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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

OB says I need Continuous Fetal Monitoring for VBAC, any advice?

57 replies

canadianmum · 29/08/2007 15:39

My twins were born by C-section at 32+5 due to severe pre-eclampsia so I have never been in labour. This time I am having one baby, have no signs of pre-eclampsia and am already 37+4. So I told the consultant (his dogsbody) that I wanted a VBAC and he was cool with that, but says I must have Continuous Fetal Monitoring from 3-4cm dilation, due to tiny risk of uterine rupture.

Anyone else been told this? Can I say no? Has anyone had successful VBAC at home or in a birth centre under similar circumstances?

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NKF · 29/08/2007 20:01

I think most hospitals use continual fetal monitoring with vbacs. If you're prepared to sign some sort of waiver, then you can probably avoid having it.

Klaw · 29/08/2007 20:01

Yes Canadianmum, chemical induction is not advised as it increases the risk of UR. A Foley Catheter is shown to be most like spontaneous Trial of labour but is not used much in Britain afaik. However, I do know that my local hospital as a few samples of a specifically designed Cervical Ripening Balloon which they will trial and this may become a much better form of induction for all, not just VBACs. As this does not introduce chemicals, instead manually dilates and encourages prostaglandins. If I HAD to be induced for a good medical reason (rather than merely past 40wks) I'd want that.

Original poster

canadianmum · 29/08/2007 20:04

Klaw - definitely never heard of the ripening balloon before! Might just ask midwife next week, although obviously I am hoping to go into beautiful spontaneous labour the day before my due date .

OP posts:

Difers · 29/08/2007 20:16

I've not had a VBAC but had CFM as had preeclampsia and an induction. I stood and leaned over the bed for a good few hours and insisted on taking the monitor off to go to the loo etc.. I also was monitored sitting on an armchair so although movement was restricted I could use positions that I was comfortable in...I hope this helps.

ejt1764 · 29/08/2007 20:19

canadamum - I am at 35+ at the moment, and am going for a vbac. The birth of my son was a horrendous experience, and I can't cope with the thought of being tethered to the bed again.

As a result of this, I have done what is called "declined the package of care offered to vbac women" ... I have declined cefm, and am in fact going to be delivering (if all goes well) in the mlu of the hospital, in the water.

I will still be monitored, but every 15 minutes by a mw with a hand-held device, rather than being tethered to the machine. If things are not going to plan ,then I will be transferred to the clu, which is in the same hospital, and I'll be going for a repeat section, as I just cannot cope with the thought of the damnable machine again.

It is not your doctor's place to decide for you what you will and will not have in labour. You are entitled to decline treatment.

Good luck - I have my 36 week appointment with the consultant next week, and fully expect the same sort of bullying tactics that you've experienced today. It won't change my mind though ... it's my body, my baby, and my choice.

Original poster

canadianmum · 30/08/2007 19:25

ejt - thank you so much, that is exactly how I feel. What angers me is that the actual consultant has never even spoken to me, it is actually just his juniors who tell me "that is the protocol". I have decided something similar, I will have my labour either mainly at home or more probably in the midwife led birth unit which is situated a 2 min wheelchair ride from hospital. I will have the 15 min checks too, and transfer if anything looks dodgy.

It is heartening to hear that someone else is in the same position! Good luck with your appt., maybe you will be lucky and get a doctor who is willing to compromise.

To be honest I think we are likely to have a higher standard of care in a midwife led unit than we are in a clu where they just tether you to the machine and then dash off to look after other women. After all, September is meant to be the busiest month for births......

OP posts:

Chirpygirl · 30/08/2007 19:52

Good luck you two! I am in the same boat (sort of) in that I am after a vbac having had a cs with DD 18 months ago, I am 35 weeks now.
Only problem I have is the birthing centre won't accept me, the hospital wont allow me in the water and my midwife could not have been less supportive when I mentioned a home birth, in fact she scared my poor DH so much that he is dead against it now!
Luckily my consultant is quite reasonable and has agreed I must be allowed to be mobiel, but is still insisting I am strapped up all the time, not sure how they are going to go together but we shall see...I might not make it into hospital until teh very last minute!

ejt1764 · 30/08/2007 20:01

canandianmum - I have decided, through much thought that the line: "it's the protocol" is the line that HPs trot out when they don't have evidence to back up their claims! I'd advise you to write in your notes (write it in yourself if need be) what you have decided. If you don't feel comfortable writing it in yourself, then ask your midwife to do it for you. Good luck!

chirpy - bad luck about not being allowed access to the birth centre ... although, if you turned up in labour, they'd have a difficult job turning you away

I would enquire of one of the unit MWs if they have a telemetry monitor ... you'd still have the straps on,but it's remotely monitored - hence you're not tied to the bed.

Also have to point out, that if you want to move, you are perfectly entitled to take the straps off - your consultant is not going to be there with you when you are in labour: in fact, a doc won't be called unless there's a problem (and, God willing, there won't be). I'd think about phoning the unit itself and asking to speak to one of the midwives there about your desire not to be strapped to the bed. Good luck!

In fact, good luck for all of us going for vbacs ... I'm due Oct 2nd - I'll look out for your birth announcements!

Chirpygirl · 30/08/2007 20:09

Good idea, in theory, unfortunately the 'birth centre' round here is through a pair of doors next to the consultant led centre...so they can very easily turn me away!

I did tell him that I would just remove them and got some veyr shocked faces, like I saida I was going to doa home cs or something!
I have my 36 weeks appt soon so shall see what he says then....

