anyone else refusing cont. efm?

[khaoskat]

I don't mind the intermittent strip, or better yet my actual preference would be to have hand held doppler monitoring.

I have had 1 fully medicalized birth and hated it with DS1. DS2 was a completely natural birth in a birth center. DD1 was sort of a hybrid, in that she was fetal demise and by the time I had gotten to the hospital in labor and they realized she was gone I was basically fully dilated and she was not in a position for delivery - not quite up/down and not vertex - she was about 10 degrees off from up/down and but first. So, the actual labor was natural, but they ended up somewhat medicalized due to the need to turn her while in labor - stop my labor, turn and then restart with pit. DD2 was an all natural labor as well, until she turned breech/transverse lay while pushing, which ended up in my c/s.

Now, I want another natural birth. My problem is that I cannot get up and mobile if I am tied to a monitor. I also don't want to listen to the HB, or have my contractions monitored, because it stresses me out too much and I start feeling the time line pressure and then totally am not able to focus and concentrate and deal with things...

If we have to go, I will not consent to continuous EFM. I also wont consent to internal exams, nor being stuck in a bed...

[ann_of_loxley]

If we have to go, I will not consent to continuous EFM. I also wont consent to internal exams, nor being stuck in a bed...

Personally I think thats perfectly reasonable. I think a few checks with a hand held doppler is all that is ever needed.

Things might work differently in this country (UK). This baby is going to be a home birth. My MW knows that I would prefer a pinnard used if possible but that I am find with a hand held doppler being used a few times. I also would not like any internal exams (there is not real need for that at all tbh). I find them uncomfortable.

My MW fully agrees with my wishes. She says I have a better chance at a vaginal birth at home - where I will be able to move around freely without constant monitoring that can cause unnessiary stress (which makes perfect sense). So I imainge, as long as these wishes were respected in hospital as well - then that is also a real benefit to you, your baby, and your body. And if that means not giving consent to constand EFM and being allowed to move about freely, etc - then so be it!

[cairomama]

I had continuous EFM except for bathroom breaks, but by the time I went to the hospital I was beyond walking the halls and I was allowed freedom of position so I labored on my hands and knees and the birth ball. I had Hypnobabies on my ipod and didn't hear anything from the monitor. I only looked at the clock once after coming back from the bathroom fully dilated and ready to push. I was in the hospital only 2.5 hours before my VBAC baby was born.

I don't think continuous EFM has to be a deal breaker. But, if you don't want it, don't agree. My midwife had a very good reputation for VBAC success and he wanted it. I had switched to him at the last minute and didn't think it was worth arguing about. I just told him that I needed freedom of position/movement and planned to stay out of the hospital until I thought I really needed to be there.

[kathan12904]

For my vbac, one of the big reasons I chose to be out of hospital was wanting to be mobile and avoid those machines. There isn't a single bit of researched evidence to say that EFM has improved maternal-fetal outcomes even for vbac labors and yet it is still routine use in hospitals even for low-risk, non vbacing mothers. As a doula, I strongly recommend my clients familiarize themselves with EFM and urge them to consider refusing it. The only thing that has changed in hospitals since the introduction of routine EFM is the number of c/s performed. No healthier moms or babies. This machine is uncomfortable and restrictive as well as notorious for false positive fetal distress readings. Although you physically can move in the bed while hooked up to one, most movements change baby's position slightly and cause a nurse to come into the labor room and reposition the monitor, a distracting and intrusive procedure. It is heartbreaking to watch a laboring woman working hard to birth normally while absolutley every eye in the room is on some dinging machine. If you plan on refusal, which I've seen women do successfully, make sure your doc/mw knows your plans in advance, that your partner is aware and supportive and ready to defend your position and demand your wishes be respected, that you have a good doula who will do the same, and that you are ready to hear very frightening language in the hospital and be required to sign liability waivers during your labor or ahead of time. Most of this is because the hospital is required to use this technology by their protocols or insurance company and any deviation from that must be documented. Good luck.

[thorn]

Originally Posted by kathan12904

There isn't a single bit of researched evidence to say that EFM has improved maternal-fetal outcomes even for vbac labors

That's actually not true, there are some studies showing that cEFM can be predictive of uterine rupture. The overall risk for UR is very low though.

I refused it for my first vbac and accepted it for my second, mostly because the hospital had started more tightly enforcing it, and I didn't get to the hospital until I was already 9cm anyway.

I did take a really long "bathroom break" and removed the belts, not just unplugged the cords. The nurse gave me about 30-45 minutes before she came in to hook me back up and by then I was ready to push.

