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Can I violate "hospital policy" on wearing a fetal monitor?

5K views 70 replies 36 participants last post by  kltroy 
#1 ·
Hey there - trying to figure out what my rights are, going into trying to have a vbac in August...

My midwife informed me at my last appointment that it's "hospital policy" that anyone attempting vbac has to be on constant fetal monitoring. I don't feel like this is necessary, especially because my previous cesarean was due to the baby's positioning. I don't object to periodic monitoring, but the midwife says that I won't be permitted to use the whirlpool tub because of the constant fetal monitoring required. I want to have the tub option - with ds it helped immensely with labor (I was fully dilated without meds before I had the cesarean). I suppose if there is no other option and it's the safest thing to do, I'll go along with the monitoring, but am I really required to? And will it really make things much safer than just checking the baby every 30 minutes or so? My midwife for ds had me sit up in the tub every 30 minutes to check the baby, and it didn't seem like a huge problem or anything...

Anyway, opinions?
 
#52 ·
Quote:

Originally Posted by Fyrestorm View Post
I think cases like mine were the reason the term 'birthrape' was coined.
HOLY CRAP!
I just read it...are they also paying for a lifetime of therapy?!
: I would never trust anyone in a white coat ever again.
You are one strong woman!
 
#53 ·
Quote:

Originally Posted by rmzbm View Post
HOLY CRAP!
I just read it...are they also paying for a lifetime of therapy?!
: I would never trust anyone in a white coat ever again.
You are one strong woman!
I just read it too. I have to thank you from the bottom of my heart for standing up for ALL OF OUR rights. I am so, so, so sorry for everything you went through. I am so glad they're paying for this. It will never undo the damage but maybe it will make them think twice before they treat anyone like this again.
 
#54 ·
Quote:

Originally Posted by Fyrestorm View Post
My case was won on the basis that I was coerced with threats in a situation where all the medical signs showed no danger. I was lied to and fortunately could prove it in court. There were court orders in my case for procedures preformed on DD after she was born that we had refused. We won on those as well since they were also proven to be medically unnecessary.

I know you can't talk about the settlement, but can you explain more about the charges you filed against the hospital, staff and police? I think many women can learn from and be inspired by your story. Physicians still love to spread the myth that the only cesarean you get sued for is the one you didn't do. Looks like you proved them wrong. And I'm so very sorry you and your family suffered so much for it. What happened to you was indeed a crime, and I really admire you for making sure people were held accountable for it.

I'm curious to know, too, whether the suit against the hospital was for malpractice--was it a civil suit? And then you also filed criminal charges against the CNM and other staff? Was anyone convicted of criminal charges? I'm assuming you also filed complaints with licensing boards--is that how the CNM lost her license? Or was it the result of criminal charges? Also, how were you able to prove that you were lied to? That would be very helpful information for other women to have.

Sorry for so many questions! But I do think other women can learn more from your experience about how they can see to it that some form of justice done in the aftermath of the type of abuse that you endured.

Also, if you don't mind PM-ing me the name of your attorney, I would really appreciate it (please note that my user name isn't my actual email address--using the PM feature here will work though).

I'd like to get in touch with him/her because I'm working with a group of attorneys who are developing a continuing education program for lawyers where they can get CEUs for learning about the patient rights abuses that birthing women endure and legal strategies (such as yours) for remedying them. We have a physician, too, who will teach a workshop educating malpractice attorneys about the medical misinformation that expert witnesses use in malpractice cases. Another attorney who won a malpractice case for an unnecessary cesarean will be leading a workshop, and I know he would be interested in networking with attorneys who have been involved with similar cases.

Thank you for sharing your story with us.

Katie Prown
Legislative Chair
Wisconsin Guild of Midwives
 
#55 ·
I would be happy to answer any questions that I can...but would you mind bringing this over to the birthstory thread in my siggie as I think this thread had been hijacked long enough...

So sorry to the OP..

Can we bring this back to the OP question?

Quote:

Originally Posted by LaughinWillow View Post
Hey there - trying to figure out what my rights are, going into trying to have a vbac in August...

My midwife informed me at my last appointment that it's "hospital policy" that anyone attempting vbac has to be on constant fetal monitoring. I don't feel like this is necessary, especially because my previous cesarean was due to the baby's positioning. I don't object to periodic monitoring, but the midwife says that I won't be permitted to use the whirlpool tub because of the constant fetal monitoring required. I want to have the tub option - with ds it helped immensely with labor (I was fully dilated without meds before I had the cesarean). I suppose if there is no other option and it's the safest thing to do, I'll go along with the monitoring, but am I really required to? And will it really make things much safer than just checking the baby every 30 minutes or so? My midwife for ds had me sit up in the tub every 30 minutes to check the baby, and it didn't seem like a huge problem or anything...

