Monitoring during VBAC?

[claraq]

I am hoping to have (try for) a VBAC with this pregnancy - due start of Dec. DD was born by elective section as she was breech, two years ago. I was told by the consultant that I will need to be fairly constantly monitored during labour, which means I will not be able to be particularly active. As I have never been in labour I do not yet know which position would suit me best but am slightly concerned about being tied to the bed if I feel like getting up and walking around/crawling on the floor on all fours etc.

I have read a few comments from people who have gone against advice and done their own thing during VBAC labour. However, is this not putting yourself and your baby at risk? And what did you do - refuse to wear the fetal monitor, or take it off when the midwife wasn't looking? Or can you still be vaguely mobile during the birth even with a monitor strapped to your belly???

Any help or comments on this welcomed...

Can't give advice from experience but I am trying for a VBAC in October after a breech CS. I spoke to the consultant and told him I was not happy being constantly monitored and he said that he would like me to be on the monitor, but that there is no way it should stop be being active. He said it is harder for midwives to fit so you can stand and move around, and you have to stay within range of the machine or the leads ping off , but it's not impossible.

Have you spoken to the consultant about wanting to move around and be active?

Chirpygirl - thanks - yes I mentioned this to consultant and she looked at me like I was a small thing on the bottom of her shoe and made some comment about it depending on whether the midwives wanted to be active as well (image went through my head of both me and the midwife jumping on a birthing ball together....). However will be seeing her again at 36 weeks so can discuss further then...

you dont have to have CFM - you can be monitored with a hand held doppler every 10-30 minutes. everything is YOUR choice.

take a look at aims.org.uk for some great vbac info.

cx

if you do a search, there are a few threads about intermittent rather than constant monitoring

also, stay at home as long as you can , where you can be unrestricted, and listen to your body

i had CFM ,but MWs made me get up and move, leads are quite long..

an impending rupture can be detected not just from CFM...

...and if they do want you to be continuously monitored, ask if they have a wireless telemetry set - some places do but rarely use it or forget it exists .

You still have to wear the belts but aren't attached to the machine itself.

claraq, funnily enough my consultant said 'it does depend on the midwives whether you will be able ot move around' and I replied that I was the one that had to give birth so I didn't particularly care if I made their day difficult (apologies to all MW's reading this!)

I had a home water VBAC so obv no CFM with that! I felt that the risk of rupture was so low with a "natura" VBAC (that is no augmentation, no induction, no epidural) and that there are other indications of rupture that should be more closely observed, that I was quite happy with my choice for intermittent monitoring. As it was m/w only arrived 15 mins before DS2 arrived so only listened in once

I had my 2nd VBAC just over 10 weeks ago.

First VBAC was as "prescribed" by the consultant - monitored constantly, completely immobile. Absolutely awful (I was also induced and had failed painrelief!)

2nd one was totally different because I knew that I didn't HAVE to follow their advice. I was mobile, monitored with a handheld doppler approx once an hour (may have got more frequent if labour had been longer but it was pretty short), I only one internal too - when I first got there. I also refused to have my bloods taken (DS3 was born at 38 weeks - I'd had my bloods taken 2 weeks earlier), and also refused to have a canula put in.

The midwives (there were 2 of them at the start - one of who was there throughout) were absolutely fine about it (I'd written it very carefully in my birthplan - which I'd stuck RIGHT at the front of my notes) - although they gave me the whole shebang about risks blah di blah di blah......adding that "well we could tell you'd done your research so haven't even bothered brining the CFM with us, but we HAVE to tell you this" (litigation and all that jazz).

Part way through labour (bear in mind I got the the hospital at 1.30 and DS3 was born at 4.17 the same afternoon) the senior midwife came in to give me the whole lecture again (I think hoping to change my mind) - told her no....and it was her that I refused to have bloods taken from or a canula put in.

Less than 1hr before I was fully dilated the consultant (no less) came in and also tried to persaude me to have CFM - again I refused (they gave up after that).

My advice is - do your research, get it written down that you don't want it, and make sure that your birth partnener knows your wishes too.

It's perfectly possible to have a VBAC without all the continous (or even intermittent) monitoring.....all though they'll probably try and scare you into it for fear of begin sued if, anything does go wrong.

ooo sorry didn't realise that was such a long post

Hi

I am a VBA2Cer and have had two of them after my failed VBAC attempt I researched avidly about it as I am convinced that the reason my vbac attempt failed was the medics insisting that I had to be permanently monitored.

It is so not true, they like you to be monitored as it makes things easier for them, but it is much better for you to be able to move around as much or as little as you need/want.

