What are the options for continuous monitoring

[barbamama]

Second pg, been labelled as high risk again (last time high bp, was forced to get on the bed, then had a shoulder dystocia) this time because of previous shoulder dystocia are trying to get me to have the full medicalised, lying on the bed birth which I really don't want and think caused the problem last time. If I have to have continuous monitoring, which seems inevitable, is there really only one option - the strap round the bump plugged into the machine? I found this really restrictive last time, it kept getting tangled with my TENS and it stopped me getting down on the floor which is what I really wanted to do. Are there any more portable units that I could maybe hire does anyone know? Thanks

Shoulder dystocia is not all helped by being on your back, as you well know! Do you know that the pelvis opens up as much as 28% more if you are on all fours or upright rather than reclining? What position were you trying to deliver in?

See Shoulder Dystocia on RADMID website for some thoughts about this.

They say you are more at risk having had a previous SD but I would wonder how much of your last experience can be down to "Sticky shoulders", Something to look into and perhaps rule out?

I certainly wouldn't think there to be a need for CFM until you get to the pushing stage. As the shoulders will not be trying to get through the birth canal until then so stick to intermittant monitoring until then, CFM has not been shown to improve outcomes for baby but has increased risk of instrumental deliveries or CS.

And then ask that you are given EVERY help to labour in the position that feels right for you, even if that means someone has to hold the belts in place!

Good idea - everything was absolutely fine last time until the pushing stage so why not intermittent until then? (assuming the high BP doesn't reoccur I suppose which was the original reason I was on continuous mon last time). I of course know that the bed is the last place I should be - indeed last time I think that is what caused it - I had been standing up leaning against the raised bed and everything was fine - 5-10cm in 4 hours, no problem, no decels etc and then the mw changed shift and the moron that took over very much pressurised me to get on the bed reclining over the back - I now realise to make things easier for her though we were too naive the first time to tell her to eff off which is what I should have done. At which point I more or less fell asleep, all the contractuons stopped and it happened - pushed head out with no contractions. Then body wouldn't follow, stuck at perineum for 8 mins, called crash team who flipped me over, did the McRoberts manoevure and got him out. He had an apgar score of 1 and had to be resusitated. Luckily no long term effect but obviously I am keen to avoid this happenning again. problem is, the medical profession seem to be advocating things which are more likely to make it happen again! I was referred to a consultant for this pg last week who, can you believe, wrote in my notes that I should have con mon, be on my back on the bed so that if (when!) it happens again they would be able to most quickly do the McRoberts manoevure!!

Sorry to rant, this has really pissed me off as you can tell. I feel like I am being forced into an ever more inevitable cycle of medical intervention when I really just want to be left alone to get on with it. Of course they try and keep you in line by making you feel like you are putting the baby at risk. I feel like my only option is to pay to go to a private birth centre (which I can't really afford) where they weren't even bothered about the previous incident and said it should be called bed dystocia!

Anyway, off to look at the website, many thanks - can I ask if you are a midwife btw? I have a follow up appt soon and think I might start gathering this sort of evidence.

what about a homebirth? if your BP is ok

shoulder dystocia is not necessarily recurrent, and the RCOG have said that the first and often the most effective way to resolve, is the McRoberts manouvre...legs round your ears!! all fours is also an excellent position, as Klaw has said, it really opens up the pelvis

CFM does not improve the outcome, and can often lead to more intervention

no-one can make you lie on the bed and be strapped to the monitor

you can make an informed choice to refuse CFM and have intermittent monitoring

being active , upright and mobile will give you a better chance of being able to listen to and move with your body to get baby into a better position, and hopefully not stuck!

barba - I'm in a similar situation to you - I'm going for my 2nd VBAC sometime in the next few weeks.

With my first (DS2) I was on the bed constantly strapped to the monitor.

This time I've been advised that I'll "have" to be continously monitored again - however I know that I can refuse - and as both my doula and my DH know my wishes (and support me) they'll make sure I don't give 'consent' when I don't really want to.

In other words I'm going to stuff what they say no matter how 'forceful' they are and I'm NOT going to be monitored contiously.

go fanny annie !

lol lulu - I think they already have an inkling at the hospital that I'm not going to give in to their demands........when I saw the consultant the other week he said (in a nice joking way I hasten to add) "you can tell the trouble makers as soon as they walk in the room"

DH asked me last night (quite late) about what would happen if my waters broke spontaneously, like the DS's, at that time of night - would I have to call the hospital and go in then - or would I wait until the morning.

