continuous monitoring: how mobile is it possible to be?

[MamaChris]

I was discussing birth plan with a consultant midwife today. I'm having twins and the typical twin labour is very managed, while I am hoping for a more normal birth. She said the hardest part of the protocol for me to change was likely to be continuous monitoring, but that I had to accept whatever the midwives on shift felt "confident and competent" to do, otherwise they could refuse to care for me at all.

So... if I do end up with continuous monitoring (with two leads/belts), how mobile am I likely to be? She claimed that it is entirely possible to be mobile - but I've heard that women feel they have to stay on the bed once monitored. Anyone managed to remain mobile, and, if so, to what degree?

You need to get lucky and have a MW willing to allow you to be mobile for a start. May be worth asking the Consultant MW to put a note in your file saying that this is what you want and that she supports your intention.

I was continuously monitored on both my births. The second started and was over so quickly that being active wasn't even an option but with my first I was induced and labouring forever, and for the majority of it had a lovely MW who agreed to support me in keeping mobile. I had to stay close enough to the machine for the wires, so mostly I was sat bouncing on my birth ball or pacing up and down next to the machine. She also unhooked me briefly (we had to move rooms) and let me get in the shower (I think this was a sneaky move on her part to allow me to get off the monitor for a while as everything was going well .

Eventually I felt I needed an epidural at which point I was obviously confined to the bed. The MWs also changed shifts soon after and I, unfortunately, had a much less helpful MW who insisted I do my pushing from a lying down/feet in stirrups position when the first MW had agreed that she would be able to help me to give birth in a more upright position. I was too knackered to argue by that point so gave in and when along with it. Still pissed off by the way she treated me 3 years on though - I knew as soon as I saw her face during the handover from the other MW that she didn't agree with anything that we'd planned between us and wasn't going to be supportive.

Ooh that's turned into a rambling post, hasn't it?! Anyway, my point is, it is possible, up to a certain degree, but you need to get the MWs on side with you.

Good Luck

At the hospital I am going to apparently they have wireless monitoring machines - it might be worth asking if they have any of those at your hospital? I'm pretty much counting on it - I really want to be mobile but am having a breech which is considered more problematic, so they want to monitor me a lot.
Good luck with your birth and congratulations on the twins!

I need to have CFM too and one consultant (I see a different one every time) told me about the wireless monitors they have. They only have four and you have to specifically request them. She said that there is a chance that there won't be one available but it's her advice to be as mobile as possible.

The monitoring I have had to date has given me cause for concern as the leads are so short that I can't even lie on my left side without them popping off. I am really hoping that the machines in the assessment unit are the ageing has-beens rather than Top Gun!

Getting induced on Monday unless the kid budges before then.

Good luck!

"I had to accept whatever the midwives on shift felt "confident and competent" to do, otherwise they could refuse to care for me at all."

Are you sure this is right ? AFAIK AIMS said that ALL mothers have the right to refuse any aspect of the care offered without withdrawal of care. Of course it would make sense to listen to why they want continuous monitoring first, but if you opted out they can monitor you intermittently with a handheld pinard or doppler.

I was told that at our hospital continous monitoring meant standing by the bed or leaning on the bed or lying down on the bed. So I have opted out for a home birth instead, no leads long enough to reach to my house ;)

I gave birth last Saturday and I was put onto CFM due to DS's heartrate rising/falling with contractions.

I had been active up until that point so was quite upset at the thought of being confined to the bed but actually the lead was really long and I could pace up and down the side of the bed, kneel on the floor, lean over the back of the bed etc. Obviously you can't go pacing the corridors but you certainly don't have to be on your back in bed.

I had CFM and was upright/walking/on bouncing ball for 5 hours - certainly didn't have to stay on the bed. Only had to lie down when I had some pethidine and I couldn't physically stand (was like a drunk!)

Good luck (and congrats Icklejess!!)

Thanks. So, some mobility possible, but not loads. Depending on midwife? I will make sure staying mobile is in my birthplan, which I intend to get signed off by everyone possible

I have asked about wireless monitors, but they only have one, and it's for the pool room (I'd need two).

I think the "confident and competent" thing comes from midwives' guidelines. She was quite clear on it, but I will push at the next meeting and ask what happens if I just refuse continuous monitoring? TBH, I think they want to do CFM because intermittent would require two midwives every 15 minutes, and the unit is already closing "regularly" because it's short staffed (quite worrying, but I'm trying not to focus on that).

ds was a homebirth - good luck Babies, and especially good luck to RR, and congrats to Ickle

Hi MamaChris,

I would be tempted to go with the intermitten with a doppler. One my can pop a doppler on one twin and then the other. They only need to do every 15 mins during labour - but then would require 2 mws to do do babies between each contraction during pushing stage.

I am due this week with a VBAC and this is my choice of monitoring instead of CFM or telemetry (the wireless one).

I also agree that you should push for something more solid that "if the mw feels confident" sounds like you have the right approach on how to/who to speak to about that.

Good luck.

Julie x

I had CFM and spent no time AT ALL in bed (except when they did the final check to see how dilated I was). I made it very clear on my birthplan but also when it came to it, it was too painful to lie down, so I spent the labour on my hands and knees, mostly on the floor, and sometimes standing and leaning over the bed. I gave birth standing up!

Tbh, I don't see how they could have told me to stay in bed - I just wouldn't have been able to. I am also extremely stubborn (and put that on my birthplan too ) but actually it just felt like I had no choice. And there was certainly no reason, practically speaking, why I should have been confined to bed.

It seems to come down to how much the mw wants to get involved, as towards the end, when I was more active and pushing, the mw's had to hold the belt in place. I guess some mw's can't be bothered? But that's their problem and not yours!

I was induced, btw, so on a drip as well as CFM. And despite both I had a 'natural', short-ish labour with no interventions/problems. I am convinced that standing and being on all fours led to a good labour for me.

Best of luck.

I was a doula at a twin birth recently. She had had two previous normal births (one a homebirth). Normal pregnancy, term labour, non identical. With the obstetrician and consultant midwofe agreed a plan of care for labour in the pool on mlu. No continuous monitoring. Active birth etc. No paeds or Dr's in the room (were close by though) and had agreed this if second twin was breech to. All went well, both twins head down. Two midwives did intermittent monitoring.
More info here-
www.magicalbirth.co.uk/6.html
Think she comes on Mumsnet twins forum too.
Selina

Thanks all. I am asking for intermittent monitoring, and the pool, but the consultant midwife seems to think these will be the biggest sticking points with the other staff.

I meet my consultant tomorrow, so will get her opinion too.