Vbac and avoiding continuous monitoring

[emmajlh]

i'm 34 weeks and hoping for a VBAC. reason for my section was failure to progress at 9cm. baby was never in any distress. this was 3 years ago and scar feels fine.

i'm seeing a consultant next week and want to 'negotiate' intermittent monitoring so i'm not strapped to a bed and can instead move about.

has anyone had success at this?

I had a VBAC under 3 wks ago (previous CS due to breech) - had cfm but I had a reasonable range of movement and the monitor was out of my line of sight so I ignored it. I was hoping to not have CFM but actually I was glad I did as DS2's heartbeat did start to dip which was good to know about.

I had a vbac and cfm and it didn't bother me half as much as I thought it would. I ignored the monitor but I found it reassuring that it was there.

You don't need to negotiate - you can refuse to have CFM and there is nothing they can do about it. That said, that approach doesn't necessarily lead to the best working relationship between mothers and their HCPs...

I'd ask lots of questions re. the research that demonstrates CFM improves outcomes for mothers and/or babies (as to the best of my knowledge there isn't any). Hospital policy isn't research - and whilst you'd hope its research based that, sadly, isn't always the case. Personally, if they're that worried about the scar, I'd rather they kept a MW in the room with me than left me in the care of a machine...

It might also be worth finding out what type of monitors they use, as not all PCT's now only have CFMs that require you to stay on the bed - either through a longer wire or remote technology movement can be an option. IIRC some trusts even have waterproof models. What they're suggesting might turn out better than you currently anticipate.

You might find these phrases by Mary Cronk useful for reminding consultants (MWs and yourself!) that they are there to recommend not dictate care and that, ultimately, it is your choice what you accept.

I precede my post by admitting that I am a bit negative when it comes to hospitals

I am hoping to have a vbac in the summer, everything crossed and my reading has told me the following. I am guessing that you are concerned with the chance of rupture if you are not monitored ?

1. Continuous monitoring only picks up 55% to 84% of ruptures. Hence it misses many too, it is not a perfect method of picking up all ruptures.

1. Unless you have a midwife continuously watching the continuous monitoring machine, will changes on the machine be acted on quickly enough ? No point being told you did rupture 30 minutes ago, whilst midwifes drank coffee in the lounge

1. Mary Cronk monitors the maternal pulse during labour and this shows a reaction 20 minutes before the fetal continuous monitor will pick anything up. Another good reason to have a one to one midwife.

1. Other signs of ruptures can often (but not always) be seen in the mother, signs of shock, one sided pain, pain which continues past contractions etc.

1. Not all ruptures are serious. Oft quoted is the rupture risk of 1 in 200. I have read that it is 1 in a 1000 for a serious affect in either baby or mother. This can go down to 1 in 2000 or 1 in 4200 depending on past births, time since last c section etc etc.

1. There is no improved outcome for mother and/or baby by being continuously monitored (NICE guidelines)

1. Mothers must be informed that continuous monitoring does restrict mothers movements during labour (NICE guidelines)

Sigh, it is a worrying thing but you are 30 times more likely to have another C-section for another reason than suffer a rupture but that is what we all seem to worry about.

HTH

I've just had a successful VBAC

The consultant had stated continuous monitoring, amongst other things that I wasn't too keen on - including an elective section at 9 days overdue if I didn't go into labour before then.

I always used to chortle at birth plans, but I wrote one this time specifying exactly what I wanted. And I pretty much got it tbh despite going into it thinking they would just laugh at my plan.

I hope things go well for you.

Yeah for you

I posted on your thread too

You very politely say "I fully understand the risks of not having CFM and have decided that I do not want it, since I believe it will restrict my movements and give me a higher chance of a repeat section." Worked for me. I was monitored with a hand held thingy every so often.

I avoided it except for the very last bit (last cm or so of dilating, plus the pushing bit) by not making it to a delivery room till then

When we first went in I was only 2cm dilated (though felt like much more) so they thought it would be ages yet and kept us hanging around reception/antenatal ward, then things started happening so fast that by the time we made it to a delivery room I was about 8cm already I think! Then the nice midwives were not in a huge rush to put the monitor on when I got there either, so I really only had it for the very last bit of 1st stage and then through the pushing bit.

Also by that point I found it didn't really bother me at all - I was still active for a while changing positions on a beanbag by the bed (which the monitor didn't interfere with particularly) and then was on the bed for the last bit but still changing positions fairly freely. Also things were pretty intense by then, so I really didn't notice it much!

If you want to avoid it altogether though, you can say no, and if you talk it over with the midwives some of them are quite sympathetic to that it seems.