Refusing continuous monitoring

[Sparrowlegs248]

I am 37+1 with dc2. Ds was elcs due to breech. I am veering wildly between vbac and elcs. I should have given a decision last week.

I've been told that if vbac, I will have to be continuously monitored, though my mw told me I can refuse. There is only one set of mobile monitoring equipment. I just can't see it working if I am to be attached to the monitor the whole time.

Equally, it doesn't feel right to refuse, is it putting the baby at risk?

Has anyone refused? Any advice? Can someone decide for me.......?

Why would you refuse what's being medically advised?

Ask for rationale behind policy- what specifically the risks are and how continual monitoring would minimise the risk. Then make a decision about whether the risk is something you are likely to be affected by. I guess it depends on reasons for section previously.

That's my problem banana, I hadn't even considered that I could refuse until the mw suggested it.

I am having regular monitoring already, and it's the most uncomfortable hour or two, and that's just laying on a bed not in labour. I am sure I will hate being 'strapoed to the bed' while in labour, and it will certainly upset and frustrate me not being able to move freely. An active mobile labour is preferable surely?

Of course if I get the mobile monitor, that would be grand!

There's a very good chance you'll get the telemetric monitor. Or could you hire one?

Even with the normal monitor, if they strap it right you should be able to stand / bounce on ball next to machine.

I'd not thought of hiring one, I certainly would!

I am pretty sure standing next to the bed will be as good as it gets with the usual monitor, and I really don't feel happy with those limitations.

I had the same situation with DD2 in April, vbac after breech CS with DD1, and had the same concerns about the monitoring. I wanted to be mobile, walk around, try different positions, maybe have a bath etc and the idea of giving birth flat on my back on a bed was really off putting, even though the midwives assured me it wouldn't be that restrictive.

When it actually came down to the birth I found myself making a beeline straight for the bed, climbed on, got stuck into the gas and air and stayed there, on my back, until she was born two hours later . It never occurred to me to move at all, and I don't remember the monitoring being an issue as I was off my tits on Entonox so focused on the labour. You may be able to negotiate intermittent monitoring rather than continuous, but it might not be as bad as you think, I honestly barely noticed it once things got going.

I remember crying at a midwife that I didn't want to lie in bed still for an hour while being monitored, it was agony so I understand where you are coming from

I'd decline continuos mentoring. The evidence that it saves babies isn't that clear cut. It also hampers your ability to move which impacts on you ability to give birth safely.

With DC1 I had intermittent monitoring until 9cm and then insisted on continuous monitoring from then on as I had concerns for baby (a few medical signs plus my own instincts). At 9cm I was so wrapped up in what I was doing and the gas and air that I didn't hear the monitors beeping, even when it stopped beeping (!) though DH did so he found it stressful I think.Personally I didn't mind the wires. I wasn't expected to lie on the bed. I did keep knocking the monitor off during contractions though so doctor suggested putting the clip on baby's head which I found a million times more comfortable (they can use the clip once the waters have broken). Intermittent monitoring had only detected 1 decel in baby heartbeat (midwife put it down to 'maternal positioning'). Continuous monitor detected that it was far more frequent and irrational and ultimately when the heartbeat disappeared entirely (bradycardia) the alarm went off (DH heard it. I still didn't hear it!) the doctors swooped it and got baby out and resuscitated within mins (baby completely unharmed thanks to quick action). So it can work and undoubtably saved DC1 from serious harm.

On the other hand a good friend of mine watched his baby's heartbeat dip with every contraction (apparently this is okay/normal to dip during contractions so long as heartbeat recovers between contractions). He found it so stressful and scary that he's had the operation to stop him having more kids! So if there's no issues it can cause unnecessary concern!

This time they are recommending continuous monitoring. My plan is to try it. If I find it too much of a problem I will take it off or negotiate breaks from wearing it (obviously only if there are no concerns). I will be active and moving in different positions and have been told this will be okay with the monitor. Once waters break I may opt for the clip again as i literally didn't even notice I had it on.

I'm about to do a bit of research on it to understand a bit more about how accurate monitoring it is etc. Will post again if I find anything interesting.

It is up to you, is the bottom line.

I was induced both times and hated being monitored I couldn't even get up to go to the loo so had to use a bed pan which was humiliating at the time because I was more than able. I just wanted to get up and move around but the slightest movement disrupted the monitor.
You are within you right to refuse but then if something was wrong you wouldn't know.

It will depend on the midwife, in my experience. I had continuous monitoring with my DS (first baby) as I was induced due to being overdue and was told that whether I would be "allowed" to move around would depend on the midwife on duty .

As it was, the midwife I had was very old school and insisted that I be on my back on the bed. Given the monitors and the drip, blood pressure cuff, etc, I couldn't even turn onto my side without assistance and she was unwilling to help until I insisted as it was just too uncomfortable. I was also not allowed to the toilet and had to use a bedpan.

I was in the same position for 7 hours and it was awful, I'm not going to lie. I think it played a significant part in why I ended up with an EMCS for failure to progress. Baby was not in distress at any point, but she was very concerned that anything other than being immobile on my back would interfere with the equipment.

The next midwife positively encouraged me to move around as much as I could, ie to be upright, on a birth ball, or in any position I found comfortable that they could monitor me in, and to use the loo. This was more manageable.

I'm not qualified to say whether you should refuse continuous monitoring in place of intermittent, but I would say that continuous monitoring could have an impact on your labour depending on how it is managed. I would encourage you to think in advance about your options and what your red lines are. It depends so much on the midwife you get and how comfortable you are challenging/asserting yourself in that kind of environment, and whether your birth partner will advocate for you.

