Help, continuous monitoring want to give birth on my knees advice

[Trickle]

My consultant and I agreed to induction at 39 weeks but she is now pushing for me to be monitored on my back during labour. I can't see me managing this, I've no problem with staying still as long as I can do it on my knees, I know my body and I know I will not manage to get into the right 'place' to give birth and cope with the pain if I can't do what it is telling me to. I've read you can change position when being monitored and that people have been monitored in all sorts of ways including on a birthing ball but she is pretty adament I'll have to give birth sitting propped up, if it's anything like last time they would have to hold me down to manage that.

On my knees is best for me anyway especially for delivery as my pelvis is a bit rickety and I'm easily injured. I'm sure I'm supposed to have a say in this so how do I get them to listen - is there any nice guidelines or blurb I can quote that says they need to work around me?

I think you are right - according to NICE guidelines, the consultant has to give you an informed choice, she can't just tell you what you can and can't do:

"Women who are having or being offered induction of labour should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals."

And from what I can see, the NICE guidelines on continuous monitoring don't say that the woman must stay in the same position throughout, and don't mandate a best position except for a few specific circumstances (e.g. fetal blood sampling).

It sounds like this consultant has quite a forceful personality, but I think you are perfectly entitled - based on the guidelines - to stand your ground and insist. Hopefully your birth partner(s) can also support you in this. She can't physically force you to give birth on your back!

i was monitered constatly with dd, also induced, and i was allowed in whatever position i wanted, the midwife just fiddled with the moniter straps to pick up the heartbeat, its harder for them but they were fine to do it :)

sorry for typos! trying to do too many things at once!

anyway like you i prefer to birth on my knees/all fours and it wasnt a problem, i sat on a birthing ball for part of my labour, stood up, rocked and ended up kneeling on the bed, using hte head end of the bed (which they put upright for me) to lean on.

i also had a consultant telling me i had to be flat on my back etc, i told him that no i did not and i would work with my midwife to find what worked best for me!

re pelvis i also have spd and yes on your knees is MUCH better.

it is highly unlikely that that consultant will actually be there when you birth! mine was there at the start of induction and wrote in my notes 'his recomendations' and that i was choosing to ignore them! the midwives agreed with me, there was no need for me to be flat on my back.

Thank you for that - I do like to go armed with quotes or guidelines when people are obstructive (I actually had a stillbirth last time and the cheeky consultant hinted that to give birth to a healthy baby I'd have to be on my back and compliant!)

Luckily DH (who was amazing last time) is totally behind me, in fact I think he is angrier than I am at the emotional blackmail and general attitude to a simple need. I'm just worried they will have me on my own on the antenatal ward without a birth partner and it's much harder to fight back during contractions :(

I didn't deliver on my knees but I did labour on them for some of the time whilst having continuous monitoring, it was too excruciatingly painful to be on my back so they was no way they could have made me stay in that position. The midwife I had was lovely and helped me into various positions including sitting on a ball, adjusting the monitor as required. I'm convinced that being upright during the process helped and was a factor in the whole thing taking around 6 hours.

I suspect once you're actually in labour you won't see a lot of the doctor but will have a midwife present the whole time, in theory the midwife should be more accommodating in helping you meet this need.

I am so sorry for the loss of your child.

Probably the best thing would be to work with the midwife looking after you - since the consultant (a) may not even be around and (b) certainly won't be in the room all the time. In fact if you are lucky, they will just swan in after and try to take all the credit for your lovely baby!!

It's perfectly possible to be continuously monitored in any position - if you want to be upright and the trace isn't very good, your lovely supportive partner may have to hold the transducer onto your belly - same for an all-fours position.

you may also like to look around at the evidence about continuous fetal monitoring in labour.....the only thing which is reduced is the risk of neonatal fits. Nothing else. That's in a straightforward labour - depending how much they need to do to induce you, continuous monitoring can be a good idea because some of the drugs involved in an induction can adversly affect the baby - that's if you get as far as needing a drip. If you just need a pessary and off you go, your labour should be treated as a low risk one.

Good luck and happy birthing!

