Question about refusing continuous EFM

[birthjunkie27]

A quick background... my last 2 babies were born at home but due to having different insurance my only options are now UC or hospital birth. I'm still undecided on which way I'll go so I'm trying to prepare myself for either scenario.

The OB I see regularly is ok with intermittent EFM, but there are 3 other doctors in the practice. I met with one of them for the first time yesterday and he said that if I am in active labor he will require that I be on continuous EFM and that that is how "most" physicians practice. I was pretty flabbergasted and wasn't expecting to hear that.

My question is, if this is the Dr. that is on call when I go into labor how do I go about refusing the continuous EFM? Do I just sign something that says I'm doing something AMA? Do I just take the moniters off myself when the nurse leaves the room until they get the point? Can I get my regular OB to sign off on a birth plan that includes my wishes.... and would that override the Dr. that is on call?

ETA: I'm leaning towards just staying home until I start to feel the urge to push and then go to the hospital so they won't even have time to do all of the standard crap like EFM. The hospital is a 5 min drive.

[Dmitrizmom]

You can refuse anything that they want to do to you if you are willing to fight for it or have someone who can fight for you (is your dh good at advocating for you?). The later in labor that you show up at the hospital, the less time they have to do any interventions.

[ShadowMoon]

I refused this at the hospital. I showed up late in labor and could not stand/sit still. I allowed them to try to use the hand-held monitor but they gave up after chasing me around the room with it.

I was lucky to have a great OB and nurses so that might have helped. To be honest though, I probably would have ripped it off or fought the nurse that would try to put it on. I got very possessive of my body during labor

[rparker]

I would discuss the issue of the other OB insisting on continuous EFM with your primary OB and have him sign a copy of a birth plan for you saying that intermittent EFM (or even auscultation with a doppler) is fine. I'd bring that and a print out of ACOG's current guidelines both to the hospital and to future appointments with any of the other OBs in the practice.

The OB who is insisting on continuous EFM stating that that is how "most" physicians practice is full of crap btw. Continuous EFM for a low risk pregnancy goes against the accepted standards of practice for his profession. Both my former OBGYN and my current family practice doctor, neither of whom are particularly "crunchy," are more than happy with intermittent EFM and/or auscultation with a doppler. (And they aren't similarly enlightened on other natural birth issues.)

[Diyan]

I agree with having your primary OB sign off on you having intermittent monitoring, and put it in in your file. There are also things you can do at the hospital to avoid excessive monitoring - spend a lot of time on the toilet or in the shower, walk the halls so they can't find you to put it back on. But be aware that waiting until you feel the urge to push before going to the hospital makes it likely you will have the baby before you get to the hospital. Most births in the car happen with families who live closest to the hospital.

[jenifera2]

Is the "other" OB assuming you'll have an epidural? It may not have even crossed his mind that you're not going to have one, so he may be thinking of his "standard" patient with an epidural and an IV and therefore also continuous EFM.

[Kelly1101]

Originally Posted by birthjunkie27

My question is, if this is the Dr. that is on call when I go into labor how do I go about refusing the continuous EFM?

"No."



As PP said, get your primary doctor to sign off on intermittent EFM. Then if you get someone else on call who wants to do it continuous, just tell them sorry, you're not doing that, and your doctor agrees. Make sure your support people know about this beforehand so that they can back you up. If they keep pressing you about it while you're in labor, I think that's grounds to rip the monitor off and throw it in their face.

[birthjunkie27]

Originally Posted by rparker

I would discuss the issue of the other OB insisting on continuous EFM with your primary OB and have him sign a copy of a birth plan for you saying that intermittent EFM (or even auscultation with a doppler) is fine. I'd bring that and a print out of ACOG's current guidelines both to the hospital and to future appointments with any of the other OBs in the practice.

Thanks for the suggestion.. I will definitely do this.

[birthjunkie27]

Originally Posted by Diyan

But be aware that waiting until you feel the urge to push before going to the hospital makes it likely you will have the baby before you get to the hospital. Most births in the car happen with families who live closest to the hospital.

I have no problem with this. I'm still considering UC so UC in the car doesn't scare me. I'll just put lots of towels on the floor.