Told him if it happens like the last 2 times (waters went and nothing else happened) I'd just wait until the morning before calling them (unless of course I woke up at 3am in agony because things were happening ) - he gave me a knowing look and said "fair enough" LOL.

If only! Both the GP mw and consultant both said they would not support me in any way if I asked for a homebirth. I wish I had never mentioned the previous sd to be honest as it seems to have sent them into a panic. Interestingly, it is not even in my notes from last time - they just verbally spoke about it (I think the mw may have been trying to hide it?). I suppose if they did the McRoberts manoevure it must have been a proper sd though. I know they can't force me - I was just shocked at the strength of the opposition I am encountering already though and what worries me, based on my experience last time, is that when it comes to it I won't be strong enough or together enough to insist on my informed choices. One thing I am doing is investigating taking a doula in with me which might help. Also, they make me feel like a selfish professional mother who is endangering her baby just to get a natural birth.

Thanks for your adcice and support - I know that I would be doing the best for my baby by trying to have a natural, active birth but the last experience was so tramatic (for dp particularly) that there is always that seed of doubt.

Hi fannyannie - sorry crossed posts - you are very inspirational! Interesting that you are using a doula too - you're right, hopefully we will just stick to our guns this time - I have to stop being to bloody British!

Hi fannyannie - sorry crossed posts - you are very inspirational! Interesting that you are using a doula too - you're right, hopefully we will just stick to our guns this time - I have to stop being to bloody British!

What's the best way to "not give my informed consent" I have written it all in my birth plan but the consultant totally ignored it!

oh definitely look into a Doula this is my first time using one (hadn't even heard of them for DS1 and 2) but having found a lovely one and being more informed about my choices in the whole childbirth business I'm feeling a lot more confident about making sure I get what I want which will hopefully make it more positive experience for me (I still feel pretty despondent about both of the DS's births and want to avoid it).

Obviously if things go ar*e over tit I may end up being monitored/having a CS/induced/forceps etc etc etc and if that is what is needed for my or baby's safety then I'll go with it - but I don't feel so negative about it this time round because I feel more informed about my choices and it's going to be my birth not the MW/consultants/hospitals.

Good luck

At the risk of repeating what everyone else has said - I would be asking for their rationale on how or why continuous fetal monitoring would be of any benefit to you. A CTG can not predict whether a baby is likely to suffer from a shoulder dystocia! If your previous one is not mentioned in the notes then I doubt very very much that it was a serious one as even if your midwife was trying to hide it, if it had been bad then there would have been lots of other staff involved and it would have inevitably been written up (surely?!)

It sounds as though you're just on the high-risk conveyor belt which includes a CTG without any real thought about whether it is likely to be of benefit to you. I suspect there's a bit of arse-covering going on which is for their benefit rather than theirs A doula sounds like a good idea.

barba - if it's just you and your DH/DP then just say no - if you've got a Doula as well then she can reinforce the fact that you've said no.

At the end of the day if they ask you to get on the bed to be monitored and you tell them no......there's NOTHING they can do about it.

The way I see it is as long as you've done your own 'research' about risks,benifits, blah blah blah of what YOU want in your labour/birth then you'll feel more confident about it.

I knew NOTHING when it came to DS1 - so accepted the CS (without even having an attempt at being induced) without question.

DS2 I knew a little bit more - but still not a lot about what I HAD (or not as the case actually is) to have/agree to and so only really managed to follow my wishes to a small extent.

This time round I've done a lot more reading and talking to people so I feel more confident in what I'm asking for and I'm hoping that will help me on 'the day' to make sure I get what I want because it'll be MUCH harder for them to 'convince' me of the negatives of it.

DaisyMOO - you are so right about the conveyor belt.

Interestingly, there were loads of staff involved - went from the one (useless) community mf in the room to 2 hospital mw's (who did the McRoberts), 2 peadriticians (who did the resusitation) and a full "crash team" with an incubator (whatever they are) who thankfully weren't needed and left after a while - they even put a call out over the intercom and everything. That is what I find a bit strange as all that is in my notes form the original mw who basically spent her whole time writing notes and nothing else (apart from telling me to push and then discovering I was only 9cm after 25 mins with nothing happenning) is "baby stuck at perineum for 8 min", the apgar score and "baby needed resusitation" - then there are all the notes from the doctors which are just about the baby - i.e repeaat apgars and details of the resusitation. The next day the community mw's teamleader came to see me in the postnatal ward and said "I hear you had a shoulder dystocia".

Anyway - doula and informed consent or lack of it seem to be my best bet - thank you and good luck fannie.

