Constant monitoring?

[sgmom]

I have the same midwife I had during my last birth, and she gave me the option of monitoring the baby during my next birth (due in May). I ended up having internal monitoring with my last because the strap kept sliding off, but this meant having a catheter.

She said I can refuse it, but it's strongly suggested that the baby be monitored incase of rupture or complication from the c-section. Can someone give me a little information on this? I (of course) don't want to risk any harm to the baby, but this seems a little extreme to me.

However, my last birth went so horribly wrong, that I'm afraid to have the home birth I want...

Suggestions?
Thanks in advance.

[MsBlack]

Have you looked into the Interntional Cesarian Awareness Network (ICAN)? I highly recommend it, it is a group that supports women who've had csecs and desire to vbac--they also keep track of the most current and best research on all matters relating to csec and vbac. They have local support groups all over the place--our city (St Louis) has at least 3 groups around the metro area that meet once a month. You will be able to see what studies are available concerning continuous monitoring, as well as discussing various vbac issues with other, experienced moms.

ican-online.org to reach the main organization, from there you can find research and support as well as links to the closest local groups for you.

Otherwise....maybe you want to at least talk to some homebirth midwives about the possibility! From what I have seen, tho no place of birth is a guarantee of safety or actually having a vbac, well--at home your chances of a safe vbac are higher than in the hospital. I don't know as any research has been done to prove that, but it is certainly what I've seen among many homebirth mws in this area.

[SarahJSG]

I'd second MsBlack-- ICAN is a *terrific* resource. Their website has "white papers" that review medical studies and evaluate best practices. Their forums are filled with successful VBACers, and midwives, doulas, OBs, and nurses with great experience and wisdom.

You might also want to check out ACOG's own revised recommendations-- they admitted that continuous monitoring (when not necessary, as during induction or in an epidural) doesn't improve outcomes, but instead increases the chance of c-section and other unnecessary interventions. There's a high rate of nurses and providers misreading strips, and it encourages staff to ignore the laboring mom (and any problem symptoms).

Here's the link: http://www.ourbodiesourblog.org/blog...tal-monitoring

I discussed this with my midwives (we're doing a hospital VBAC), and they agreed that continuous monitoring wasn't necessary. They'll do intermittant monitoring instead, which will also mean that I'll see more of them. Of course, if there are problems, we can always go to continuous monitoring.

I hope that is helpful...

[SarahJSG]

I'd second MsBlack-- ICAN is a *terrific* resource. Their website has "white papers" that review medical studies and evaluate best practices. Their forums are filled with successful VBACers, and midwives, doulas, OBs, and nurses with great experience and wisdom.

You might also want to check out ACOG's own revised recommendations-- they admitted that continuous monitoring (when not necessary, as during induction or in an epidural) doesn't improve outcomes, but instead increases the chance of c-section and other unnecessary interventions. There's a high rate of nurses and providers misreading strips, and it encourages staff to ignore the laboring mom (and any problem symptoms).

Here's the link: http://www.ourbodiesourblog.org/blog...tal-monitoring

I discussed this with my midwives (we're doing a hospital VBAC), and they agreed that continuous monitoring wasn't necessary. They'll do intermittant monitoring instead, which will also mean that I'll see more of them. Of course, if there are problems, we can always go to continuous monitoring.

I hope that is helpful...

[khaoskat]

This is one of the reasons that I will be HBAC this time.

The theory is that with CEFM they can pick up trouble with the baby that may signal a UR and then rush you off to surgery.

In reality, if you Cthe results readings the same.

In a mother who is going through labor unmedicated, the mother has a better chance of catching a UR than the CEFM. From what I have read is that your labor pains change distinctively and very noticeably.

BTW - here is my last experience with CEFM. I walked into triage with DD2. I was feeling massive amounts of pressure down there, like needing to push. I was hooked up to the monitors and monitored for a few minutes. I told the nurse how I was feeling, and also the fact my last living child was born 20 minutes after getting to the birth center. She looked at her monitors, and told me in no certain terms that I was not even in real labor yet. That my contractions were barely 4-5 minutes apart and not lasting but maybe 40-50 seconds and I have a long long long time to go. DH called my OB, he was down there about 10 minutes later and checked me - I was fully effaced, fully dialated, and my waters were at a +2 or +3 but baby was still very high.