It is OFTEN possible to monitor you in other positions such as on your knees but not always. For example, if you are of a normal BMI, or BMI up to about 30, it will probably be ok. Sometimes if a womans BMI is higher it is harder to monitor in general and so being in other positions is not possible if they are to clearly monitor your babys heartbeat and your contractions. I think you need to find out why she thinks in your case being on your back is necessary. It may not be a case of 'won't' but a case of possibly 'can't.'

Of course you still cant be forced to stay on your back, but it may be that clear monitoring of your babys heartbeat or your contractions is compromised.

Good luck OP.

OP I have been told that I may need monitoring but have been adamant that this will only happen if there is an actual medical need. Have got a consultant to agree with this and that any monitoring is done with full discussion. Like you I want to be active/upright in labour.

My midwife has also said that at my hospital they have a remote monitoring unit which means you are not hooked to any wires and can move freely. Apparently this is normally available as people don't know it's there. I have been advised to request this if monitoring is needed to enable me to be active.

Can you ask if they have this equipment at your hospital? It may be the perfect compromise...

Thank you snowsquonk, it happened very unexpectedly with no explanation before labour.

I only needed two pessaries last time - 6 hourly ones - and it was fast, so fast it suprised the midwife. I know that the monitoring and not being allowed to move can cause labour to slow and extra intervention inc the drip which I am keen to avoid.

I started this pregnancy at just normal BMI 24.5 and have put weight on at a normal rate. Besides either DH or my doula could hold the monitor in place if needed. Going by last time I'd move much less if allowed on my knees anyway, I threw myself around a lot more when they tried to get me to change position from that - which surely would make everything harder to monitor anyway.

The only way I can see me managing to sit back is if I had an epidural and I NEED to know what my hips are doing, it's so important AND I don't respond to local anaesthetic normally anyway so it might not even work! It's a bit more than spd, it's hypermobility syndrome too, I've had Dr's promise to be careful and then injure me batting my legs out of the way while doing things like smears. It's going to be no good if I give birth only to be unable to roll unassisted and be bedbound for weeks/months afterward - which is a real risk for me. For birth itself on my knees will not only speed things up, probably be what my body tells me to do and help avoid tears (only grazed last time and it's supposed to be another risk of the HMS) - it will safeguard what mobility I have left.

countrylovescheese thanks for the info - but I can't actually walk around, unless you think it might be the wires they are worried about getting tangled then I'm not sure it would solve anything for me.

Trickle - First of all I'm sorry about your last baby. Is that why you are being induced and monitored?
About the monitoring - there is no point doing it if the quality of the trace is inadequate. Lots of women manage perfectly well in the most peculiar positions and on your knees should be fairly easy to monitor in my experience. However if, despite the assistance of the mw and your partner, the quality of the trace is poor you could consider having a scalp electrode applied to the baby's head. It's not the first thing I would suggest but if it's important that you are monitored then it would allow you the freedom of movement you need. The scalp clip is minimally invasive and very accurate and if applied by an experienced mw or doctor it should not cause any trauma. People do have conflicting views on them but worth thinking about. Good luck on the day!

Thank you trafficwarden yes only reason for induction and monitoring is my son. I know someone who had one of those clips put on the baby, I hadn't even thought about asking about that - I thought they were for emergencies for some reason, it does sound like a good compromise though if the trace isn't working on the monitor. Tbh I don't even know how important the monitoring is, though the consultant said something about it being the only reason she was inducing me, she hadn't even mentioned monitoring till today (33 weeks). She had made out before it was a) Just to be on the safe side b) for my peace of mind so I didn't have to worry about going overdue. She's been really funny about me having questions and about answering them. Today she was on about the baby's growth and the umbilical cord and keeping an eye on it, but I'm having extra scans due to cysts in this baby's brain - there is nothing wrong with either growth or the cord, they thought there was but there isn't - baby happened to be sat on cord when they did a doppler trace and now she seems a little obsessed by it.

My son was small (which she has mentioned) but at 5ib 13oz I was told it wasn't medically significant and he was just a normally small baby - someone has to be. His placenta was normally small too - this one isn't. I'm short so is DH and so are the rest of our families, sorry if this is drip feeding I didn't mean it to be. This baby has slowed in growth but it's still well within normal too, movement is good and ctg traces all good - my mum can't remember my birth weight but my MIL never had a baby bigger than 6ib 10oz and she had 5.