Any other thoughts on shoulder dystocia most welcome.

God, that sounds really scary and I am just appalled that it wasn't written in your notes. Very strange. Baby stuck at the perineum doesn't really give the full picture at all, it sounds as though he was taking ages to crown

I doula-d for a friend once whose consultant was adamant that she should have continuous monitoring because of problems with a previous birth. He found it increasingly difficult to justify when we debated this with him and in the end it boiled down to 'because I'm the consultant and I say so'. (Friend went on to have lovely homebirth )

I know, weird eh- I don't think there was much problem with the crowning from what I remember and dp says - certainly she didn't put out the call for help until the head had been out for a while (a minute maybe?)

Anyway, I know I shouldn't dwell on it - I will just practice being forceful and stroppy before the next appointment (not normally a problem tbh, think the emotions are getting in the way with this issue). I was so shocked at her comments that reclining on my back gave more pelvic room than standing or all fours and that is hwat she would be proscribing with CFM that I just left as it seemed pointless to go on with all my questions. I think she must have meant easier to get into McRoberts manoeveure surely but what is the point if that position makes the need for it more likely anyway? I did query that bit and she said it can take too long to get the women from all fours into the McRoberts position and it would be dangerous - utter boolocks as they flipped me over in seconds last time. Did require 2 mw's though, maybe it is yet another resourcing / ease of management thing.

I'm on the high-risk conveyor belt too (though my consultant seems a sight more helpful than yours)

One thing I saw the other day that looked very useful indeed was in the 'interventions' chapter in the NCT 'Your Birth Year' book (from library, worth a look if you can lay hands on it).

They suggest using the mnemonic 'BRAIN' to assess interventions that may be offered / suggested during labour:
What are the Benefits of the intervention to me and the baby?
What are the Risks to me and the baby?
are there any Alternatives?
What do my Instincts tell me?
What will happen if we do Nothing?

Even DH thinks he'll be able to remember that...

FannyAnnie - I've had 2 vbac and no continuous monitoring - the Ist vbac had some monitoring when I arrived and then it was stopped. I seem to remeber the M/W putting the fetal monitor disc on my side when I was kneeling but not sure. The second birth was too quick & I just got to the hospital in time. For the second the birth the doc wanted continuous monitoring but I just refused & got that down in my notes.

I had continuous monitoring for ds and was able to move around. And did. I don't know if I had a different type of monitor though, and I didn't use TENS.

There's a kind of monitoring called telemetry which is wireless and enable you to move round fairly freely. You can of course try and mobilise with the wired-kind, but it depends a bit on the attitude of your midwife and getting a good trace at the same time. Both types though still have one major downside, which is that routine use increases the chance of you needing other interventions, including a cesarean without any evidence that it improves outcome for the baby.

Barbamama, I am a trainee Doula and yes, I always suggest printing out whatever evidence you can find to suport your case. If they ask you to accept procedures you are not happy with then ask them to produce their research based evidence to support their plans. Sit back and watch them fluster!

You sound strong and fairly well informed, keep it up, you'll be fine!!!!

Keep asking the questions and make sure that your bp knows your birth plan inside out. This is where a Doula supports the husband.

I had to find out a lot of info when preparing for my VBAC so tend to be a little bit militant, please bear with me!

Militant is good - don't worry - it is the only way it seems!

Unfortunately, that is what many of us VBACers find....

It shouldn't have to be that way.

Read this thread with interest as I've specified intermittent monitoring on my birth plan in order for me to move about, but am worried about what will happen to my labour if I end up strapped up and unable to move.

Everything I read says it's counter-productive to the labouring process. It's my first baby, and my main worry at the moment is how 'out of it' I'll be to be forceful during labour about my wishes. I plan to resist pethedine, so am I right to assume that I'll remain lucid and able to say no to any procedures I don't like? Or do you become completely consumed with the whole process and pain?

Annie75, you do eventually get too in to yourself during contractions and this is where you need to prime your birth partner of your wishes so that they stand up for you when you shouldn't be interrupted.

It may help you to know how your hormones work in labour... \link{http://www.sarahjbuckley.com/articles/labour-hormones.htmDr Sarah Buckley's hormones article} Read some of her other stuff too.

Be open with changes in labour but also have a firm idea of your wishes. Tell your bp to ask for all pros and cons to every procedure they want to do so that you can make informed decisions.

When you start asking for pain relief that is when you need support, being told that you are coping well, being held and/or physically supported, whatever makes you feel that you are not alone.

Have you written a birth plan which highlights your wishes?