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

Dr Sarah Buckley's hormones article .... D'oh!

Annie, I only had TENS and Gas & Air last time and i did feel like my decision making process disappeared towards the end - I think I might have overdone the G&A. I think, from what everyone is saying here, the trick is to make sure your dp/dh or doula are aware of your wishes and will advocate for you - egthe BRAIN thing - I had heard of it but was in no fit state. Also, you have to have a degree of flexibility to respond to whatever happens on the day. In my experience, I am sorry to report, the birth plan is not worth the paper it os written on - all that will make a difference is being loud, vocal and being a pain. Don't worry about being polite/offending them - this is where I went wrong. In a hospital (again in my experience, may not always be like this) you will be processed along thepath of least resitance, least resitance, least amount of time and most easy for the staff to manage unless you really make your feelings clear. Plus they always have the upper hand as they can just tell you what you are suggesting is dangerous for the baby if they don't want you to do something which is very hard to resist, esp first time around.

Of course all this seems to happen more once you have been labelled high risk - hopefully your pg won't have any compliactions and I'm sure it will be much less of a problem.

Thanks for the replies Klaw and Barbamama. And thanks for the link Klaw - just read the article and it's a lovely overview of how hormones work. Funnily enough, that's exactly the situation I think back to when I think of labour - the time when my cat had kittens at the bottom of my bed when I was a child! Animals do seem to have it sussed.

I do have a birth plan, but yes, am concerned that at the mention of 'slow progress/baby in distress/unable to monitor heartbeat' the DH will panic and I'll find myself in the next passing ambulance! Maybe I'll talk him through the BRAIN mnemonic as well as my birth plan.

Not read all replies so sorry if repeating, BUT;

I hoestly can't think why a previous shoulder dystocia would mean that a ctg is needed this time. Other things such as a previous section, or abruption then yes I can see the rational.

If you had been on a ctg last time it probably wouldn't have shown anything unusual up until the shoulder actually got stuck. Ask your m/w or ob to show you some research that says that this needs doing - bet they can't.

SKSS, I said to ask them to produce evidence based research in an earlier post! Do we know each other?

I said to sit back and watch them fluster! Am getting very militant in this thread! and in many others mind you, as a staunch VBACtivist, I have to be careful not to come over too strong!

nice to meet you! >

Thanks for that - I am preparing my evidence for the nest appt and will indeed ask them to produce research based evidence - it is great to know I am not suggessting anything dangerous as they make out - thank you all, will let you know how the appt goes.

Just wanted to add a big 'GOOD ON YOU' for standing up to the beaurocracy that seems to be our NHS these days!
Am having similar trouble with clauses and 'just in case' scenarios over my birth - think you are right that they are mainly interested in ease of management from their point of view.
Hope you manage to stay strong and resist it.

Not sure this is the most up to date version but you may find useful anyway. Interaction of points 2.1 and 2.2 in Guidance most relevant: www.nice.org.uk/page.aspx?o=16818

Likely to have to go through this situation with my pg, except this time will have benefit of insider knowledge from SIL who is snr mw .

She has previously suggested to me that you go through your birth plan with midwife as soon as you meet them, and if you can't agree how you will manage your wishes and her professional advice, ask to speak to supervisor of midwives on duty.

I know there is a lot of pressure but I'd agree with other posters about the BRAIN stuff - unless the Benefits are specific to you and your baby and the Risks explained and accepted by you, go with your instincts.

No need for continuous monitoring because of previous shoulder dystocia. Just say you do not want it! Intermittent auscultation is the term for used for listening in every 15 minutes for 1 full minute after each contraction.

Just let the staff know you don't want to be continuosly monitored unless there is a problem picked up listening in intermottently. I am a midwife and am very happy not to use a monitor.

Thanks that is very useful!

That sounds like very good advice to go through birth plan with the midwife - problem is I won't meet them unti I get to the hospital to deliver and last time I was5cm dilated and in no fit state. this really annoys me - so much for one woman one midwife! I have my checkup appointments at the GP with a community midwife who does not do the deliveries - I will get whatever hospital midwife is allocated on the day. Funnily enough I was thinking of phoning the supervisor of midwives at the hospital to ask advice about how to get the message across so will def do so.

Thanks!

barbamama - what you can do is ask to speak to the senior midwife of the labour ward. Where I work, I meet women when they come in in labour, however I discuss with them what they want for their labours. We have had women meet with the senior midwife to discuss any areas of concern and then the co-ordinators of the labour ward are notified of the woman's wishes in advance. It will do noo harm to do this. Your community midwife can help you arrange it.