[miriam]

Suggestion: educate yourself a bit more and have a home birth. It is worth it.

khaoskat is correct; an unmedicated mother will know that something is going wrong before a CEFM. However, the doctors and nurses are trained to read the tracings of the EFM better than listening to a mother. And the tracings hold up in court better.

[sgmom]

I WANT a homebirth (or at the very least a hospital VBAC), but I'm completely nervous about something going wrong again.

I'm hypothyroid (and didn't know until a couple weeks ago). My last labor lasted 26 hours, I was induced about half way into that, had an epidural a few hours after the induction (I was told I could be in labor for another 12 hours and he was "right next door"), internal monitoring, 5.5 hours of pushing (baby never lowered past -1), a low grade fever (which turned out to be caused by chorioamnionitis), and ended up with a c-section. Baby was 10/10 on the apgar (9/10 immediately after delivery, 10/10 after the first minute), and 9.1 lbs.

I'm still not being treated for the thyroid, so needless to say, I'm terrified of my next birth being similar.

It seems like all I've done is internet studies, but I'm still not feeling confident about this. I really want this to happen though.

I've bookmarked ican-online.org... thanks!

[JayJay]

I'm having a hospital VBAC with a good OB, who is going to monitor me intermittently with the strap - say 20 minutes and hour, which I'm planning to spend probably with my knees on a pillow and my upper body supported by my birth ball. Better than on my back in bed!

I am also going un-medicated. I think the chances of "noticing" a UR would be greater if I could feel what was going on - lol!

All in all, write yourself a good birth plan, go with someone REALLY, genuinely VBAC friendly, who is not afraid!!! Consent to monitoring for 20 mins out of the hour, and then just have faith in your body, listen to the signals it sends, and the likelihood is HUGE that there will be NO uterine rupture at all, anyway

*HUGE hugs* - you can do it! XxX

[ACsMom]

I'm with Jay Jay. Agreeing to intermittent monitoring or a certain percentage of every hour would give you more freedom. In my first birth I was hooked up continuously (the justification being that I was induced) and I think it's the reason why my baby never dropped - gravity was working against us the whole time. Ended up with a section. Planning an HBAC this time.

Uterine rupture, at least the kind of complete rupture that puts mom and/or baby in danger, is SOOO rare. Fetal monitoring does not improve outcomes, as someone else said.

Keep reading about VBAC - I bet you can do it! Talk to your midwife about what you read, and what the real research shows. If she's still not supportive, you might consider seeking another one out if you can.

[khaoskat]

Originally Posted by sgmom

My last labor lasted 26 hours, I was induced about half way into that, had an epidural a few hours after the induction (I was told I could be in labor for another 12 hours and he was "right next door"), internal monitoring, 5.5 hours of pushing (baby never lowered past -1), a low grade fever (which turned out to be caused by chorioamnionitis), and ended up with a c-section.

My first birth..

I started like 2 am Monday morning with early labor. I went in on Tuesday, since I was 42+4, I was not able to leave. I got there around 10 am. We walked the halls and walked the halls and walked the halls. I had almost no progress by 8 that night. We consented to a low dose of pit. Around 9 pm, the pit was started. By 11 it had killed my contractions. About 4 am, I was contracting again, but couldn't really sleep through them. OB gave me something to help me sleep. AROM around 6 am. By 3:00 pm I had made only a small amount of progress on effacement and none on dilation. Was told consent to epidural, or C/S immediate. I consented to epidural. Infused rapidly two bags of IV fluids. Epidural around 4. Didn't take, repositioned, still not effective on right side. Pit had been increased every 15-30 minutes all day long. I feel asleep. Woke around 6, nurse checked me, and I was complete. Tried a few pushes, and then told to wait till OB got there. He got there around 6:30 and started pushing. Born at 7:05 pm on Wednesday night. About 22 hours after pit was started.