When I arrived at labour ward in labour with my second VBA2C the midwife did try to get me on the monitor, I just said that i would go home (and I would have done).

find the ukvbachbac website on yahoo, my only proviso on that is that they are turning more and more homebirth orientated. I had two very positive hospital births, it is your choice.

Good Luck, hopefully we will be reading about your triumphant vbac at the end of the year

One last point, it is dangerous to induce - added pressure on scar in uterus, I went to 42+3 weeks before my dc4 finally decided to make her presence known, the 40 weeks are just an average, don't let them fob you off with the old " we need to do a section now cos baby hasn't arrived yet"

This is all very worrying. I am in a very similar position to original OP - DS was elective due to being breech and will be 2yrs2mths when this one is born in NOv. I want a VBAC so the recovery time is quicker but I really don't want to be strapped down to a bed (sounds totally prehistoric to me!). Am considering hiring a doula to help me (even though DH will be there), so that she can help me fight my corner, but all this 'mw's and consulants want to CFM you' is worrying - I don't want to piss off the hospital staff when I may need them most.

Hello! I feel quite strongly about this....

I had a vbac in 2002, after an elective section for placenta praevia (so was in a similar situation to you, claraq, Chirpygirl and smiling, insofar as my vbac was my first experience of labour). I was so lucky. I had a very enlightened consultant, who was completely on my side about this. He agreed that CFM was unnecessary, wrote this in my notes and signed it. This meant that I was then able to wave his signature before the midwives once I was in labour and put in my birth plan that 'Mr X has agreed that CFM will not be necessary in the first instance'.

I feel that the 'in the first instance' is important. I (obviously) was not prepared to put my baby at risk, and at the first sign of any distress or anything at all that was irregular or worrying I'd have agreed to have gone on the machine. However, as long as thing were progressing normally, I felt much happier with intermittent monitoring. A midwife came and checked the baby's heart every 15 mins or so (... and at one point dd2 was pronounced 'the most laid-back person in this room' so she was obviously not in distress) and they even got a monitor you could use underwater so I didn't have to get out of the bath (I laboured in the bath until I got to the second stage).

You will be much more able (I believe) to labour effectively if you are able to move around, to use water or whatever. It really is worth sticking to your guns on this, if on nothing else (I agreed to having a cannula in, for example, 'just in case', because that battle just didn't seem worth fighting - though in the event I never got one as it moved faster than they thought so by the time they'd found a doctor to do it I was pushing and they decided it was unnecessary). Ask to see a different consultant if the first one you see if unhelpful. Or (depending where you are, obviously) even consider a different hospital (I recommend the Royal Berks!). You cannot just go along hoping that the midwives you get in labour will be sympathetic - you are not in the best position to argue your case once you are in labour. So I'd definitely try to get the consultant on your side now and get his/her agreement written in your notes.

If you do a search on my name you'll find other VBAC threads I've been on which might also have more info. But the CFM thing is really the one thing which, for me, I feel made the difference between a successful VBAC and another section.

Good luck and HTH.

I'll echo Ellbell re getting the consultant on side - I'm not a VBACer but have another risk factor that means the deafult setting for my labour is flat on my back strapped to a bed.
After discussion with my consultant he did exactly as Ellbell's did and has written and signed in my notes 'Would prefer not to have EFM unles indicated'.

Have you met your consultant? Is he reasonable?

I had a VBAC in Aug 05 after an elective for breech in Jan 03. I read all the old threads on here (hi Ellbell - recognise your name!) and the AIMs site, UKVBAC, and some great links mears posted.

I wrote an overly detailed plan which boiled down to no interventions on a 'just in case' basis. So I refused a cannula (even though they waited until my dh went to get the bag from the car to wheel in three doctors to try to persuade me again). I said I wanted to go straight to section if things weren't progressing, no syntocin or ARM.

I agreed to baseline monitoring, on the understanding that if everything was fine the monitor would come off after 30 minutes. dds heart was fast and so I agreed to keep it on. It kept slipping out of position and the staff didn't seem to bothered - that is they didn't rush in to replace the leads.

I had SPD, so limited mobility anyway, but felt very strongly that it was up to the staff to make their machinery work with my positions, not the other way around.

I didn't even see a consultant during my pg (fobbed off with locum SHO) and during my labour, the consultant anaesthetist dropped in, but no one else. If any senior (more senior than a new SHO...) doctor had shown concern, someone who knew what they were talking about, rather than the 'well this is the protocol, even though you don't need a drip now, Mrs X', I would have listened to them.

I think the key is to be clear what you want and to accept that it may not go to plan. My birth plan was written more for my dh's benefit, so he had something to refer to.