Oh the good old conveyor belt / protocols / guilt trips etc. I completely sympathise.

I'm on my first and have been labelled high risk because of 1 impaired GTT test (even though blood sugars been normal since & baby being correct size / & everything else OK.)In spite of everything being normal - they still want me to have induction by 40 weeks/Epidural/CFM & be stuck to the bed in the High Tech Delivery Unit instead of the midwife birthing unit I wanted etc - 'just in case' & I hate the thought of it.

I sincerely believe all of these things with their increased risk of intervention etc will be more of a risk to me & baby than what might actually possibly go wrong linked to my blood sugar level which is now - no different to any one elses ! I know they are just covering their own back - but I don't feel like a real person any more - just a 'high risk case stuck on the conveyor belt.'

They just make you feel like a bloody helpless selfish idiot - rather than the well informed intelligent woman you actually are !

Good luck - I'll be thinking about you.

jojoxx

Jojo, I suggest that you follow your instincts too and if that means saying no their 'offers' and waiting for spontaneous labour then so be it! If all goes well you'll be pleased you trusted your body and if you need help with anything you will be entitled to it just like any other first time with an unexpected problem.

You are an individual and deserve to be treated as such! We all grow at different rates, and there are many variations on the norm.

Ask for evidence based research to support any of their claims.

jojo - I agree with klaw. No need to go along with protocols if you don't agree. It is meant to be 'woman centered care, not dictated!

jojo sympathy for you too! This is exactly what happenned to me first time (high bp not the GTT) and I do feel it made things worse. I wasn't really aware that I could say no, and you always worry about the safety aspect - I fought so hard to get into the birth centre instead of the labour ward but never managed it - hopefully you will have more luck. My firend recently did this by deliberately not taking her notes with her on the day so they didn't know she'd been classified as high risk! Not sure I'd have the guts to do that! As long as you know you and your baby are healthy don't let them bully you too much - good luck!

Thank you so much for your support Ladies & sorry for butting in on your discussion - but it really struck a chord with me - it's so nice to hear that I'm not the only only one who feels like they're invisible !
Good luck to you Barbamama - hope we both get what we want !

xxxx

Hi if anyone is still following this I just wanted to let you know that I was at the hospital today and asked whether I could make an appointment to see the supervisor of midwives, as suggested on here. She saw me straight away and was lovley. She agreed with me that the consultant who told me I would have to be lying on the bed with CFM becausue of previous shoulder dystocia was talking rubbish. She immediatley made me an appt to see a different consultant who the midwives all favoured because she had a much more modern approach in line with theirs. She said she saw no reason for CFM - as you all said, intermittent would be fine, they would just keep a closer eye on the baby's descent etc at the time and have the registrar nearby in case. She said they would also keep a closer eye on the size of the baby and his positioning - all of which is fine by me.

So thank you all for giving me such good advice - I feel much better now and am no longer dreading the birth. Whatever happens on the day, I know the midwives will be amenable to letting me have an active natural birth if possible. thanks!

great news, you must be so pleased!

i hope it encourages other women to question their consultants or midwives when they are not comfortable with the advice given

I am and am so glad I did - they were so nice about it and it turns out that that particular consultant has got a reputation for being a bit of a dinosaur so I was just unlucky - I feel so much better as I was dreading everything being a big fight and hassle again. I don't think I would have questioned it if you all hadn't made me feel that I wasn't being a selfish mother wanting to endanger my baby just to get a better experience than last time so thank you all again.

Well done barbamama.
Agree that IME mws are generally v supportive of what you want, but you have to vocalise.
Advise JoJo to be beligerent - even if you are induced with a pessary, doesn't necessarily mean you have to have a drip/epidural etc to assist with the 'hospital conveyor belt system' as Daisymoo says.
I agreed to be induced at 39 wks with both mine (pessary only) due to 'borderline' raised BP although no symptoms such as headaches and had completely fine pregnancies both times, not even any morning sickness (so was induced to ar*e cover as mentioned by other posters). With DD last year, after the first few pushes, told Registrar to leave me alone when he suggested getting the epidural going - felt fine and she was born about 3 hrs later. Didn't even have gas and air. Mw said good on me for telling Reg to go away!
So would emphasise that whatever issue has identified you to be 'high risk', you are still the patient and you have the right to demand the labour you want in hopsital. Is quite difficult to vocalise when faced with a knowing healthcare professional looking smug (and I mainly work with men all day so am as ballsy as they come!), but as advised on here, get your DP/DH gen'd up as well so that he can advocate.
Sorry for long post.
Hope all goes well for you all!