Suggestions on how to "persuade" doctors/MWs not to continuously monitor?

[kookiegoddess]

Looks like i'll be induced at 37 weeks due to cholestasis.

Any suggestions for polite ways to request no continuous monitoring and intermittent monitoring instead? Anything my DH can do/say? Am very anxious about being made to stay on the bed and am worried that my anxiety will then impede progress and lead me down dreaded CS route. ANY tips gratefully received.

Ask if a mobile monitor is available. If they say no then ask if you really need the monitoring or if it can be done your way. I was continuously monitored though and it was fine; I needed the reassurance, as I have a bad history with birth. It's not all bad.

there is some research available in the cochrane review IIRC that shows CFM makes no difference to outcome

you are perfectly within your rights to make an informed decision to refuse continous monitoring and have intermittent

AIMS is good for advice on this sort of thing

Don't get an epidural (or wait as long as possible for one). Once you get the epidural you will have to be monitored.

I was induced with ds1 and it was a great experience. I did have a mobile monitor and although I didn't feel like walking around it allow me to move around more. Although it is harder to stay in place when you're moving so it may just be a huge pain in the ass.

Tell them (not ask) that you will only accept continuous monitoring if you can remain mobile and upright, otherwise you will only consent to intermittent monitoring.

Remember that it's your body! It doesn't matter what "hospital policy" is if you don't consent.

Practice saying "Thank you for your advice, but I am only prepared to consent to intermittent monitoring" and repeating it as often as required.

If you find yourself having been manipulated into continuous monitoring with a lack of mobility, take a trip to the bathroom. The sensors will need to come off, and it's up to you whether they go back on again.

Lulu and P&L are quite right, but also consider consulting your consultant (yes yes, very funny)

mine was fab and wrote in big letters in my notes 'No intervention unless clinically indicated' and signed it, so any junior doc reading it knew they'd have to answer to him.

Will chat to AIMS people on monday.

Am concerned that they will try to dazzle me with info or say things that make it sound like they have to - has anyone experienced this? I know that I find it difficult to disagree with doctors and when I try to put myself in the situation, I see myself either getting totally emotional or losing my temper and attempting to give birth while locked in a loo...

Please tell me it's going to be ok!

NICE guidelines say

NICE clinical guideline 70 (Induction of labour)

"1.6.1.3 After administration of vaginal PGE2, when contractions begin, fetal wellbeing should be assessed with continuous electronic fetal monitoring. Once the cardiotocogram is confirmed as normal, intermittent auscultation should be used unless there are clear indications for continuous electronic fetal monitoring as described in ?Intrapartum care? (NICE clinical guideline 55)."

NICE clinical guideline 55 (Intrapartum care)

"1.6.23 Changing from intermittent auscultation to continuous EFM in low-risk women should be advised for the following reasons:
? significant meconium-stained liquor, and this change should also be considered for light meconium-stained liquor (see recommendations 1.11.1 and 1.11.2)
? abnormal FHR detected by intermittent auscultation (less than 110 beats per minute [bpm]; greater than 160 bpm; any decelerations after a contraction)
? maternal pyrexia (defined as 38.0C once or 37.5C on two occasions 2 hours apart)
? fresh bleeding developing in labour
? oxytocin use for augmentation
? the woman?s request."

Have that printed out and ask them to explain how their advice fits with the NICE guidelines.

Although I notice that that does advise continuous EFM if you're on oxytocin (which seems likely if you're being induced at 37 weeks). It's still only "advise", though. Might be worth reading guideline 55, which has a whole section on oxytocin and EFM.

Do you have to be induced at all? I read somewhere that they don't need to induce for cholestasis anymore (sorry, can't remember where!) unless you have evidence of jaundice i.e raised bilirubin. If you can put up with the itching, you may be able to hang on but I expect you'll need to deliver in Consultant Unit.

Do you have to be induced at all? I read somewhere that they don't need to induce for cholestasis anymore (sorry, can't remember where!) unless you have evidence of jaundice i.e raised bilirubin. If you can put up with the itching, you may be able to hang on but I expect you'll need to deliver in Consultant Unit.

Port and lemon thanks so much for finding that, will print out, or perhaps laminate and attach to my belly...

HH - am planning to try to see OC experts at Queen Charlotte if poss for a 2nd opinion... hope they'll tell me if induction is best thing based on my results etc. No idea if they'll let me speak to them tho if I'm not at their hosp.

I was adamant that I would just take it off if they couldn't 'find' the mobile unti and make them put it back on. The consultant wasn't best pleased but the MW there said, (as an aside) we would put it back on you evey 10 mins or so, but if you keep taking it off there isn't much we can do.

For what it's worth though, I didn't take it off as I completely forgot it was there, I had extra long cables as my notes 'warned' I would remove it, and although I stayed on the bed I managed to kneel and ended up leaning on my hands and knees for most of labour and gave birth sitting up, so it needn't restrict you.

I might get flamed for this post, however I have had 2 babies induced at 37 weeks for cholestasis and feel that my experience is relevant.