Anyway, opinions?
 
#56 ·
Don't we all wish we lived near the Farm? I bet many of us may not be here trying to VBAC now....

You can have a telemetry unit and bathe w/ it.

I was supposed to but when they did AROM and saw how much meconium came w/ it, they slapped an internal monitor on (which I had refused, refused, refused) without asking. Sigh.
:
 
#57 ·
...going back to the original poster's question about violating "hospital policy" - and related to Fyrestorm's absolutely horrible birth story (I'm so sorry that happened!)

let's all be realistic here for a minute. I think that a lot more can be accomplished re: getting hospital staff to cooperate with you and having a good hospital birth experience if you go into it with a good attitude. Getting the L&D nurses on your side, being a pleasant person etc goes a long way towards letting them bend the rules for you a bit. If you really have a serious problem with a known policy, consider going somewhere else or birthing at home. Hospitals generally require continuous EFM for VBAC because it's what the ACOG guidelines suggest. If they have a telemetered system it's annoying but at least you're not tied to the bed. And if they don't, keep "having to pee" and/or negotiate with the nurses and your doc/MW.

I think walking in the door pissed off and with a bone to pick, as much as we want TO MAKE A STATEMENT and to have OUR BIRTH to be the way we envision, is generally counterproductive and can create obstacles. Do what YOU need to to have the best birth experience that YOU can have, but remember that at the end of the day your top priority is that you and your baby are healthy. Best case: you have a great experience AND a healthy baby. But, as all of us mamas who have had c/s know, sometimes you have to "take one for the team" whether you want to or not, and whether you think it is for a good reason or not. And whether we like it or not, we are stuck with the medical system that exists in this country - best, then, to do what you can to make sure you get the best experience you can when dealing with it, flawed though it is.

So please, politely refuse or negotiate (it will get you farther than copping an attitude usually), but make sure you can live with the hospital policy before you go there. Making sure that you MW has a good relationship with her backup doctors and hospital is a good precaution, too - in case things go south.
 
#59 ·
Regarding the OP, I don't know. I wish I knew, and I am going to research the legalities (in BC, Canada) before my next. I was basically confined to the bed, in a lying position, with an IV and an internal monitor, and only allowed to get up to go to the bathroom. ALL I WANTED was a nice, hot shower on my back.

My baby was posterior.

Had tea at a friend's house a few weeks after delivery. She told me that one way her delivery nurse coaxes the babe to turn during delivery is through a nice, hot shower.

I cried when I heard that!

Fyrestorm -- thanks for telling your story.
 
#60 ·
Quote:

Originally Posted by rmzbm View Post
What on EARTH are you talking about? I don't EVER need to "take one for the team!"
:
I'd take whatever I had to if it meant the life of one of my children. Perhaps that's what she meant by 'take one for the team'? It doesn't mean I'd like it, it doesn't mean I wouldn't try to do things different next time, but in the moment, if it was absolutely necessary, you bet your ass I'd 'take one for the team'. Wouldn't we all?
:
 
#61 ·
Sorry, quick response to the OP. There was a fantastic article in last issue of the NCT's UPDATE for specialist workers about the hospital in Southampton who are using a monitor designed to work under water, and are doing something like 75% of their VBACs in water at some point- with higher success rates. The government guidelines over here (NICE) state that VBAC is the preferred option in most circumstances, that women should be under the care of an obstetrician and that continuous remote EFM should be used. although being the UK, theoretically women have the right to be stroppy and refuse. I can scan it and send it to you if you're interested.

Fyrestorm, I am so sorry this happened to you
 
#62 ·
Quote:

Originally Posted by wifeandmom View Post
I'd take whatever I had to if it meant the life of one of my children. Perhaps that's what she meant by 'take one for the team'? It doesn't mean I'd like it, it doesn't mean I wouldn't try to do things different next time, but in the moment, if it was absolutely necessary, you bet your ass I'd 'take one for the team'. Wouldn't we all?
:

If the team is the baby, I think ANYONE would "take one"-- within reason (there are exceptions to everything, and there are times where even a cesarean wouldn't save the baby, and where it means more risk for the next baby at no gain for this one). But team usually implies a group, and in the context of a thread on hospital policy, it could be inferred that they're the team.

And you know what? We owe "them" nothing. They're getting our money. I know many health care professionals, including a few in my own family, went into it for altruistic reasons, just like I went into teaching for altruistic reasons. But each of us is just one of hundreds of patients to them. Do you think in the long run the team really cares that much about us individually? I know in my profession, I love my students and do remember many after the fact (and remember, that's seeing them every day for 180 days, an hour at a time, and more time at concerts and dances, compared to what, 12 office visits at 20 minutes a pop and a few days in the hospital)....but no way do I remember all of them, and no way do I get bent out of shape if a few don't like me or my classes.

