reasonable monitoring during labor and birth?

[sanguine_speed]

What do you consider 'reasonable' as far as monitoring of mom and baby during labor and birth?
I want to have as little intervention as possible, including monitoring, but I don't want to unreasonably expose myself and my baby to risk. I just think it's not all necessary.

I'm thinking the occasional fetal heart tone during labor to check for decels...mama's BP in my case because I've had PIH including high BP recently that fluctuates.
I think a vaginal exam after transition/during extended pushing phase if there seems to be trouble intuited by midwife or mom--I've had a cervical lip before and am slightly concerned about allowing this to go on for too long lest I have swelling, but also don't want to worry unnecessarily either--I know many of these can be pushed through.

What say you about monitoring during labor/birth?

Edited to Add: It would be very helpful if you could give reasons why you choose a certain degree of monitoring rather than just listing what you will or will not accept.

[Kelly1101]

I'll be hospital birthing with an OB again, as long as all is well we're both comfortable with 15-20 minutes per hour on the external monitor. I'd probably be okay with less and he'd probably like a little more, but it's a fair compromise and I can do the monitoring strip on the birth ball, so it's not that big a deal.

Last time I had bp checked a couple times an hour, because my bp had been very high for the last few weeks of my pregnancy.

I allow vaginal exam whenever I feel like it, I find them kind of motivating. I definitely want one if I feel the urge to push, because I don't want to push against a cervix that is not ready and risk swelling, so I want to know when I'm complete.

[sanguine_speed]

Originally Posted by Kelly1101

I'l I definitely want one if I feel the urge to push, because I don't want to push against a cervix that is not ready and risk swelling, so I want to know when I'm complete.

I'd like to hear more about this as it's a concern I have too.

What I've learned is that many cervical lips can be pushed through, and that the vaginal exam itself can inhibit progress...so I don't know whether confirming full dilation is something I'm interested in. But I'd like to know more about this because if it's evidence-based, I'd probably accept it too.

I am also hoping that I can avoid the feeling of needing external validation and 'permission' to give birth, if you KWIM.

Interested in hearing more...

[SublimeBirthGirl]

As little monitoring as possible and no exams for me. My first was a hospital birth but I still had very little monitoring. I was on Pit for about an hour and had it then of course, but other than that it was the hand-held for a couple of minutes maybe once an hour all through first stage. More frequently during 2nd but still just the doppler.

[sanguine_speed]

Originally Posted by SublimeBirthGirl

As little monitoring as possible and no exams for me. My first was a hospital birth but I still had very little monitoring. I was on Pit for about an hour and had it then of course, but other than that it was the hand-held for a couple of minutes maybe once an hour all through first stage. More frequently during 2nd but still just the doppler.

Oh interesting...I didn't think of every hour through first stage as "little". What is considered 'average'?

[AlexisT]

IIRC, the study that showed intermittent ascultation to be equal to continuous EFM had the CP checking every 15 minutes. If I were a low risk labor I would probably use that as a baseline.

With high blood pressure/PIH, I would want more monitoring, not less. Preeclampsia put my daughter into distress.

[Right of Passage]

I had no monitoring during my last 2 births. They tried with DS2 but they aimed too high and I kept pushing their hands away from my belly (nurses in a hospital).

I was perfectly fine with the monitoring my midwives offered, which I don't remember but it's very baseline, but my babies came too fast to monitor. After experiencing it twice I wouldn't want it any other way unless something intuitively told me otherwise.

[Honey693]

With DD i had a hospital birth and was completely ok with the monitoring. I showed and honestly didn't know if I was in labor so they did a cervical check and monitored me for 15-20 minutes. If I was doing a hospital birth again I wouldn't do it that long, but whatever. Then they came in once an hour with the doppler to check the baby and I had another cervical check when I felt like pushing b/c I wasn't sure if I was complete or not.

[katelove]

My birth plan assumes that I will remain low risk. If I had any risk factors then my monitoring desires would change depending on the exact circumstances. So I'll just list what I'd like if I stay low risk...

No CTG monitoring (no evidence that there is any benefit for low risk women but the risk of intervention increases).

One VE on arrival in birth suite (my hospital doesn't usually admit women to birth suite until they are 4cm or more. I plan to go in well after 4cm but they may want to confirm and I am ok with that). I will probably choose not to have any more but it is possible that I may want the motivation of knowing that I am progressing so I will play that by ear. My reason for limiting VEs is to prevent time pressure, reduce risk of infection and avoid discomfort.

My vital signs hourly (this is what the hospital likes to do and I'm ok with that as they are all done manually so can be done wherever I am and in whatever position. Probably don't need them that often but it's not something i feel the need to argue over).

Auscultation of foetal heart every 30mins (again, this is hospital policy and as it can be done anywhere, in any position then I feel no need to argue).

[sanguine_speed]

Thanks for sharing!!

My second birth I had a lot of VEs for encouragement, but ended up finding them discouraging.
My third birth I had ONE to help decide when to go to hospital with my breech pre-term baby. I was offered another, but felt that if I was too far along I'd panic and if I wasn't far enough along I'd feel defeated. So I refused. I am definitely leaning that way again (refusing).

[MegBoz]

Originally Posted by sanguine_speed

What I've learned is that many cervical lips can be pushed through, and that the vaginal exam itself can inhibit progress...so I don't know whether confirming full dilation is something I'm interested in. But I'd like to know more about this because if it's evidence-based, I'd probably accept it too.

I was concerned about this too and wanted that "permission" to give birth from my MW.

I've since read about "the rule of 10." There are some great MW articles (I found the links from here on MDC) that basically state that Mom's own instincts are the best "guide" for when/how much to push. So... if Mom feels the urge to push & she's only 7cm, then that pushing can help dilation complete.. if she's just going with her body, it's not a bad thing & won't lead to a swollen cervical lip! Fascinating stuff, it honestly hadn't occurred to me! But I guess it makes sense.

If you really, truly feel the urge to push & you just follow your body's lead, it makes sense to me that that path should, most often, lead to the best outcome!

But I don't know what is "evidenced based" - I'd love to know!!

Anyway, as far as VEs in general are concerned, I also didn't want time pressures, risk of infection, sheer discomfort - not just physically, but the sorta humiliation of the procedure. But also - I didn't want to "do the math!" Intellectually I know that 8 hours of labor to make it to 5 cm does NOT mean another 8 hours to make it to 10 cm, but it would be really hard not to feel that way!! It would just be too tempting to let my mind slip into that worry...

I felt the same way about VEs in late pregnancy. I could be 80% effaced, 2 cm, +1 station & no contractions... and labor could still be a week away! Likewise I could be hard, high & closed & go into full blown labor that night. Intellectually, I was aware that such data is, well, meaningless (unless you want to know likely success of induction, & I wasn't interested in induction.) But it would still be hard not to let it get me down if I was high, hard & closed. Easier to just not know!

I wanted to stay in the moment... since you have no choice but to stay in the moment, because there is just simply no way of knowing how much longer you are going to labor. Monitoring "progress" would have pulled me out of that labor-land head space.

[sienna]

Originally Posted by MegBoz

I've since read about "the rule of 10." There are some great MW articles (I found the links from here on MDC) that basically state that Mom's own instincts are the best "guide" for when/how much to push. So... if Mom feels the urge to push & she's only 7cm, then that pushing can help dilation complete.. if she's just going with her body, it's not a bad thing & won't lead to a swollen cervical lip! Fascinating stuff, it honestly hadn't occurred to me! But I guess it makes sense.

I've always wondered about that. What did women do before they had some paternalistic nurse screaming DON'T PUSH DON'T PUSH?