Ruining my chances, or a standard precaution? - Page 2

[oddduck]

Had a VBAC yesterday (woohoo). I gave birth in a hospital (midwife attended with continual fetal monitoring and an IV (GBS+).

I sat on the birthing ball, laboured/pushed unplugged on the toilet (with occasional doppler checks). They just noted any unplugs on the charting sheets. I also pushed leaning over the back of the bed, never really felt overly attached and pretty well moved freely around the room.

From anyone else I've talked to (in Ontario). Most MW groups strongly prefer VBACs done in the hospital. In the city I am in only 1 group with allow HBACs due to previous issues.

[AlexisT]

Originally Posted by Climbergirl

From what I have read, having the baby's heartrate monitored every 15 minutes by Doppler is just as effective as CFM. CFM is something that is interpreted, it is not a cut or dry kind of thing. 3 different people can look at a tape and will most likely say 3 different things.

It's just as effective in low risk women under certain conditions--I'm not sure VBACs were included at all in the main study looking at EFM vs IA. A study comparing IA (intermittent ascultation) to cEFM for VBACs has never been done and probably never will be, since there is evidence that it does detect UR. The question is really, "does the increased chance of detecting uterine rupture outweigh the negatives of EFM?" And we don't have an answer to that question.

NICE and RCOG in the UK also recommend continuous CTG monitoring for VBACs (they do not recommend its routine use in all labors, and UK midwives use IA).

[Climbergirl]

I think if I was doing VBAC after 2 or 3 c-sections, I would be a little more conservative. But, since this is my primary VBAC, the risk of uterine rupture is not that higher than a women that is not a VBAC. Now, if I have a c-section with this one, I may be more concerned that my uterus has been through a lot more and the risks would be higher. But as it is now, other than this c-section, the only thing done to my uterus/cervix is pap smears.

When I spoke to the midwives, they did have a high epidural rate for VBACs. They did say they do as much as they can, but sometimes a birthing ball and unplugging to sit on the toilet is not enough and the patient requests an epidural. They were clear that the CFM does hinder some patients, but they do the best they can to keep it from doing so.

Since I am really wanting to not have an epidural because of my blood pressure, that reassurance was not enough for me. But again, that is definitely my particular circumstance!

It is interesting to me that some women find it a minor inconvenience when others are downright annoyed with it. I found the whole think last time to seriously be annoying (I was annoyed by the IVs to, so maybe that is a "me in labor" thing). Maybe my nurses just were not good at using the dang thing, but they were seriously adjusting it all the time and got upset if I moved because the baby would move and then they would have to readjust (and my epidural was nice so that I really was able to move by myself). I got fussed at a lot about it. It could have also been because my placenta was in the easiest place to find the baby so they were having to avoid that and that made it harder on them. I would love to know if that is a possibility. But I do have the same placenta placement this go around as well. Hum......

Originally Posted by AlexisT

The question is really, "does the increased chance of detecting uterine rupture outweigh the negatives of EFM?" And we don't have an answer to that question.

Exactly. I wish we did.

But, to answer the OPs question. I am not convinced it is setting you up for failure. But I would understand its limitations and if they start saying the baby is in distress, I would ask for a doppler reading to confirm that. Technology can be useful, as long as it is used wisely. I would definitely try to negotiate that you don't have to have it on from the moment you walk in the door too. That way, if you get there and you are fine leaving it on, great. But if not, then you have given yourself some options.

[AustinMom]

My main quarrel with cEFM is that in low risk mom studies, 1)it's shown to not improve out comes of mom or baby, 2)the same readings can be read differently by different CPs 3)limits movement and 4)shown to increase the CS rate. ALL things I don't want with my VBAC. Especially with the increase in CS, up to 300% in some studies. Soooo....if I were in a hospital, I feel they would be looking at me even more so as a bomb of a uterine rupture about to go off and cause cataclysmic destruction and death to me and my baby....I wouldn't want to give them any more fuel for that fire and have them 'misread' the tracings, and have a CS just because 'well, we thought something was wrong'. YKWIM?

[_ktg_]

Originally Posted by AustinMom

My main quarrel with cEFM is that in low risk mom studies, 1)it's shown to not improve out comes of mom or baby, 2)the same readings can be read differently by different CPs 3)limits movement and 4)shown to increase the CS rate. ALL things I don't want with my VBAC. Especially with the increase in CS, up to 300% in some studies. Soooo....if I were in a hospital, I feel they would be looking at me even more so as a bomb of a uterine rupture about to go off and cause cataclysmic destruction and death to me and my baby....I wouldn't want to give them any more fuel for that fire and have them 'misread' the tracings, and have a CS just because 'well, we thought something was wrong'. YKWIM?

