 more mins since there were no signs of foetal distress...as evidenced but the bl**dy monitoring!)

Apparently there are some hospitals that use wireless sensors meaning that you can move around and use the pool.

I think I would allow them to use CFM again with any future VBACs. It did give me peace of mind - especially given the current research mentioned on the bbc today www.bbc.co.uk/news/health-17353803

Overall I was happy with the delivery and do not regret having a VBAC. Recovery was so much quicker and breastfeeding got off to a much better start.

Thank you both for your further replies. Very helpful.
I managed to speak to another midwife this morning. She gave me the standard line and said that I should clearly state my wishes in my birth plan (which I have done) and that it would be taken into account when we arrive at the hospital. I have probably left it too late to fight being admitted to the labour ward, but will stand my ground on the CFM unless it is really necessary obviously. At least we have our doula and my husband in on board.
Fingers crossed...

Hello. I refused CFM with DS4. My waters tend to break at least 24 hours before I start contracting and then it takes a couple of hours of contracting and pushing for it all to happen. I didn't bother with a birth plan, though I knew I was going to refuse it. I tend to be classified as a high risk birth due to risk of infection after long ruptured membranes - so no planned home birth, water birth etc. - but want to be unrestricted. I stayed out of hospital as long as possible. Then when I arrived, i refused it. They explained. I refused. They tried again. I growled. DH intervened. 40 mins later ... job done. They checked babies heart beat a couple of times because I asked. MW was very supportive of me being in control and breaking all the "rules" in place for my type of birth - even though I'd only met her 40 mins before!

I genuinely don't want to upset you op it is your decision completely but just wanted to share my story.

I had cfm. It was horrible. I had a frighteningly fast op labour with no pain relief at all. Stuck on my back in agony because of a crappy midwife and an even crappier h who didn't say a word. I wouldn't wish it on anyone.

however my baby would have died without the monitoring. Horrible to hear but sadly very true. I'm sorry but for me there is no contest.

If I was ever lucky enough to have another baby I would insist on cfm. I would be a lot more proactive about pain management and making sure I was happy with my mw but there's no way I could take that monitor off. Not for a second.

I understand how you feel op I truly do but for me, the safety of the baby will always come first.

Only you can decide what is best for you and I am sure whatever you do will be the right choice for you. I'm not in the business of scaremongering I just felt it was important for you to hear this side of the coin.

Another place you could probably get good advice from is the Yahoo VBAC group

If you have a look on the nice website the full guidelines have the evidence base for each guideline summarised. 11.2 in the 2011 Ceasarean Guidlines I think. There are a few NHS trusts that support waterbirth for VBAC on request.

iCAN, I assume OP is choosing intermittent monitoring, not none at all?

Sadly beehive intermittent monitoring wouldn't have saved my baby.

As I said I genuinely am not judging and the op should feel completely supported whatever she chooses.

Just sharing my story in the interest of balance that's all.

Id also like to add a positive for monitoring , however I only had it for an hour . Low risk , fit healthy , turned up at hospital only 2cm dilated . Put me on the monitor just to take a look , all looked fine , debating to send me home then wham, heart beat dropped off, alarms went off , few minutes later meconium came flooding out , my clothes were yanked off and I was in theatre being knocked out with a GA for a crash section in an instant .

Baby came out with the cord wrapped tightly around her neck. Had I not been on the monitor at that instance she would be dead . It sends my blood cold when I think about how I nearly went home , or was going to delay going to the hospital , go up to the ward etc .

I don't plan on having another after that . However , I don't think crash sections are the norm , and if you decide to go ahead with no monitoring just trust your instinct if you think something isn't right etc .

Good luck.

I just wanted to add I was not having a vbac, it was my first labour. My labour was considered to be low risk and completely "normal".

In my opinion any situation that puts either you or the baby at higher risk warrants cfm.

I do not expect everyone to share this view and it is not based on any medical knowledge whatsoever.

It is just my view.

iCan Just to say, that whilst in your case it may have been beneficial, studies have shown that CFM has actually been shown to not improve outcomes for mothers or babies in low-risk situations (no idea about VBAC or other 'high risk' women) yet it raises intervention and CS rates.

I had CFM with my delivery but wasn't strapped to the bed at all. I could use the rocking chair, ball, stand, sway and pace a little. On the bed I was encouraged to try different positions. When there were concerns about losing the trace or my son's hb decelerating my midwife was really good, checking with the senior mw and the doctor and they were very reasonable about whether he needed a clip on his head or I needed to lie down flat. They tried hard to give me as much freedom as possible. In the end I did have intervention but i'm not sure it can be blamed on the CFM. I'm happy it was just a combination of factors and I was given the best chances possible.

I posted the other day on this thread but have found myself thinking about it this morning. I just want to say I think birth can be made in to such a massive thing and if you didn't feel it went right last time, you put your all and can get quite obsessive on how you want it to be done this time, almost to put the last time right IYKWIM.
My first baby was an emcs under ga. I went for a routine app with my midwife at 36 weeks to be told I had pre eclamsia. I was rushed in an ambulance to have my section. I spent the first night in intensive care.
It was a shock but I was fine about it all. My second baby I was pushed in to having a vbac when I really didn't want one. I have to admit I'm a bit of a control freak! I had my birth all planned and felt very confident it would all go the way I wanted. It didn't. I don't think the birth even was very difficult but I felt it was the worse thing ever and I was so upset by it all, I truly feel this contributed to me having pnd. I really just kept going over and over it in my head and was just so distaught about it all.
I think what I'm trying to get across with this essay is just really try not to be so set on something, because if it doesn't happen like you want it might be hard for you to accept. If you truly don't want the cfm then don't have it, but be open to the fact that things can change, you might need it, you might end up with another section. Try not to build yourself up to something you might fail at.
My third baby I went in with the attitude that I wasn't going to like it but I was coming out with a baby and that's all that mattered. The birth was awful and much worse than my 2nd but it didn't bother me at all. I got my little girl so however many hours of pain and discomfort wasn't important.
I really hope it goes well for you, if it doesn't just remember, it can't last forever and you are not doing all this in order to give birth and have a positive experince, you're doing it to have another child. All the best.

Fantastic post convert says it all perfectly.

Thanks again for your replies.

Just to clarify:

• I am happy with intermittent monitoring as routine.
• I will of course be happy to accept CFM if there is a medical need for it.
• And finally as I think my explanation of how my first delivery went, I don't at all have a set idea of how this birth should go. I ended up with the exact opposite of what I had wanted that first time around but have no hang ups or upset about it. It is just the way that it went. We were booked in for a home birth, there were no community midwifes to send out so we went to hospital. After fully dilating and pushing for several hours, I ended up with a section and I am perfectly OK with that. It was the only way the whole thing would have gone.

I am approaching this birth in exactly the same way. Trying to do my research, be informed, prepare myself for how I can best deliver this baby (for her sake not for me). But I will of course take what comes and always put the health of my child first.