Why is constant monitoring insisted upon with a VBAC

[eastendmummy]

I'm 33 weeks with DS2 and am planning a VBAC. I had a very traumatic labour with DS1 resulting in an em c-s for fetal distress. It has taken a lot of talking with a counsellor plus being caseloaded by the hospital so that I now have the same midwife throughout care and delivery to make me confident that I can have a successful VBAC. I was absolutely petrified about the birth from the minute I got pregnant but now feel positive that my body is capable of delivering a baby vaginally.

My midwife is fantastic. She's promised to be my advocate in labour and is very confident that I can have a natural birth. My fear though is that she said that I will have to be monitored continually and I'm really not sure why and am really worried about the impact it will have on my labour. I am very keen to stay active and upright and although she has said that the monitor will allow me to be upright and bounce on a ball, it obviously won't allow me to pace about and generally feel comfortable.

Is there a genuine reason for the insistence on the monitoring? Is it for the hospital's benefit or mine?

It's taken me a really long time to get my head into a good place with regard to this birth and this is the one thing that is nagging at me and I'm worried that once strapped to a monitor, I'm going to start freaking out and then have a cascade of intervention. I would rather have an elective section than go through the trauma of an emergency scenario again.

My question is really, can I refuse continual monitoring? What are the potential consequences if I do? What about internals - can I refuse those as well?

Sorry that this is very long, and thank you for reading. Any advice would be gratefully received.

Apparently this are the risk statistics:

"NICE guidance states that women with a previous caesarean section can be offered induction of labour but they should be aware that the risk of uterine rupture is increased (to 80 per 10,000 using non-prostaglandin agents and to 240 per 10,000 with prostaglandins).9,11"

And apparently:
"Prolonged, late or variable decelerations and bradycardia seen on fetal heart rate monitoring are the most common and often the only manifestations of uterine rupture. In 3/4 of cases signs of fetal distress will appear before pain or bleeding. "

hence why CFM is recommended.

This is the article if you are interested:
www.patient.co.uk/doctor/Uterine-Rupture.htm

Libras, you make some really good points and I'm not understating the seriousness of a potential uterine rupture. But I'm strongly of the belief that a more natural birth means less likelihood of a rupture in the first place.

There is emerging evidence that the first sign of scar dehiscence is a change in the mother's pulse rather than the fetal heart rate.

Two things which haven't been mentioned.

Firstly, CEFM is not particularly reliable. It can be temperamental and need careful positioning to get accurate results.

Secondly, caregivers don't always react as they should There have been several cases of rupture where warning signs on CEFM were misinterpreted or ignored.

Another point about VBACs is that VBACing mothers are often carrying a lot of psychological baggage and anxieties. Watching a monitor adds to anxiety and fear. Fear produces adrenaline which inhibits oxytocin, thus stalling/slowing/inhibiting labour.

It's not a simple debate.

I know the monitor was picking up serious problems with our baby but that is no use if the midwife is not there and/or interpreting the findings correctly. I had a student midwife delivering me, which I wasn't happy with as I knew I was high risk, but she was amazing and I was the last mum she had to assist before coming a full trained midwife.

I also know that if I hadn't have been able to push out my baby in 7 minutes I would have been in a lot of trouble and so would the baby. The emergency button had been hit and the room was full of doctors but they were all so amazing I had no idea.

My son was born blue but they did an amazing job and he is pretty much okay now.

Sorry for going on, it is kind of helpful to say these things, but I hope it hasn't worried anyone or upset them but sometimes it helps to hear peoples stories who have actually been through things rather than just read about them.

We took the decision not to have any more children as it is too risky for us. Ironically the emergency section that saved DS1 has meant that we had to stop after DS2 but they is fine with us. I would have loved more though but not at the expense of DS1.

I will go now and shut up .

Sorry have only had time to read OP but I had a VBAC with wireless CFM. Had the belt on but was free to walk around, they could still monitor me from the toilet! Worth asking if your hospital has one because I wouldn't have been offered it if I didn't know to ask.

Should maybe add that I did stay upright all the time up to pushing stage, was only 3 hours active labour and (just about!) managed with gas and air. I am utterly convinced that I would not have been able to do it lain flat on my back.