In that context, even if that's not what the poster meant by taking one for the team, I could definitely see one of us VBAC moms getting a little upset by the idea. The only people who matter to me in my next birth are myself, my husband, my daughter and the new baby. Having a repeat cesarean after a cascade of interventions caused in part by hospital policy hurts all of us.
 
#63 ·
On hospitals requiring continuous EFM for VBACs, when I was planning my VBAC in coastal NC, there was a great CNM who just moved there that I was working with. I told her I really didn't want continuous monitoring and she didn't even bat an eye. Same thing about the IV. Ended up moving, and had a homebirth anyway, but you can find providers who are on board with no interventions in birth. You just gotta look around for them. I just got lucky with her b/c she was the first one I called.
 
#64 ·
Quote:

Originally Posted by wifeandmom View Post
I'd take whatever I had to if it meant the life of one of my children. Perhaps that's what she meant by 'take one for the team'? It doesn't mean I'd like it, it doesn't mean I wouldn't try to do things different next time, but in the moment, if it was absolutely necessary, you bet your ass I'd 'take one for the team'. Wouldn't we all?
:
Yes this is *exactly* what I meant (that "the team" is my baby - not the doctors). I mean that if you honestly think your perfect birth experience is more important than your baby's lifelong health, well... I don't think any mama really thinks that, so I won't insult anyone here by suggesting it. Sometimes C/S save lives. (and many times they don't make any difference, and sometimes we don't get a choice about it, whether we think the odds are worth the risk or not). That's all I was trying to say.

And for the record, I'm planning a VBAC for kid # 2 too, so I'm in the same position as lot of you.
 
#65 ·
The problem is that "the team" is all of these doctors and CNMs telling you that IF YOU DONT DO THIS YOUR BABY WILL DIE which is scary, very very scary. But they are not always being honest. You need to do your own research and come to your conclusions, and hospital "policy" be damned.

I have spent a good 6 months researching birth in regards to MY specific body type/conditions (vbac, history of high bp, etc) and if something went wrong that I did not understand, I would go with their advice, but if I know dang well that a cesarean or internal monitoring or constant monitoring is not right for me, I'm not going to have it. I don't really care what the policy is.

As for the suggestion that "if you dont like it go somewhere else" I think its great that you have that option, but not every pregnant woman has that option. I interviewed EVERY SINGLE OB AND CNM in my health care plan (blue cross and blue shield) it was about 12 practices as well as touring every hospital that was within an hour drive of me (3 hospitals to be exact) and in all of that, my last pregnancy, I was told over and over again that I was not able to have a VBAC. (my records were destroyed and therefor they had no documentation on the incision type even though the probability was that my incision was the one they feel is "right") I had so many doors slammed in my face, but I kept pushing and pushing. I even read the patient rights, spoke with hospital administrators, got very involved in ICAN and tried to learn what I could from them (think I even spoke with Katie a few times
when I was collecting information about my rights and legal options) You know what I learned from all of that? That not a single doctor in TWO COUNTIES would touch me and no hospital in those counties would "allow" me to VBAC. One of them would not even allow me to walk at all unless "doctor orders it" and would be taking the baby for 4 HOURS right after birth for monitoring (we get 20 min or so before they take her unless there is a complication - how sweet of them!) and there was no chance of avoiding that situation, period.

I then started calling midwives. Its illegal for midwives to attend home VBACs in south carolina because VBAC is classified as high risk, and midwives are not allowed to attend high risk births, or they will loose their license. Nobody would touch me with a ten foot pole. They felt bad for my situation of course, but had no desire at all (understandably so) to risk their license to help me. Even the doula I paid backed out when I decided to home birth regardless. My only options were to a) have a pre-scheduled cesarean, b) go into labor and then show up with no provider (my provider actually "fired me" for not agreeing to the cesaeran and the notice came ON my due date) and then fight tooth and nail to not get cut open without a reason other than not knowing my scar type (forget for a minute the many interventions that I would not want to have... I couldn't even be sure I wouldn't be forced to have a cesarean) or c) stay home and have the baby unassisted because everyone was afraid of the consequences of helping me.

Any guess what I did? ~

I had an unassisted birth and despite my original CNM Midwives assuring me that the baby would probably die if I tried a home birth, it was the most beautiful and perfect birth imaginable, and my daughter was born after 20 minutes of pushing and 3 days of labor, without a single problem, and in perfect condition. Pink, happy, bright eyed, and completely responsive in every way possible.