I would recommend the induction at 37 weeks with an epidural and continuous monitoring. This is what I had with my DS (first baby). Accepting that this was what was going to happen, the birth was absolutely fine and everything healed fine and DS was fine.

My personal opinion on your best way forward is this: think about the sort of birth I have described - it was absolutely fine, I was calm and everything was under control. I would also urge you to try and accept that the doctors are doing the best for your baby (and you).

I am all for doing things naturally, if it is appropriate. eg I exclusively breastfed my DS for 6 months following a "medical/unnatural" birth. However, if you are being induced with a drip, my opinion is that the baby should be monitored and an epidural is an extremely effective method of pain relief.

Re the bilirubin reading of 10 on your other thread - that's perfectly normal.

Re not being induced at all for cholestasis: there's not much evidence about and there is no categoric answer. I had another baby earlier this year and she was also induced at 37 weeks. Better to be safe IMO and deliver to avoid any problems resulting from the cholestasis.

Could you find out how they'll induce you? I was induced with gel when having dd (admittedly not at 37 weeks) and no-one ever suggested continual monitoring until it all went wrong (pyrexia, meconium etc).

It may not be that bad - with ds (not induced) they were worried about the trace and his heartrate wasn't recovering between contractions so I was monitored continuously. I couldn't move too far from the bed but was pretty mobile on the bed - don't remember it being too much of a problem (though it did slide off quite a bit)

I was induced as I was overdue and had an epidural and continual monitoring. Well, I don't know how anyone could get through it without an epidural as the contractions were so frequent and I had a long labour.

I am so glad I had to be monitored continally. DD's heartbeat was all over the place and they were worried. Nearly had to have a c-section. Surely, without monitoring, they would not have been aware of this?

here is the reference for the Cochrane review

I can see both sides though.

I dug my heels in & refused CFM for my VBAC attempt - managed to get the consultant to agree to this (didn't get VBAC in the end, had el c/s, long story)

BUT

had my labour augmented with first labour & had CFM (didn't know I was "allowed" to refuse first time round ) Yes it restricted my mobility, but DD ended up getting distressed during contractions (apparently a lot more common when labour is augmented/induced) & I had to have an em c/s. If I hadn't had CFM they probably wouldn't have picked it up so quickly & who knows what might have happened

Ask if they have telemetry (wireless CFM) that way you get the best of both worlds

if you feel you've made an informed decision to refuse cfm, then just smile (this is before labour begins lol) and say you don't want it thanks. if pos, get it signed up in your notes that you refuse it. also write it on your birthplan so you can point at it in labour or get dh to point at it. repeat endlessly as required. you can get into arguing about stats and reports but you don't have to if it's not your kind of thing. you can of course also change your mind at any time if you decide to

You can always say that whilst it's true that being continuously monitored may allow the EARLIEST detection of "something being wrong", you find it too uncomfortable to relax, which I did. Had intermittent all the way through. But it was tiring having to stand my ground.

From PAL's NICE guidelines, I fell into the category of "audible decelarations" after a contraction, but my assertion was that she made me lie flat on my back, thereby compressing the placental blood flow, hence the one deceleration that she heard.

I'm not sure that you can realistically refuse continuous monitoring if labour is being induced/augmented with syntocinon (oxytocin) as they're quite within their rights to just refuse to continue with the induction if they feel it is unsafe.

Would definitely recommend telemetry if you do go for monitoring, I've seen it work very well.

I think the issues re: continuous monitoring are different for women with complicated pregnancies. For low risk women it's clear that CEFM has no benefits if labour is progressing normally. You really need to talk to the OC consultant about how your baby may benefit (or not) from CEFM in labour.

Either way - it is your right to refuse monitoring.

As a high risk mum (I had gd in both my last two pregnancies) I chose to forgo CEFM with both babies initially. However, once I needed my labour augmenting with my second I was happy to accept it because I feel that interventions of this sort (induction and autmentation) carry additional risks for babies and justify the use of CEFM. I didn't find the monitoring a problem. I had a doula and an IM who kept me upright and mobile while helping me not become exhausted. Have you thought of having a doula? It might help you feel more relaxed about the interventions that you are likely to be offered.

Hiya,

I was induced due to pre-eclampsia at 38 weeks. I had CFM once labour was established (I had gel pessaries only) I said that they could monitor me standing up and leaned over a raised hospital bed for most of the labour then swatted, semi squatted on the bed, later on leaning on the headboard for support. I just strapped the monitor on with the pink straps and it didn't move and they got an acceptable reading, I couldn't lie back without being in extreme pain due to symphsis pubic dysfunction anyway. My birth was totally great, no pain relief, 6 hours, it was well worth the effort standing up to just have a easy painless birth.

yay for yr lovely birth poohbah! Am trying to keep an open mind for now and will see what docs say/suggest before having a tantrum unnecessarily...Thanks everyone for advice and helping me to see I need to pause and reflect before deciding about monitoring.