Think much of this has been said, i was induced, waters broke early, but then nothing happened, so was monitored, had a brilliant student midwife who happily followed me around the corner of the room where i was 'tethered' to the monitoring machine, i was able to move from sitting on the floor, over a birthing ball, on all fours etc, did end up delivering on bed, but had ventouse so was tricky otherwise (i assume) trace wasn't consistently brilliant, but enough info to keep midwife and supervisor happy, and similar to above, ended up with a clip on ds, which although a little uncomfy looking for him, soon recovered and perhaps as you say is an option for you to save you being on your back throughout. So sorry to hear about your other baby, hope you have a good birth, and sounds like your dh is going to be great!

Thank you for posting about this, I'm being induced tomorrow and if possible don't want continuous monitoring as with ds the only way I got through it was pacing up and down our landing for 4 hours and then 4 hours in the birthing pool so this is very useful info, especially snows.

No one has discussed with me induction, it's just been booked in after having 2 sweeps as they think I'm giving birth to a huge baby, at least now I've got some ammo to take with me!!!

Thanks again

Bump Pootle78 just don't want to loose the thread and was wondering how you and your LO are? I know it could be ages before you are back but have been thinking of you

Trickle, the health care professionals cannot force you to have anything you do not want. they can only advise you.

if you do not want monitoring you can decline it.
If you do want to be monitored I'd be tempted to bluff your way through and tell them that you are happy to be monitored but only if you can be active through your labour and that if you can't then you will refuse all and any monitoring.

I think that's what has thrown me off a bit thisisyeaterday, monitoring has not been discussed, wasn't mentioned before I said about wanting to be on my knees. Consultant has just assumed I will do whatever I am told and that I don't need to be informed of any of her plans, nevermind me having any of my own.

ahh well thank goodness you are sensible enough to do your own research!

it's odd because I have a friend who is in almost the exact same situation as you and I thought you might even be her until I looked on your profile and saw where you live

but yes, from the sounds of it it's perfectly reasonable to ask to have mobile monitoring, and I would question them at length as to why this is not possible for you!

Don't know if anyone remembers this thread but wanted to post an update just incase.

Fantastic phisio got me a meeting with head of labour ward who was fab. They see no reason for me not to be as mobile as possible, and agreed I'm not going to be particularly still anyway if I'm in pain and don't want an epidural, so they are happy to cope with monitoring me while a) on knees unless I change my mind b) while throwing myself all over the bed. Also V happy unless complications for me to deliver while on knees - which is all I wanted agreed to.

Basically the midwives are very sensible and too professional to say anything about the consultant, but seemed to think some of her ideas were maybe a little prescriptive for a labouring woman.

Oh and if it gets to difficult to monitor with the external strap on things ( ) then because breaking my waters is part of inducing me they will use a scalp monitor on baby. Will try to avoid this I think but is another alternative, which is always good.

hi trickle,
as a midwife i alawys try to keep women mobile who are being induced. can i ask what the reason is you are being induced? i might have missed i whilst reading the posts. if you are not being induced for medical reasons, you don't always need to be continuously monitored on the CTG. at the unit i trained in, if it was a low risk induction and you only need pessaries and/or your waters breaking, we could treat you like any other woman so just intermittent monitoring with a handheld device.

if you do need continuous monitoring the main concern is obviously getting a good trace of the baby's heart, and i'm not going to lie, that is not always easy, and it's down to position of the mother, position of the baby, size of the mother etc. i always do my uttermost best to keep women as mobile as they can be. however, if i am really struggling, and the woman does want to be mobile still, then the only way forward would unfortunately be the fetal scalp electrode that you mentioned. i know it doesn't sound nice, but it is just a little clip that goes on the baby's head just below the skin, and it makes being mobile much more easy (though it should be used as a last resort).

good luck with your labour :)
Emma - midwife

Thanks for the reply midwifeemma I'm being induced with the monitoring due to previous stillbirth, I'm not strictly high risk and I'm a normal weight (or I was prepregnancy). I won't be moving off the bed anyway as I'm mobility restricted - I can shift myself around on a flat surface (if it was safe and I had my way I'd be on the floor) but I can't stand and walk.

ok, well good luck! there is no reason you cant do it on your knees :)