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.......?

Yes, you are within your rights to refuse - however I can't help but think the only reason your community midwife suggested this was because she won't have to deal with the consequences!

The machine has wheels and the leads are long. You will not be tethered to the bed. Why on earth would you decline this (other than it not quite fitting with your birth plan)??

No1 knows how labour will go ever. I wanted water birth but due to pre eclampsia at the end i was induced and very quickly went from 15 minute obs to blood pressure hitting 210/180 and being told i had to lay down and have epidural and be on constant monitoring due to risk of stroke and losing baby. There was no way i was refusing that. Yes i ended up laid on the bed unable to move bottom half but so be it. It meant me and my child were safe. I would tell them your concerns but also see how it goes, at any point you could end up needing the full monitoring and I dont know why people would refuse. 🙄

I had mobile monitoring when I was drip induced with dc3. The midwife said she had never used it before despite having worked in the dept for over 10 years... She said no one ever asks for it and they wouldn't think to mention it so fingers crossed you'll be lucky.

I did have to switch to continuous monitoring eventually as the mobile one kept slipping off but I got up on the bed on all fours and leaned over the back of the bed which was much more comfortable than lying on my back.

I was continuously monitored during labour and it was only afterwards that I realised I could have refused. I hated being on the bed. They said I could be as mobile as possible, but after shift change my midwife kept telling me off for moving because she had to keep adjusting the equipment

I genuinely think it slowed my labour down. Next time I'd refuse and allow occasional monitoring.

Thought I should update this.

DC3 was born at the end of Jan. I had a bit of a protracted labour, in that it involved a handful of contractions the Sat night, a handful the Sun night and then the Mon. I went to the hospital early on the Tues morning as had lots of very bloody show. They were going to send me back home after assessment but found me somewhat dilated so I got to stay. A few hours of not many contractions later they were going to send me home again but I was at 7cm. I stayed at that for 3 hours. They (doctors) wanted to augment and therefore monitor but I declined. MW managed to break forewaters and I finally went into proper active labour. Until I reached 10cm I only had intermittent monitoring. Once the second stage started I had continuous monitoring via telemetry. Second stage only lasted approx 5 or 10 minutes. Healthy baby born.

I know if I'd had continous monitoring I wouldn't have been so relaxed. I was possibly too relaxed, and therefore labour was quite slow, but the end result was excellent. I felt really in control.

Iintermittent auscultation in the first stage of labour is every 15 minutes. In some cases of uterine dehiscence or rupture (and I've seen it, it happens), the first and sometimes only sign is fetal bradycardia (baby's heart rate going down and staying there).

An emergency caesarean can be done quickly but with the best will in the world, it's going to take 10-15 minutes at minimum (the criteria for emergency sections actually allow 30 minutes). And (if my memory serves) 16 minutes of bradycardia in a healthy, normal baby, previously coping with labour well, was the first point in the limited research done where babies started to get oxygen-starved enough to have fits in the neonatal period. Which is probably why that evidence linked to on the Cochrane site says that continuous monitoring reduces neonatal fits, if nothing else.

All of that to say: you have a recognised risk of encountering something that will cause fetal bradycardia. It's not "one in a million", it happens. If it's picked up immediately, and if the necessary actions happen smoothly and quickly, your baby would probably not end up having fits due to birth asphyxia. If it isn't picked up for 10 minutes (intermittent auscultation), even the slickest obstetric and anaesthetic team can't stop your baby being affected by 20-25 minutes of bradycardia.

I'm very pro natural delivery. I know it has its problems and limitations, but please think very carefully before refusing CFM with a VBAC.

Sensible advice above ^^
It's great that there was a positive outcome for the OP & most people are lucky enough to achieve a straightforward labour & delivery. As such it is quite a luxury to be able to sit back before the event and muse over the ideal birth experience.
The cluster of baby deaths in the news recently at the Royal Shrewsbury hospital highlight how important correct and timely fetal monitoring is.
During my first labour my baby suffered hypoxia (oxygen starvation) and my uterus almost ruptured. I was considered a low risk patient & had been hooked up to the CTG monitor for over an hour after arriving at the hospital in early labour . As I was waiting to be taken to the delivery suite I joked with my husband that our NCT teacher had told us we should ask to take it off after 30 mins. A short while later my sons heart rate started to show decelerations with each contraction and was steadily dropping. We could actually hear his heart rate on the speaker, I still feel sick when I remember the awful thud...thus getting further and further apart. A decision was made to perform an EMCs and he was out less than10 mins later. When they opened me up they found I had a tight band around my uterus and it was close to rupturing. My son was not breathing and needed resuscitating. Still has on going problems aged 5 with his mobility and hearing albeit mild. I am so thankful that we are both alive & that I didn't insist on having the monitor taken off.
Looking at it from my own perspective I find it difficult to comprehend that people would refuse the monitoring, and yes complications are rare but they do happen. I certainly didn't think it would happen to me. It did.