[kltroy]

Fetal bradycardia is the ONLY interpartum predictor of UR that seems to be reliable, so in fact there is good science behind why they would suggest continuous EFM. I had it for my hospital VBAC and spent my labor mostly on the birth ball. It was completely fine. The monitors were an annoyance, but they turned down the volume and I basically ignored it. I got up and "disconnected" to pee whenever I needed to, and really, I didn't want to move that much during labor anyway. The ball was working for me. I ended up having a great natural/unmedicated VBAC birth.

Some ladies may disagree with me here, but I say you should pick your battles. If this one is important to you, put up a fight. But if there is something else that is more important, you might consider going along with standard procedure to shut everyone up on this one. If you don't like what you'll get in the hospital, consider a home or birth center birth instead. If that's not an option, you'll just have to live with it and compromise as best you can.

[womenswisdom]

Originally Posted by thorn

That's actually not true, there are some studies showing that cEFM can be predictive of uterine rupture. The overall risk for UR is very low though.

Do you have links to those studies?

[khaoskat]

Originally Posted by kathan12904

and that you are ready to hear very frightening language in the hospital and be required to sign liability waivers during your labor or ahead of time.

I have done it before. With DD2, I walked out of the hospital AMA, after being told I needed an immediate c/s or my baby would die, without them giving my anything more than she had the cord wrapped around her neck and she was breech.

I have had all my kids born with the cord, so to me that was not a big issue. As for the breech, my kids have always moved around till they were ready to be born, so again, not a reason for an immediate c/s.

The final straw for me, was when they threw out the dead baby card, considering I had just had a full term loss 1 year 3 days previous to this threat.

I did end up with a c/s, but not because they pressured me. I had showed up in labor, basically read to push. She was heads up instead of transverse, and the OB was fine with that. But she had so much amniotic fluid, even after my waters broke, she had freedom of movement. She pulled up out of engagement, which she had gone into when my water finally broke, and turned to transverse again. She then proceeded to stick her arm out and wave at everyone.

I think we will have a bigger push for CEFM right now, since the hospital on July 7th, just lost a major lawsuit involving a VBAC, with an award in excess of $31million. And the fault was fully on the nursing staff, for the negligent monitoring and failing to inform the OB of the problems on the mother, even though she was on CEFM.

[GOPLawyer]

As I understand it, EFM is the best indicator of an actual UR (not predicative). However, that is just EFM...not *continual* EFM.

Further, studies have shown that CEFM is not reliable generally. Not just VBACs.

If you don't want something...just refuse it. It is absolutely w/in your right to do so.

[khaoskat]

Originally Posted by kltroy

consider a home or birth center birth instead. If that's not an option, you'll just have to live with it and compromise as best you can.

We currently have no "visible" home birth support in our town or area. We just had a family criminal prosecuted for giving birth at home. The prosecution is still going on. Everyone has gone underground right now.

Our only birth center for many hours will not allow VBAC.

We are going UC right now, with hopefully the aid of a few friends.

And I will fight every battle I have to. If they don't like it, they can leave the room.

And research has shown that CEFM does not pick up UR.

As for freedom of movement, up until I am pushing I need to be able to walk about and change positions. with DS2 I made a nice circuit in my bathroom - tub for hot water bath; toilet to pee and change position on. Indian style with head resting on birthing ball on the floor hunched over. Hands and knees resting my head on the side of the tub.

I will not be getting an epi, and the position changes are needed to deal with the pain.

[mamatolevi]

would you consider EFM if telemetry units were available? That way they can be happy you're on the monitors and you can move around. the one I used had a limited range, but it worked as a compromise for my vba2c labor.

[khaoskat]

No, because the last time I had one, I was constantly being chased around by a nurse because it kept loosing its connection to the nurses station. The minute I sat down for 2 seconds to eat something, the nurse was trying to rip it off and hide it away to never be found. Buy, I knew my OB had given written orders, so it did her no good.

Most likely if I show up in a hospital, I will be fully dilated pushing.

I don't believe in the EFM anyways. Last time I was on one, the nurse believed her machine over me and told me I was not in labor yet. I was telling her I needed to push and my last child was born w/in 20 minutes of getting to the hospital. Her monitor said I was 4-5 minutes apart at least and only lasting maybe 40-50 seconds. Needless to say when my OB showed up because my husband called him, I was ready to push in triage.

[momtokimari]

I refused it at my second hospital birth. And it was preterm. They just used the doppler. Go for it.

[mamatolevi]

Originally Posted by khaoskat

No, because the last time I had one, I was constantly being chased around by a nurse because it kept loosing its connection to the nurses station. The minute I sat down for 2 seconds to eat something, the nurse was trying to rip it off and hide it away to never be found. Buy, I knew my OB had given written orders, so it did her no good.

