Evidence about continuous monitoring...

[AliGrylls]

I am 4 months pregnant with second child and am considering my options in relation to the birth. I know that I definitely want a VBAC and am also booked onto a hypnobirthing course.

However, the problem is that of continuous monitoring. DH and I have been looking at the evidence today in relation to continuous monitoring. We have both found a couple of articles that say it is basically a waste of time as the risk of uterine rupture is so small. Also, one paper I read suggested that actually it increases the risk of having an unnecessary C. However, there is a chance it could help.

I am feeling in two minds about the whole thing. I don't want to be continuously monitored as it did nothing but make DH and I more stressed in the first labour (the monitor kept on falling off and showing no heart beat) and also the fact it really stops you from moving around. Another part of me though is nagging - what if there is a problem, what if I am really unlucky and things go wrong. The age gap will be 17 months difference so it does make me wonder that there could be a risk.

Can anyone suggest any papers I can read / give me any information which might help me to make up my mind.

Speaking as a former midwife (who hasn't read the latest research) I would say that if your first labour was "normal" and this pregnancy is normal then there is no need for continuous monitoring unless you opt for an epidural, or need extra drugs to speed things up. If there are no contra indications it should be ok for the mw to listen in with a doppler every 30 mins or so, and use the monitor every few hours. Talk to you mw and ask lots of questions about the common practice at your local maternity unit.

As far as I remember it's not one of those things you "choose" beforehand, it's usually a decision based on the particular circumstances of your labour. What's best for you and your baby at the time.

Speaking as a former midwife (who hasn't read the latest research) I would say that if your first labour was "normal" and this pregnancy is normal then there is no need for continuous monitoring unless you opt for an epidural, or need extra drugs to speed things up. If there are no contra indications it should be ok for the mw to listen in with a doppler every 30 mins or so, and use the monitor every few hours. Talk to you mw and ask lots of questions about the common practice at your local maternity unit.

As far as I remember it's not one of those things you "choose" beforehand, it's usually a decision based on the particular circumstances of your labour. What's best for you and your baby at the time.

I had VBAC and am HypnoBirthing teacher.. was told I had to have continuous monitoring, negotited intermittent while standing at side of the bed. Even so found it incredibly disctracting, seeing the machine going up and down takes your focus away from the internal. Also daft midwife kept losing baby's heartbeat which was distressing. Towards end waters broke with meconium so had to go back on but by then didn't really notice.

Check out PubMed if you haven't already for medical articles and remember everything is negotiable. They can't make you do anything but they probably will try to scare the crap out of you.

Other thing that was more irritating than monitoring was insisting on venflon (needle in place) in my arm. Couldn't get vein, stuck in elbow, kept falling out and bleeding all over the floor. They want it so if you did need to go to theatre they could do things quickly but they manage to get lines in fast in A&E so don't see why they need to do it in advance.

negotiatied I mean

still didn't spell it right.. giving up

Sorry - don't have any papers to recommend but wanted to say, if you do end up having CFM, it doesn't have to mean you're flat on your back.

With my VBAC, my midwives were great and were happy for me to do whatever I needed - I did have to have CFM as I had a low level of synto (waters went, labour didn't kick off properly) but I remained upright for most of my labour - in fact it was only when I lay down that they lost the trace completely (but by then I'd had a shot of pethedine, so had to lie down as was unable to stand!!) and I could bounce on the ball, move around the bed as far as the lead (and the drip would let me and it was all good .

Good luck with your VBAC - mine was great!

I had CFM in both of my labours. First time around although it didn't keep me strapped to the bed ( i spent a lot of time in rocking chair next to bed) like the OP i was quite focused on the monitor which didn't help me.

2nd time (3 weeks ago) they had me on a wireless monitor which was brilliant. As I wasn't actually physically attached to the machine I was able to move around freely and I was hardly aware of it at all.

Would recommend anyone who knows they are likely to need constant monitoring to find out if their unit has one of these monitors as I'm convinced it helped me to have a calm, straightforward birth this time around.

A wireless monitor sounds brill. Spoke to my afve midwife and she told me if they are monitoring you properly they should be on top of it anyway and you should not need CFM. I am in love with her and would trust her with my life so I am happy to listen to her.

Thanks everyone - so looking forward to this labour now. I am having hypnobirthing too. I so want it to be different from the last one.

VBAC is an indication for continuous monitoring in many Trusts. The reason is that irregularities in the fetal heart rate are present in almost 100% of uterine rupture cases, so it a sign of fetal distress is an indicator that UR may have occurred. If you are delivering at a Trust where CFM for VBAC is part of their policy, you will need to start negotiating now to have intermittent monitoring, otherwise you will have lots of lots of people coming into the room trying to convince you to have CFM when you get to the maternity unit in labour. Go and see you consultant, or consultant midwife, or VBAC midwife or whoever has some clout, your community midwife can suggest someone.

Our Trust has recently stopped routine CFM for VBAC and we also offer the pool to VBAC women. It's going well, our succes rate for VBAC is good.

Also, have you seen the informed choice leaflets from MIDIRS? These are brilliant, basically all the latest research evidence boiled down to something easy to understand. They aren't biased either and if the research is inconclusive they do say so. They do unfortunately cost £3.50 to download but a really trustworthy source. There are a few you may consider reading - the monitoring one and the c section and subsequent births one may be good for you.

www.choicesforbirth.org/information.php

Thank you. I appreciate that link.