Hospital Policy

[Climbergirl]

Ok, I want a VBAC. I am seriously considering a homebirth (like 99% sure of it). But I do want to interview the midwives that deliver at the local hospital. I think the deal breaker for me is the continuous fetal monitoring policy the hospital has. It can only go 8 feet. And no, there is no way to decline it. And it can only be off if I go to the bathroom.

(Ok, yes, I get the fact that I really can decline it by taking the dang thing off, but I know the dead baby card will get thrown and DH is not strong enough to resist that. I love him for so many reasons, but that is definitely a limitation of his

So, would this a deal breaker for delivering in a hospital for you? Why or why not?

Just curious....

[liberal_chick]

It was one of the deal breakers for me.

My last ds was born at home and we toyed with the idea of going to the hospital this time since our insurance would cover it (we don't have quite as much fluid income moving around this time). But I couldn't have delivered naturally without moving as much as I did, and 8 feet wouldn't have been enough for me. I walked in the park, I bounced on a birth ball, I got in a pool of water. If I'd have been esentially tied to a small area (or strapped in the bed, as my local hospital won't even let you out of the bed after ROM, literally) I don't think I could've done it w/o an epi.

[onyxravnos]

yep. it's all about the homebirth anyway. If you are so inclined you could try the 'against our religion card' technically they can't question your religious beliefs (not to say they wont try) you could just keep repeating ''it's against our religion''

but really why bother fighting with them when you could just do it in the peace of your own home.

[kltroy]

*shrug* it wasn't a deal breaker for me, but I also wasn't dead set on a home birth. I had a really nice intervention-free hospital VBAC with continuous monitoring. I sat on the birth ball next to the bed for most of my labor and it was just fine. I got up and peed whenever I needed to and for however long I needed to. The monitors were minorly annoying but I was very much in laborland for most of it, so I didn't really notice them. I suppose it depends on your own comfort level.

Do you believe that monitoring has any value at all? Personally, I do believe the medical literature that monitoring is the most reliable way to pick up UR as early as possible. While I was perfectly OK with my 0.5% chance of UR, I also didn't have a philosophical problem with the monitor, because I understand the value of it. It's a safety net. I liken it to wearing a rock climbing harness. Sure, I'm a good climber and I rarely fall. But it seems smart to wear one just in case you need it. I may be slightly more risk averse than you - to me it was a no-brainer that I would have a VBAC instead of a repeat C/S, but I made my peace with the monitoring because I thought it made sense to be in a hospital for the birth just in case. (Now granted, had there been a good birth center option I would have taken that instead).

At the end of the day you and your husband both need to feel good about the choices you're making for the birth. If he's on board with a HB and you guys think that's the right choice for you - great. But if he's got a lot of concerns or you just can't find the right HB MW, or if everything about the hospital situation is great except for that pesky monitor... well, go with your heart.

[CoconutCutie]

It isnt a deal breaker for me. But They also have the wireless units avaliable as well. Also I have negotiated a time limit with my doc of 20-30 mn continous and the rest off. Maybe your doc and you can negotiate.

[Climbergirl]

I asked about negotiations. I was speaking with the patient advocate at the hospital.

They do not have wireless ones. They have it on their wish list, but they don't have it. They will have something that can be used in the water tubs, but that is only on loan for one particular patient, and after that, it has to go back and they can not afford to buy it.

She told me that the doctors can not allow a rest. Period. The nurse will make you put it back on. After my last nurse experience, I would believe it.

We are interviewing the midwifery group that does VBACs there, just to really cover our bases, so we will see what they said.

My concern was that last time, they had a hard time finding and keeping the monitor on DS's heartrate. So, they made me lay down and stay very very still. I am not sure I can do a natural birth in that circumstance and with my low blood pressure, when I got the epidural, my BP dropped really low. So I am concerned that would happen and then, oops, dead baby card, off to c/s when everything would have been fine. I almost died after my last one, so I am very nervous about another c/s.

I am a rock climber so I very much get the analogy. This is something we plan on discussing with the HB midwife.

It is good to hear the different perspectives

[MNHall]

It was not a deal breaker for me...but I wasn't in the hospital long before delivery. I arrived at 5cm, 30-45 minutes later I was pushing...granted I pushed for a long time...but I was so in the zone that I didn't notice anyone but my husband or doula...looking back, I don't remember anything besides looking in the eyes of them. So, my labor in the hospital was short, that's the part that more freedom would have been necessary, but for those 30 minutes, we were just getting situated and dealing with contractions anyway.

So, you said they are loaning one out for one patient for a tub birth....so, why can they do it for her? What if you want a tub? Why can't you have a loan for a monitor too? I'd pressure for some questions like that.

I can totally understand based on last experience though....it makes a big impact on how you will feel going into this experience. Like for me, the monitor wasn't a big deal last time, so I don't think it will be next time. But, since it did hinder you last time, it could at least mentally hinder you again...like maybe you will spend a lot of emotional energy on being irritated about the monitor...that kind of thing! So, that right there could make me consider it being a deal breaker!