If I had not had the courage to UC, had not been 3 minutes from a hospital, had not been relatively free of complications, I would have had no choice but to have a hospital birth, and I am afraid to think of the consequences that would have ensued for both my baby and I, as far as the treatment and forced proceedures put to us.
 
#66 ·
Quote:

Originally Posted by wifeandmom View Post
I'd take whatever I had to if it meant the life of one of my children. Perhaps that's what she meant by 'take one for the team'? It doesn't mean I'd like it, it doesn't mean I wouldn't try to do things different next time, but in the moment, if it was absolutely necessary, you bet your ass I'd 'take one for the team'. Wouldn't we all?
:
That assumes that I agree that whatever they're wanting to do, CEFM for example, is what's best for the life of one of my child. If I don't agree that's what's best, then, no, I won't "take one for the team" just to make it easier on the hospital staff. IMO, doing so will only seek to further the attitudes of many docs/hospital staff and many times the ACOG themselves.

I for one am no longer willing to do that. Women have done it for long enough and someone, somewhere, has to be willing to say "enough!"
 
#67 ·
Quote:

Originally Posted by Jenlaana View Post

Nobody would touch me with a ten foot pole. They felt bad for my situation of course, but had no desire at all (understandably so) to risk their license to help me. Even the doula I paid backed out when I decided to home birth regardless.
Edited to add: This isn't directed JUST at the above poster, it's an overall attitude that I've seen time and again that just never made much sense to me.

Interesting that it's somehow acceptable for the midwives and doula to 'refuse to touch you with a ten foot pole', yet it's somehow different that an OB would feel the same way. An OB being unwilling (or unable in many cases due to malpractice insurance issues) to attend VBAC's is just as understandable IMO as the midwives' and doula's refusal, perhaps even more so since OB's are more likely to be sued should something go wrong.

A VBAC mom may not be a medical time bomb, but she certainly is a lawsuit waiting to happen from an OB's perspective. Why is it ok for a midwife and doula to refuse to attend a VBAC (at home or otherwise, due to law, due to hospital policy, due to insurance reasons, whatever), but somehow it's horrible for an OB to do the same thing?
 
#68 ·
Quote:

Originally Posted by LaughinWillow View Post
"We don't know how to answer that question." In the end, they told me to ask my midwife. WHAT? I'm the FIRST WOMAN at this hospital to ever want a waiver for certain procedures???

.

what they are saying is that your midwife's orders trump their policy.
 
#69 ·
Quote:
I haven't gotten a doula, because what I really really want - and what I wanted with my ds (the previous cesarean) is to be ALONE in labor.
they can meet you at the hospital at the last minute. they can also help navigate the staff so you get a good nurse. if money is an issue, some work on a sliding scale or take you on as they are getting their certification.
 
#70 ·
Quote:

Originally Posted by wifeandmom View Post
A VBAC mom may not be a medical time bomb, but she certainly is a lawsuit waiting to happen from an OB's perspective. Why is it ok for a midwife and doula to refuse to attend a VBAC (at home or otherwise, due to law, due to hospital policy, due to insurance reasons, whatever), but somehow it's horrible for an OB to do the same thing?
I actually don't think it's ok in either case. I think it's particularly odious for OBs to do it b/c their profession has put women in this position of fewer birth choices b/c of that first cut. Perhaps that's why so many women take greater issue with them.

Of course, on another note, the "due to law, due to hospital policy, due to insurance reasons" when it comes to midwives is most often out of the midwives' control b/c as a society we have given far too much power to OBs and their trade union (the ACOG). It's one thing to have to work as a midwife within an OB dominated birth climate and quite another thing to be an OB in that climate.

Yet another reason why so many of us are fighting for change.
 
#71 ·
Quote:

Originally Posted by Jenlaana View Post
I had an unassisted birth and despite my original CNM Midwives assuring me that the baby would probably die if I tried a home birth, it was the most beautiful and perfect birth imaginable, and my daughter was born after 20 minutes of pushing and 3 days of labor, without a single problem, and in perfect condition. Pink, happy, bright eyed, and completely responsive in every way possible.
Two unfortunate things strike me about your story, which turned out wonderfully (and I congratulate you!). First, is that so many women *DON'T* have the option for a supervised VBAC - or even an HBAC - and are left with only non-ideal choices (despite what other people think, IMHO an unassisted VBAC is not ideal). This is really unfortunate and is a serious problem with the medical environment we live in. (I think most women agree that having someone with medical knowledge at their birth gives them peace of mind just in case something goes wrong). If only the medical community would get a clue about this and maybe compromise by supporting VBACs we wouldn't be in this situation.

The second thing is that I sense so much *anger* in this post (and in many others). And rightfully so - I think a lot of us are angry about lack of good options and scare tactics. But it is unfortunate nonetheless.
 
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