Im due Oct 6th so not far behind you!

DaisyMOO · 30/08/2007 21:04

Chirpy - some people have found that if you call their bluff and say you will have a homebirth if they don't allow you to use the birth centre that they change their minds and let you in! Might be worth contacting the head of midwifery and seeing what they say. Good luck.

ejt1764 · 31/08/2007 10:12

To second daisymoo (hiya!), one thing I did to get me booked for the midwife led unit was to say that my ideal was a hbac ... they weren't to know that it wasn't really!

morocco · 31/08/2007 21:04

had great home vbac (after vbac in hospital though) and didn't have cfm either time. the mw were really good at doing regular checks instead and i felt very looked after. i remember going for the 'lecture' before booking my hb and being told the bad thing about hb is not being able to use cfm and saying 'oh but i wouldn't be using that anyway' to shocked faces. i guess not too many people say no to it?

DaisyMOO · 31/08/2007 21:08

ejt - hi - your due date is the second anniversary of my HBA2C! Maybe that's a good omen?

Pammi · 02/09/2007 13:47

I am just getting over a nightmare second birth during which the previous scar on my womb ruptured. Had I not been monitored, this would not have been picked up as quickly as it was. I was rushed into theatre and thankfully baby was fine, but the outcome could have been very tragic if it was left undetected. I would advise being monitored - scar rupture is rare but does happen. Better safe than sorry.

Klaw · 02/09/2007 13:59

Pammi, so sorry to hear about your experience! How long ago did you give birth? Do you want to talk about it some more? I'm a doula and just had a client suffer a rupture... did you have any other signs other than the CTG? How are you coping emotionally now? Have you asked to get a copy of your birth records? (you can get them free within 40 days)

Rupture is a very real risk, but tiny and less than some risks of elCS. It is something to be considered with due respect and so I'd love to hear more of your experience if you are able to share.

Hope that you are continuing to recover well.

ejt1764 · 02/09/2007 14:05

Pammi - sorry that you had a bad experience - I know that the risks are small, but it never helps when it happens to you.

DaisyMoo - I like the good omens ...

puffylovett · 02/09/2007 14:11

hi, i haven't had a vbac, however because i went 18 days overdue they did advise me to have cfm in case baby got into distress due to meconium etc.

i declined and they insisted that they would have to monitor me every 15 mins, whcih was fine. however, in the end no-one bothered to come in an monitor me (must have been busy that night) so i almost birthed him myself !

my point being, that even if i had been on cfm, the fact that no-one entered the room to even look at a machine would have meant that any distress wouldn't have been picked up anyway. hope that makes sense !

at the end of the day it's your decision, your body, your intuition , but they are the experts and they do have your best interests at heart.

mears · 02/09/2007 14:11

canadianmum - I have looked after women having VBAC and not done continuous monitoring and even used the pool.

Scar rupture can be detected outwith fetal continuous fetal monitoring by using observation and closely monitoring maternal pulse The risk of rupture is very low and it is best for labour to start on naturally. That neams no induction at all.

If you have an epidural you must have continuous monitoring as the signs of rupture could be masked.

Klaw · 02/09/2007 14:27

Mears, >

Can I talk to you about my lady who's scar separated this week? I'm talking to all sorts of people on this and would dearly love some more mw opinions...

I don't have CAT facilities so if you willing to chat would you please contact me via my website on my profile?

mears · 02/09/2007 14:55

Done

Original poster

canadianmum · 02/09/2007 15:18

pammi - so sorry to hear about your dreadful experience. I hope you are healing well and enjoying your baby.

mears - I will definitely have CFM if I have an epidural or even the slightest sign of something worrying during labour. I just don't want to start off with a highly medicalised birth IYSWIM. If I didn't have a private midwife who is paid to just be with me then I would probably give my consent to CFM from the beginning.

As puffylovett (love the name!) wrote, it is more important to have a human being having a look at you than a machine, but I know that some consultants LOVE their technology.

klaw - hope you get the help you need, how is your lady doing??

OP posts:

ejt1764 · 02/09/2007 15:54

hiya canadian mum - I'm in the MLU where there's not CEFM anyway, but I have been told that they'll be monitoring me with a hand-held device every 15 minutes or so anyway ...

CEFM would make it impossible for me to use the pool - which I'm praying is a available when I go into labour!

mears - thank you for reassuring me that there are MWs out there who are comfortable with the idea of vbac women using water ...

klaw - I'm so sorry to hear of your lady's problems - I hope she feels up to talking to you soon.

Klaw · 02/09/2007 17:22

Ejt1764 - so do I! Selfishly so that I can get some answers but mainly so that I can provide her with answers. We ALL know how hard it is to deal with something if we can't talk to someone about it and our thoughts just go round and round and round......

Canadianmum - I don't know how she is, they've withdrawn from me

Please talk to us Pammi, we must learn from these experiences.

Klaw · 02/09/2007 17:25

I believe in Mary Cronk's Scar monitoring procedures but there was no time for any of that with my lady.... Maybe she should have gone to hospital earlier but she was wary of going in too early and ending up with unwanted interventions...

I'm now wondering if she feels I let her down...

ejt1764 · 02/09/2007 18:47

Klaw - you were acting as a doula, rather than as a midwife ... the important thing is that you supported her in her decision to go to hospital - and that she got there in time.

Was there a midwife there with her at the time?

Thanks for the link to Mary Cronk's guidelines for scar monitoring - I have printed off a copy, and put it in my notes!

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