[MNHall]

Oh, PS, my doula and I talked about going to the bathroom a lot during labor. Funny, but, she said a lot of her clients favorite place to labor is on the potty. Position wise and because you can shut the door and the nurses don't bother you much..sure, they might ask if you're okay...but 30 minutes in there, to yourself...every hour! Not a bad deal there!

[kltroy]

Originally Posted by Climbergirl

My concern was that last time, they had a hard time finding and keeping the monitor on DS's heartrate. So, they made me lay down and stay very very still.

Yikes! I guess this would make a pretty big difference. They did get to this point at the very very end of my labor (and kicked me off my ball) but by then I really didn't care too much -- I was mostly through transition and I wasn't going anywhere. I guess one option if you ran into this situation at a hospital would be to opt for the internal monitor at that point, since they are less prone to movement artifacts and can, in fact, give you more freedom of movement. I would definitely ask the MW about her feelings on this. It's my impression that being able to position those dumb belts is somewhat of an art, and that some people are better at it than others.

either way, good luck with your decision!

[shenanegans]

I really don't like continuous monitoring. I had it with my son and while I was trying to sleep it kept losing the heartbeat and the nurses would rush in when the machine started beeping and try to readjust it. yuck!
for me this time the dealbreaker to really go for the home birth. (besides the trauma I experienced last time around) was...

1. there is no guarantee that my Dr. will actually be there for my birth. He is vbac supportive but who knows about whoever may be on call.

2. they still regularly induce vbac patients there.

3. continuous monitoring

So we have a private midwife and a homebirth planned. Now I just need to tell my Dr. hmmm.

[AustinMom]

UH, YES! Our hospital "requires" continuous fetal monitoring, and they have a portable unit, but that still wasn't enough for me. I think there are too many risks of using CFM, like the fact that cesarean section rates triple, and being a VBAC, thought that would be even higher as everyone is so scared of uterine rupture, etc, that I felt the slightest inkling of FHT craziness would cause the decision to incision.

You are NOT crazy for wanting to HB, especially for this, go with your gut, and birth where you (and your sphincters) are most comfortable.

[cairomama]

It was not a deal breaker for me. I told my midwife I was concerned about being restricted for the monitoring and he said that the monitoring was his problem and he would work around me. He had a good reputation for VBAC success in the natural birth community and so I trusted him. He kept his word. I was on my hands and knees for almost my whole labor and for pushing as well. I was only in the hospital for 2.5 hours before she was born, also.

My plan was not to go to the hospital until I was past the point of walking the halls and needed to seriously focus. I was 8 cm when I arrived.

I would check out the reputation of the provider and refuse to be a slave to the monitor.

that said, if you have a good HBAC option and you are comfortable with it, then go for it!

[Climbergirl]

We have an interview today with the midwives that deliver at the hospital

I should clarify the portable monitor situation at the local hospital. There is a woman delivering VBAC in the May/June timeframe and did not want to have to be so limited. She contacted a medical device company and got a rep to loan the hospital this particular portable monitor that can allow her to be in the water as well. The hospital can not afford this monitor, so once the company wants it back, they have to give it back. I could probably try the same thing, but my guess is the company is not in the business of loaning out equipment that a hospital is not going to buy. The lady at the hospital told me they hope the company forgets and just leaves it, but I would doubt that.

I am going to ask the midwives a lot about this and other hospital policies.....

Thanks for the thoughts!

[khaoskat]

For me it is a deal breaker...especially after the lawsuit our big/main hospital recently lost. VBAC with CEFM....the nurse totally failed to read and relay information correctly to the OB on call....I have personally seen the little boy and his family and what the ensuing lawsuit and trial did to them all (including the kids).

CEFM is not perfect, and it is only as reliable as the person reading it...There have also been studies done, showing that out of 5 OB's, you may get anywhere from 3-5 different interpretations of what the monitor is showing.

I have also heard stories of Mothers, from their own mouths/e-mails/postings, that they knew something was wrong well before any monitor showed a problem. That they pushed based upon their own intuition and when went in for a repeat c/s, they discovered the only reason no one was hurt yet was the position of the baby - basically the baby saved both mother and baby's lives by blocking the ruptured area, or something else along those lines.

Either way you go, you are taking a chance --- you are taking a chance w/o the CEFM of not knowing about a rupture; you are taking a chance w/ CEFM that your nurse is actually paying attention and accurately reading the machine and what it says.

I am a prime example of how the CEFM can suck or not work --- with DD2 I showed up in labor, very calm and confident and not cracking under the pain....In triage I was hooked up to the monitor. No matter how much I complained to my nurse that a) My last living child was born 20 minutes after arriving at the hospital; b) I have a long history of percipitous (aka fast) labors; c) and I was feeling a lot of intense pressure down there, the nurse's response - "You are not even in real labor yet. Your contractions are 4-5 minutes apart and are not even lasting 40-50 seconds." after she consulted the monitor and refused to call my OB for another 20 minutes. Guess what, my DH called my OB down immediately, he checked me and I was fully dilated/effaced and my BOW was coming down/out ahead of the baby and at a +2 or +3 station.