My personal view is that next time, I will be having an ELCS because I couldn't cope with continuous monitoring if I had to be on my back. But that's me, not you, and you might well feel it was a price worth paying for giving VBAC a go.

I recently had a VBAC after an EMCS. As my water had been leaking they had to speed up my labour with the drip, so I had an IV in my arm and the CTG round my tummy.

I was comfortable lying down until I got to 6cm at which point they broke my waters and I couldn't contemplate lying down any more.

I explained I wanted to be as active as possible to the Dr and she was happy for me to stand up - I had a pair of maternity leggings on which helped keep the monitors in place. I got through labour just swaying and pacing around in the square meter next to the monitors / IV and then leaning over the bed when the contractions hit. They were also fine to take the monitor and IV off for me to go the bathroom.

When it was time to push the midwife wanted me on the bed and I got on my hands and knees and she was out in 5-10 min.

So for me the monitoring really wasn't a hindrance. My labour was only 3.5 hours though so I can imagine it would be different if you have a long labour.

I'm really pleased I went for a VBAC. I have a toddler and was so pleased to be up and about straight after the birth so I could give her lots of cuddles!

Can recommend a really good book - your body your birth your baby, written by a midwife who looked after 'high risk' labours massively helped me be prepared to assert myself if needed. The though on being forced to lay on my back for labour fills me with horror I was on my knees the whole time.

I do think.i will be OK to be assertive. I will be on the monitor this afternoon so will look at how much movement I'd be likely to get.

I'll keep my fingers crossed that the mobile monitor is available!

I was induced both times and had continuous monitoring plus a couple of drips on the go.

The first time I wasn't supported to be mobile, which made the pain harder to manage I feel.

Second time I had a great midwife who supported me to be mobile, walk to the toilet etc. It made all the difference and I had a very positive experience second time round.

Have a good read around on here. It is an excellent resource of evidence. Might help you decide what is best for you. www.cochrane.org/CD006066/PREG_comparing-continuous-electronic-fetal-monitoring-in-labour-cardiotocography-ctg-with-intermittent-listening-intermittent-auscultation-ia

I have had VBACs and had continuous monitoring, tbh I didn't notice it and had unassisted deliveries in spite of being limited to how mobile I could be. Dsis's friend though had her and her baby's lives saved by continuous monitoring when her previous CS scar ruptured during a subsequent labour.

I had a vbac in September and was concerned like you about being "strapped to the bed". When it came to it, I laboured quickly and arrived at hospital in transition,; and moving was the last thing on my mind. I was monitored but wasn't aware of it. The only place I wanted to be was on my side on the bed clinging to dh for dear life. When it came to pushing it was upright holding the back of the bed as was adamant I wasn't going to give birth flat on my back. An hour later the mw said I had to move as baby was getting distressed. 2 pushes later (flat on my back) I had a baby in my arms. Completely not the birth I'd planned but I wouldn't have done anything differently. If you're confident about what you want and why that helps, but don't be afraid to go with the flow on the day.

Whatever happens, good luck, and enjoy every moment with your snuffling little newborn

You can refuse continuous monitoring, however it is advised by NICE and RCOG if you have had a precious CS. You are at risk of uterine rupture and one of the ways of detecting that is via baby's heart rate. There are other ways of monitoring this i.e. Bleeding, continuous pain, maternal tachycardia etc but CTG is still seen as the better way for VBAC. However, there is some research that suggests CTG is not appropriate for detecting uterine rupture. Request to speak to your supervisor of midwives about this. They can be very helpful. You can mobilise with a CTG on, sometimes it can be harder due to loss of contact. If you can get a clip on baby's head that makes it easier. Good luck in whatever you decide

OP to me the fact that the MW said you can refuse it may indicate that it is 'standard practice' at your hospital but she doesn't think it need apply to you. I agree with a PP who said push further as to why it is necessary, what are its risks and benefits for you.

Personally I could not contemplate being on my back throughout labour as for me contractions were so intense I would honestly have ended up ripping the equipment off and flailing around. Not through awkwardness, I just wasn't fully in control. You know best how you labour and how much of a problem it would be - but I think if you had CS before you are statistically likelier to have another, therefore anything that interferes with natural birth is not going to help, and you may wish to either decide for no CM (depending on MW advice) or straight to ELCS.

It's worth asking if there are any specialist midwives you could discuss this with. My consultant has assumed that I will be fine with continuous monitoring and refused to discuss it further (wouldn't even tell me the reasons she felt it was necessary!) I saw my midwife the week after the consultant appt and she has booked me in with a specialist midwife whose job is to support women to have a safe active labour and negotiate a birth plan to help with this.

I have just had an appt with a Consultant Obstetrician today, where I advised him I will not be having continuous monitoring for my second vbac (I have recently transferred to a new Trust and was referred to him just because ). Anyhoo as it happened I had seen a Consultant MW at my old Trust re monitoring and she'd written a letter supporting my wishes, which he read. He was more than happy with the plan I'd agreed with her, which is:
20 mins continuous monitoring on arrival at labour ward. If all seems well then intermittent monitoring only.
If continuous monitoring indicated, to be done via telemetry.
Consent to continuous monitoring in second stage if does not interfere with position, otherwise go for fetal scalp electrode.

Apart from the fetal scalp electrode bit this was my plan for my last labour. Unfortunately DS pooed and they got a bit concerned so I consented to the telemetry. Unless I was standing or lying it would frequently lose contact so I'd have a MW fiddling about which was completely distracting. Really want to be able to relax thus time around (due in 6 days!).

Thanks gum there is apparently only one set of the telemetry monitoring, so who knows if it will be in use.

I've been on the monitor twice weekly and just can't see if being an option during labour. 39+5 tomorrow and going in for a sweep so watch this space!