I'm sorry but bolding is mine, as I think this is a fear-mongering statement. You have chocies, you have to consent to a C/S, it not just here- you're having a c-section, unless something is truly wrong, and there could be multiple signs besides the CFM tape (mother's BP, baby HR, probably some bleeding which is outside of the norm). Again - this is why as a patient, you (in general) need to have conversations with your healthcare providers (MDs, CNM, CPM, LPM) about your goals with birth, your desires/wishes, and see where all your choices are.

VBAC'ing in a hosptial can be a totally respectful and supportive environment have a doula, get your partner on board, have LONG talks with your MD. If you don't want CFM - don't consent to it. Period that's it, the end, ask what are the other options (Intermittant, doppler, telemetry) and continue to ask your options all the way through until that baby is pushed out.

[GOPLawyer]

Originally Posted by _ktg_

I'm sorry but bolding is mine, as I think this is a fear-mongering statement. You have chocies, you have to consent to a C/S, it not just here- you're having a c-section, unless something is truly wrong, and there could be multiple signs besides the CFM tape (mother's BP, baby HR, probably some bleeding which is outside of the norm). Again - this is why as a patient, you (in general) need to have conversations with your healthcare providers (MDs, CNM, CPM, LPM) about your goals with birth, your desires/wishes, and see where all your choices are.

VBAC'ing in a hosptial can be a totally respectful and supportive environment have a doula, get your partner on board, have LONG talks with your MD. If you don't want CFM - don't consent to it. Period that's it, the end, ask what are the other options (Intermittant, doppler, telemetry) and continue to ask your options all the way through until that baby is pushed out.

It would be fear-mongering if it weren't based in reality; however, it is sadly true. Doctors DO do this (not all...but some). I had a doctor try to force a c/s using EFM (at just 28 weeks...long story). She kept ignoring my questioning her...she just kept looking at the tape and saying over and over that it didn't look good (her acting was horrible BTW) The nurse had me turn to my side and all was fine. My suspicions were confirmed when the doctor shot the nurse a true look-of-death. The doctor knew everything was fine but SHE wanted a c/s.

[limette]

Originally Posted by AustinMom

My main quarrel with cEFM is that in low risk mom studies, 1)it's shown to not improve out comes of mom or baby, 2)the same readings can be read differently by different CPs 3)limits movement and 4)shown to increase the CS rate.

I was just reading on a gov of canada site that they recommend that if fetal distress shows up on the monitor that a scalp sample should be the next step because the fetal monitor wasn't enough to determine whether or not to have a c-section.

After being told I was killing my baby, I had to insist on the scalp sample with dd1. After several attempts with the broken equipment they had, it came back inconclusive and they did the c-section anyway. There was quite a bit of time between the decels and the c-section and she came out perfectly fine with no signs that she had ever been in distress.

[_ktg_]

Originally Posted by GOPLawyer

It would be fear-mongering if it weren't based in reality; however, it is sadly true. Doctors DO do this (not all...but some). I had a doctor try to force a c/s using EFM (at just 28 weeks...long story). She kept ignoring my questioning her...she just kept looking at the tape and saying over and over that it didn't look good (her acting was horrible BTW) The nurse had me turn to my side and all was fine. My suspicions were confirmed when the doctor shot the nurse a true look-of-death. The doctor knew everything was fine but SHE wanted a c/s.

I'm sorry that was your experience, and our realities are built from experiences. My beef is the continued promotion of distrust of HCPs, and instead of opening a dialogue with them. This its getting OT and my own personal views - but it often feels like for women trying to VBAC we (NCB) drive them to lie, hide or avoid doctors at all costs, instead of what we should be doing which is not tolerating their actions when they make their intentions clear, and when it doesn't match the patient's and firing them when needed.

[Climbergirl]

_ktg_,

Unfortunately, dialog is a two way street. My medical records clearly show that my child was not in distress and my c-section was "non-emergnet" (that is actually in my medical records). If you look at my doula notes (where she was documenting everything for us as a "keepsake"), it says the same thing I remember: "You baby is in distress and needs to get out now". Those are two very different things.

I asked DH if he thought the reason for the c-section was because DS was in trouble and we had to do it to save his life. He said "yes". So when I showed him the medical records, let's just say he was less than pleased. We both felt they lied to us to get us to consent to a c-section which had many negative things happen because of it.

I had every one of those long conversations you are talking about, but when my OB decided to take a vacation when I was 39 weeks (to Hawaii), I was pretty much let with her backup options. I trusted she had good backups, she didn't (1st pregnancy). Now, I don't trust so much anymore. And yeah, I feel like I have a good reason not to. No one told me to not trust OBs and L&D nurses, my experience with my birth, my sister's births, and my MIL (a L&D nurse) has given me ample exposure to have a distrust. And for that matter, the idiot nurse who discharged me 4 days post-op when I told her I was having trouble breathing and she blew it off. Yeah, that meant another 5 days in the cardiac unit and if I had waited 12 more hours before going to the ER, I would have been in the ICU on a vent. Thanks lady!