Most likely if I show up in a hospital, I will be fully dilated pushing.

I don't believe in the EFM anyways. Last time I was on one, the nurse believed her machine over me and told me I was not in labor yet. I was telling her I needed to push and my last child was born w/in 20 minutes of getting to the hospital. Her monitor said I was 4-5 minutes apart at least and only lasting maybe 40-50 seconds. Needless to say when my OB showed up because my husband called him, I was ready to push in triage.

Sounds like you had a couple of very poorly trained nurses.

Telemetry definitely has its limitations as to range and needs a lot of tweaking to keep the signal going. It's NOT popular with the nurses where I had my vba2c b/c of the loss of signal issues. I eventually had to hold the sensor in place as I walked around (to keep from being chased around the halls), but it was leagues better than being tethered to the bed or stuck in that tiny little room. For me, I felt I was getting an honest shot at a vaginal birth so I could compromise on that issue rather than on other things that were more important to me. Now, if the telemetry units weren't available... that would be a different story.

A few months after I had that baby, the hospital "lost" the telemetry units - or they were broken; it depended on who was talking about them.

[AlexisT]

Yes. Same reasons as kltroy: picking my battles. I have to use an OB (high risk), and that's one of their conditions for VBAC.

[fwlady]

My 6th was a planned UC. I went in after 90 hrs of PROM and finally was in labor, to have meconium staining. I was also 23 days "late", and they didn't blink an eye. They said the baby was fine, and if I would stay, they would proceed VBAC (my 5th VBAC, btw). The only condition, a heplock, which I needed after all. They let me labor in the shower. The only required 10 min of EFM every hour. They did do a couple of VEs. The OB went to do a csection, and the MW went home to pump for her infant during an hour before I delivered. But, I warned them. I wasn't too uncomfortable, but I was at a 4cm, and so I told her that was fine, but to be back in an hour to hour and half. And, DD was born 1hr 27min later. They said, "if you say you have quick laobrs or the baby is coming, we believe you. your body is yours and you know it better than we do."

Now, I have heard since, that even though I have the same practitioners for my back up here, that the hospital actually has a VBAC ban now. However, the OB has not mentioned this. He told the nurse in L&D that if she showed up and refused a csection, they cannot do it. The MW just told me to come late in labor. That is hard to gauge with me though. We were absolutely thrilled with our experience there though. So, if you live 2 hrs of Marshall, MO, that is the go to hospital for VBACs. And no cEFM, if you tell them you don't want it. That is really all I had to say was that I only wanted bare minimum. And, I had MECONIUM! So, there ya go.

Although I prefer UC, this hospital is great for VBACs. Kymberli

[khaoskat]

Fwlady - if you go to the ICAN webpage, a huge group of people called all the hospitals they could to find out their VBAC status.

I live in Ohio, so we shall see. Although I used to live in MO (Jefferson City and then Kansas City, I graduated from NWMSU).

[DocsNemesis]

I won't be having it but I'll hopefully be having a homebirth. I do realize it's indicative of uterine rupture, but I'd rather have occasional checks with the doppler and trust that I know my body well enough to recognize a UR. I mean, by then its already happened right? How many women have UR and have no extra pain? I know what labor is supposed to feel like and I won't hesitate to go to the hospital if it doesn't feel right. (I also only live a few minutes from the hospital, its VBAC friendly, and I have no issues walking right back out if it turns out everything is ok and I'm not too far along to do so...somehow going home at 10cm's just doesn't sound like fun )

[khaoskat]

Originally Posted by DocsNemesis

I won't be having it but I'll hopefully be having a homebirth. I do realize it's indicative of uterine rupture, but I'd rather have occasional checks with the doppler and trust that I know my body well enough to recognize a UR. I mean, by then its already happened right? How many women have UR and have no extra pain? I know what labor is supposed to feel like and I won't hesitate to go to the hospital if it doesn't feel right. (I also only live a few minutes from the hospital, its VBAC friendly, and I have no issues walking right back out if it turns out everything is ok and I'm not too far along to do so...somehow going home at 10cm's just doesn't sound like fun )

I also live only 2-3 minutes away from the hospital, but walking not driving time. It would take us longer to drive than to walk.

[stoof21]

My OB has agreed to 1 20 minute strip on admission, and intermittent doppler monitoring thereafter, as long as I don't have an epidural or anything that would prevent me from feeling the pain of a rupture. Since I don't plan on hitting the hospital until I feel pushy, that sounds just fine to me.