I went from 5cm to pushing in under three hours and my mw said that even in women who haven't laboured before, the cervix 'flips' open in second pg. I don't know how general this is, but it was all much faster than I was expecting!

Thank you all so much for your advice. I am reassured to know it is possible to labour without continuous monitoring and will defintely try and push for this to be included in my notes when I next see the consultant at 36 weeks (MrsBadger - my consultant is a she and didn't seem too interested when I indicated I was not particularly happy about CFM but then I wasn't armed with the information I hope to be next time round....).
I have already said I do not want to be induced so it may well be another c-section if I go too far over my dates.
Big up to all of you who stand up to the medical profession. I think I am just a little nervous of telling them exactly what I do and don't want as they are the professionals. But this info is definitely helpful (and hopefully for others too).

hi claraq, thanks for this thread. I am 34 weeks and planning a VBAC after CS for breech. Have just this minute taken a call from the doula who I am going to have supporting me and I am really excited!

I know exactly what you mean about not wanting to annoy the hospital staff- I;m a bit of a "pleaser" and don't like to be obstreperous- however I am sure there is a middle way with issues such as CFM e.g. agreeing to be baseline monitored on arrival, followed by intermittent monitoring on the understanding you'll go to CFM if any sign of distress. I hope that I'll be able to report on a successful VBAC by the end of September!

BTW Ellbell- am encouraged tht you recommend the Royal Berks since that is where I am booked!

good luck to all

p

clarag - the midwifes who looked after me while I was in labour were fantastic - infact one said something along the lines of "it's obvious you've done your reseach" (she even called me an "intelligent woman" ) and they weren't at all bothered by the fact that I stood up for what I knew I was entitled to.

The senior mw, and the consultant were a bit ar*ey but I the contractions were so close together and painful I did't give two hoots what they thought by the time they were talking to me LOL.

Oh - and the consultant I saw during my pg was instant I would HAVE to be monitored blah blah blah.

At the end of the day you have to remember that yes, of course there are risks associated with a vBAC, BUT many of the major things that could go wrong actually have a very low chance of doing so. The professionals simply want you to have the monitoring as form of "damage limitation"..

QOQ... don't be ... You are an intelligent woman!

Pendulum... I had one grotty midwife, who booked me in when I was in labour and commented loudly in my hearing that my birthplan was 'very demanding' . But everyone else was superb and really supportive. I got everything I asked for. I don't know if he's still there (I moved away from Reading in 2003) but if possible you want the male consultant (initials MS). He was really supportive in both my pregnancies. I was in hospital for 10 weeks with dd1, so I got to know the place and staff quite well! I still think of room 13 on Marsh Ward as 'my room', LOL! Mr S also agreed to me using the pool in labour, though I didn't get to in the end as someone else was in there. I had to make to with the bath! If no-one's using it, even if you don't want to use the pool, it's worth asking if you can use the room next to the pool (I think it's room 15) as it's much nicer than the other delivery rooms (sort of home-from-home... though with slightly dodgy Greek-goddess decor iirc).

thanks Ellbell- freakily, I stayed in Marsh room 13 after my CS 3 years ago! I know who my consultant is and it isn't MS, but have been told she is quite accommodating as well. Fingers crossed!

Well, they can't make you doing against your will. They can advise you of their opinions but the only thing they can do is write in your notes that you refuse, against medical opinion.

CFM has not been shown to improve outcomes for baby but has been shown to increase risj of intervention for the mother (I can back that up!! )

Mary Cronk's scar monitoring procedures

Do your research, print out anything you find relevant to keep in a file to back you up. If/when the HCPs make any claims or statements that you're unsure about ask them to provide research based evidence to support them.

Whoa, pendulum. That's spooky! You were in my room! (I was there from March to May 2000). Good luck!

My first (and so far only) experience of childbirth was fully monitored but I stood up the entire time. I was told to lie down on the bed but after a very short space of time I told them to shove it, if they wanted me on a monitor I was standing up. It was much, much more painful to lie down. To be honest, the monitor turned out to be really useful because it was something to focus on ? watching the contractions come in and DS's heart rate which was a bit wobbly. And it told me when to chugg back the gas and air! Also, standing up made the first stage very fast. Went from 0cm to 9cm in 4 hours . They still got all the information from the monitor so don't believe them if they say you can't stand up. Sorry, I have been a long time lurker on mumsnet but this is my first actual post. Be kind!

Did quite a bit of research on VBAC some months ago and have a recollection that the risks associated with c-section are greater than the risk of scar rupture in a spontaneous labour.
Unfortunately can't remember where I read this, and anyone feel free to tell me if they know for certain I am wrong. But I am using this information as another "tool" for insisting on VBA2C for me when the time comes!