I have tried to find a provider that would be willing to do intermittent monitoring. In my area, it does not exist (as far as I can find). And that includes the midwifery group that delivers at the nearest hospital. So, if the providers are not willing to accept that I have a CHOICE and support me, then I go and find one who does. And that meant going to a homebirth midwife.

And, in some places, not consenting to a hospital policy like that can lead to a court order to force you to have a c-section. It has happened. Rare, but it does. So, tell me again why they automatically deserve my trust and respect when they clearly have not given me the same?

[_ktg_]

Climbergirl - I applaud you in researching out your options, and making an informed choice about what your options are, what you choose to consent to and etc. I wish you well for your upcoming birth and I hope that you find peace with the traumatic birth events and what appears to be medical malpractice you had with your first.

My view is simply mine and has been building each time I visit this forum, as I read over sometimes wonderful advice and then terrifying advice all too often. These are my thoughts and opinions, but personally I believe that respect begets respect often and if it doesn't well then, its time to leave.

To the OP - good luck with your decision and I wish you the best of luck

[PhotoJournMama]

Originally Posted by oddduck

Had a VBAC yesterday (woohoo). I gave birth in a hospital (midwife attended with continual fetal monitoring and an IV (GBS+).

I sat on the birthing ball, laboured/pushed unplugged on the toilet (with occasional doppler checks). They just noted any unplugs on the charting sheets. I also pushed leaning over the back of the bed, never really felt overly attached and pretty well moved freely around the room.

From anyone else I've talked to (in Ontario). Most MW groups strongly prefer VBACs done in the hospital. In the city I am in only 1 group with allow HBACs due to previous issues.

I just wanted to say Congratulations Thanks for sharing your experiences with me.

Originally Posted by AlexisT

It's just as effective in low risk women under certain conditions--I'm not sure VBACs were included at all in the main study looking at EFM vs IA. A study comparing IA (intermittent ascultation) to cEFM for VBACs has never been done and probably never will be, since there is evidence that it does detect UR. The question is really, "does the increased chance of detecting uterine rupture outweigh the negatives of EFM?" And we don't have an answer to that question.

That's a good point, and a good question. The midwife did tell me that there wouldn't be nurses in and out of the room and so on - that she or her backup would be there the whole time, and that there would be two midwives during the actual birth. I hope that this means that they are the only ones checking the monitor and that they won't be as section-happy as most OBs.

[AustinMom]

I just want to reply to all the thoughts (not siting names as I don't really want to scoll down the page and site everyone of you) mentioned

1)yes, it is your choice for a CS, but knowing that I as a mom (as most moms) don't have the ability to interperate cEFM tracings, I would be left to my CP's thoughts. Otherwise the conversation could very well be risky for me NOT to trust them. So of course, I would say, 'yes, let's do a CS if the baby is in distress' and then I know (based on other stories mentioned) there is also a chance of it just being a CPD, failure to progress, non-emergent CS in the end.

2)I don't distrust a CP, I only have the option TO trust them, that's why I'm not doing an unassisted birth. I think the open-dialogue yes, goes two ways, and I think most women find that much easier with a MW than with a typical OB (look at the length of prenatals for ex.)

3)I'm sure other countries like Canada and the UK have more laxed alternatives to fetal distress than the US. I don't think there is a Dr. in my area who would even know what a fetal scalp stimulation test is. They just don't offer it.

4)Yes, you can be your own advocate, and you can get all the nitty gritty details about making your decision, but keep in mind, with a situation like fetal distress, I don't want to be nit-picking or spending any more time necessary finding out what is accurate. I don't want to do that EVER in labor, much less when/if my or my baby's life is truly at stake.

[oddduck]

Originally Posted by PhotoJournMama

I just wanted to say Congratulations Thanks for sharing your experiences with me.



That's a good point, and a good question. The midwife did tell me that there wouldn't be nurses in and out of the room and so on - that she or her backup would be there the whole time, and that there would be two midwives during the actual birth. I hope that this means that they are the only ones checking the monitor and that they won't be as section-happy as most OBs.

At the hospital I delivered at the EFM sends data back to the nurses station. Everything that your MW have told you so far is very similar to what I experienced. As I progressed they called down to the nurses station to keep them updated on our progress.

We were left alone until after birth when the MWs called over the OB. They needed some help stitching me up as they don't mess around with 3rd/4th degree tears or deep vaginal/cervical ones. I'm actually quite happy I birthed in hospital as I would have ended up there anyway and this way I didn't need to worry about the huge mess I made everywhere.

[kltroy]

Originally Posted by oddduck

and this way I didn't need to worry about the huge mess I made everywhere.

ROFL this is the MAJOR reason that my mom, a very naturally-minded CNM, gives for being pro-hospital birth. She always says to me, "birth is messy. let someone else clean it up!" (then again, with the hosp. births that *she* attended, the level of intervention was generally minimal/none). I have to admit, mine was messy too, and I didn't want to clean it up either!