anyone "refused" to have continual monitoring for their VBAC attempt? Confused and emotional!!

[basilbrush]

My son's birth was pretty scary, I was going for a HB but transferred after 17 hours of proper labour on midwife's advice for slow progress. (was 6 cms) Placenta abrupted on way to hospital in car, was zoomed into emergency theatre and DS, although small at 5lbs as placenta had been failing for some weeks, was OK, thank god.

I have been told that the chance of a repeat abruption is very small but DH and I are going for a hospital birth this time just in case. I am 33 weeks and was scanned last week to check on baby's size and will be again at 36 weeks. At moment, baby is bigger than DS was at same scan which is good sign.

I have read up on VBAC and know that my best chance is to keep mobile, find positions that suit me, etc etc. I want to be in the midwife led unit which is literally down the corridor from the cons led unit in the hospital so if there is a problem, I can be transferred in two seconds.

However, consultant told me last week that because I've had a C section I have to be in the CLU, strapped to foetal monitor throughout my labour, with IV drip in hand and nil by mouth in case I need surgery. I think this will radically reduce my chances of success.

She got grumpy and said that my only option is to sign a legal waiver saying I don't want continual monitoring if I want to be in the MLU and gave me a lecture about how intermittant checks every 15 mins still leave plenty of time for my baby to die...

I am very torn. Should I sign the waiver or should I just accept that my DS did almost die and I should just do what I'm told?

HELP!

How/why does CFM not improve baby's safety? Why would hospitals do it if it doesn't? I am quite certain my baby would have died without it.

P.S. my mum gave birth in the 1950s completely naturally but in hospital. She wasn't "blacked out". She didn't have forceps.

shouldbeworking, can see you are intrigued , my reasons were pretty much as mistermoo describes. I am also quite happy with fairly high risk in life in general, both for me and my family, altho I don't feel my decision to have a hbac was particularly risky. deep down, I was also very freaked out at the idea of hospital, I decided on hbac quite late on, after the hospital tour. I'm a bit hospital phobic perhaps, based on long series of hospital stays for me/my family, often also involving misdiagnoses, poor medical treatment, incorrect drug prescription etc etc etc. It doesn't help build any confidence whatsoever in the whole hospital 'experience'

just been googling something else and this article explains exactly why I feared a hospital birth, at least with a planned hbirth you get 2 midwives
www.dailymail.co.uk/pages/live/articles/health/womenfamily.html?in_article_id=444833&in_page_id=1799

I had a long heavily medicalised labour the first time and felt trapped by the machinery. Then I had a VBAC with CFM and I didn't notice it. My husband swears it was a different kind of gadget. I can't remember but it didn't make me feel immobile and I can't even remember having it. It might be worth checking out exactly what they have in mind.

Eekamoose - It does seem bizarre, I agree. Obviously I don't know about the circumstances of your baby's birth, and you may well be right that CFM saved him/her.

(As it happens, it probably saved my daughter too. I was pressurised unecessarily into having augmentation, synto drip got blocked for 2 hrs without anyone noticing, then simply unblocked when discovered, leading to a massive influx of the drug that had backed up over 2hrs, huge, long ctx and DD's heartrate dropping to 60. Obviously by then no-one was in the room to see this happening to the monitor, apart from me and DH, who had to go running around corridors to find someone, anyone, to help)

But apparently now even the Royal College of Obstetricians and Gynaecologists recommendations are that CFM is not beneficial in normal labour (this wouldn't include labours once an epidural or augmentation was in place, I expect).

I too, do not understand why it is still routinely used in hospitals. I guess that maybe some of the following might be half-explanations... that some doctors/midwives don't always have the ability to keep up-to-date with the latest research, that some hospital protocols take a long time to change, that some pp, perhaps particularly those with a scientific mind (e.g. doctors) prefer the appearance of 'certainty' and sense of 'control' that a machine-that-goes-ping gives, as opposed to the messy unpredictability of every individual woman's labour and baby (for which, I cannot blame them)... but, I really don't know!

Eight studies covering vast numbers of women (35,000 in one American trial) have shown that CFM does not improve the outcome for the baby and may actually harm it. It seems that CS and forceps rates (33% in one study) are increased because CFM picks up 'distress' and is acted upon more frequently, but the outcome is not improved by the operative delivery. This can explain why so many babies born operatively because apparently 'in distress' are found actually to be perfectly fine at birth ie APGAR scores were over 7. (If a baby is born with APGAR scores of over 7, I understand, it is unlikely they were ever truly 'in distress')
And operative deliveries have higher risks for both mother and baby than a vaginal delivery .

The reason for this is hypothesised to be that prior to CFM, some indications of distress might naturally (and normally) have occurred at certain points in the birth, e.g. as the head moves down past the ischial spines. These changes would not have been picked up before because the equipment wasn't sophisticated enough, but are now, and often interpreted as 'distress' needing an immediate surgical delivery.

dunno if that helps... I am also intrigued as to why this is...

I had a VBAC without continuous monitoring, Basil. However, I did it with the support and blessing of my consultant, who agreed with me that there was absolutely no need for continuous monitoring and wrote in my notes that he agreed to intermittent monitoring (and I asked him to sign it, just in case, and he did!).

I did agree to the cannula and to them taking bloods to cross-match and save, even though I have veins the size of the M4, which you could drive a truck down, never mind a needle. As it happened, things progressed quickly. This was back in the day when they had to get a doctor to come and put the cannula in (I gather midwives can do it now), and by the time the doctor arrived I was in transition, took one look at the needle, threw up in her general direction and she decided not to bother! The cannula is annoying, but it wasn't a 'deal breaker' for me. The key thing for me was to be able to move around, get in the bath, or whatever.

It really makes me a bit that hospitals are so insistent about the CFM, but they are still willing (at least, they were when I had dd2, which was now 6 years ago) to induce women who've had a previous section, despite the evidence that induction massively increases the risk of scar rupture. They also seem to be willing to give epidurals to VBAC-ers, even though the epidural can mask any unusual pain from the scar. And yet they are so hung up on CFM. The midwives who were with me when I actually gave birth were fine about it, but the one who admitted me wasn't at all happy. I just kept repeating my mantra: 'Read my notes. Mr S. has signed them. He says it's not necessary.' [V grateful to Mr S. emoticon ]

Good luck.

Sorry, meant to add that it might be worth asking to see a different consultant for a 2nd opinion.