Horrible labor. Swore I would never go through that again, and went all natural from there on, unless complications arose that needed medical intervention.

Now DS2 was totally different. Felt what I thought was BH from about 7 pm till 9:30, and they were coming at regular intervals, and getting closer together and the tightness was getting stronger, but fairly painless. I would have to stop and breath through the tightness. Then they fizzled out till about 11:30. Took a long hot bath to relax, and got out of the tub to dry off, and had 15 minutes of one on top of the other, and they were just extreme tightness with little pain. Got back in the tub. Around 2, DH started timing them, they were 2-3 minutes apart, lasting 60-90 seconds. They were extreme menstral cramps. Left house at 3 am, got to birth center and checked by nurse at 3:40 am, DS2 was born at 4 am.

[sgmom]

Originally Posted by khaoskat

Was told consent to epidural, or C/S immediate. I consented to epidural.

I don't understand this. Why would this be a factor towards an immediate c-section? And am I correct to assume that both births were natural? No c-section?

I think the reason for my concern comes from the chorioamniotitis during my last labor (what is the likelyhood of that happening again?), and the fact that I have low thyroid (either of which can cause complications). I'm afraid of refusing intervention when it's really needed.

This VBAC stuff is scary! LOL

[khaoskat]

Originally Posted by sgmom

I don't understand this. Why would this be a factor towards an immediate c-section? And am I correct to assume that both births were natural? No c-section?

I think the reason for my concern comes from the chorioamniotitis during my last labor (what is the likelyhood of that happening again?), and the fact that I have low thyroid (either of which can cause complications). I'm afraid of refusing intervention when it's really needed.

This VBAC stuff is scary! LOL

Basically I was trying to go Natural, and after being on Pit for 19 hours was not handling labor myself and I was making no progress. I had refused all pain meds, was being withheld food, water and even ice chips (although DH and my best friend were sneaking me stuff). So, I think their choice was, I was no tolerating labor and baby was having decels - try to take pain relief or we are going for a c/s to get baby out because after 19 hours I had made no progress on pit.

No c/s till DD2 was born, and contrary to what a few people believe, I and DH both feel it was medically necessary (transverse lay with arm sticking out the birth canal and shoulder engaged in the pelvis).

I have learned a lot since my first birth experience, and will avoid many things. I was tethered to a bed on CEFM; I had an IV, which again limited movement, I was induced with a somewhat unfavorable cervix, etc. With my DD2, I did everything I could to avoid a c/s, even though they had been pushing for it for a few days before birth. I wait till I went into labor on my own, I did natural turning methods since no one would do an ECV, I even attempted a but first breech till she turned and did what I previously mentioned.

As for the Chorio, I think it will depend upon what you consent to. You could have developed an infection in there from too many internal vaginal checks, from internal monitors being inserted (contraction/pressure and/or fetal electro in the baby's head). All those things can lead to the introduction of bacteria, and lead to infection.

Most people, on here, will agree that once your water is broke, avoid all vaginal checks and insertions of things, as it increases your risk of infection and other interventions. The things they stick inside of you, while clean, or not technically "sterile" and may contain dirt/bacterial, etc.

[sgmom]

Wow. One thing I learned about this whole VBAC stuff is that this time around, I want NO medical intervention unless ABSOLUTELY NECESSARY.

With my first baby, my water broke at home (no labor) and there was mec in it, so they told me to go straight to the hospital. They monitored me for 8 hours before inducing me. I guess this was my first mistake?

[MamaMelis]

This is the main reason that I am having a HBAC this go round. I did have a great VBAC last delivery, in a hospital, but for me personally, with longer labors, it is impossible for me to labor without pain relief while trussed up to fetal monitors. My hospitals policy was that for every 1 hour of monitoring you are "allowed" 20 minutes off. NOT enough for me. I needed to be up and walking in labor, sitting still in bed was hell to me.

Whatever you decide I wish you much success!!!!