Originally Posted by jenifera2

Is the "other" OB assuming you'll have an epidural? It may not have even crossed his mind that you're not going to have one, so he may be thinking of his "standard" patient with an epidural and an IV and therefore also continuous EFM.

Nope, he knows I've had 2 previous homebirths and I specifically told him I want this birth to be as low intervention as possible. He still stated that ALL of his patients MUST be on continuous EFM.

[2ID_Wife]

Talk with your doc, just cause he signs off on it saying it is ok doesn't mean the doc on call will go by it in some practices though.

[cileag]

I recommend just moving around and they will have to chase you with the monitors. Or spend a lot of time in the bathroom. Or just forget to call them when you get out of the bathroom. Or just unplug them if they get in the way. There are lots of ways to get around it.

[HappyMommy2]

Originally Posted by cileag

I recommend just moving around and they will have to chase you with the monitors. Or spend a lot of time in the bathroom. Or just forget to call them when you get out of the bathroom. Or just unplug them if they get in the way. There are lots of ways to get around it.

I agree that this is your best bet. Let them chase you.

Also, be prepared, and prepare your birth support team, that the docs/nurses are going to try to threaten you with very scary scenarios. They might even "play the dead baby card" to try to get you to conform to their standards. The more you anticipate this, the better you will be able to say no without falling for their scare tactics.

[SC_Jan]

This has the makings of a baaad situation. Are you stuck with these doctors? I really wouldn't want to stay with a practice where I only had a 25% chance of having my wishes respected. You do have the right to refuse ANY interventions in the hospital but wouldn't it be better to not have it be an issue in the first place? I have stopped seeing doctors I really clicked with because I didn't like their practice partners. I also notify the doctor I like of the reason I am switching.

If he is so unwilling to budge on this issue, I'd say he'll be the same way about other things such as episiotomies, C/S, etc. If you really have no other options for care, I would lean toward UC if that's a realistic option in your case. A note from your other doctor is not going to get you diddly squat with this guy.

If you do stay with this practice and deliver in the hospital, your nurse can really help or hurt the situation. Start finding out who the granola bulldogs are now so you can request one of them when the time comes.

[MegBoz]

I think you've gotten some great advice already - especially "find the granola bulldog" nurse.

The only thing I wanted to add was that, isn't it pretty likely the OB on call, whoever he is, won't be around much during your labor? So how will he even know? Seriously!

So as long as you have a birth plan, signed off on, that says "intermittent" & the nurse assigned to you is OK with that, I would think you'll be fine. (Now, during pushing phase, it's a different scenario, but I personally didn't mind continuous EFM during pushing - a nurse held it in place so I didn't have to wear the belt.)

[April422]

Originally Posted by MegBoz

So as long as you have a birth plan, signed off on, that says "intermittent" & the nurse assigned to you is OK with that, I would think you'll be fine. (Now, during pushing phase, it's a different scenario, but I personally didn't mind continuous EFM during pushing - a nurse held it in place so I didn't have to wear the belt.)

Around my neck of the woods it doesn't matter if your DR signs a birth plan, the physician on call when you go into labor has standard orders the nurses must follow. So if DR Continuous Monitoring is on call it wouldn't matter that DR Intermittent Monitoring signed your birth plan. The nurse would be required to follow Continuous Monitoring OBs orders.

[mrsberman]

Originally Posted by April422

Around my neck of the woods it doesn't matter if your DR signs a birth plan, the physician on call when you go into labor has standard orders the nurses must follow. So if DR Continuous Monitoring is on call it wouldn't matter that DR Intermittent Monitoring signed your birth plan. The nurse would be required to follow Continuous Monitoring OBs orders.

I still don't understand how a dr can try to force something after a patient says they don't want it. Does this mean the patient has to fight with the nurses and drs the whole time?

Also, is it an option to fire the dr while in labor? Tell him if he can't comply with your wishes then get a dr that can. When I was getting close to my due date with DD I called my insurance and asked if I could do this if I didn't like the dr that came in the room and they said absolutely (I had an issue with a practice refusing to see me even though it was very likely they could be on call when the time came).

[Kelly1101]

Originally Posted by mrsberman

I still don't understand how a dr can try to force something after a patient says they don't want it. Does this mean the patient has to fight with the nurses and drs the whole time?

That's what I'm wondering. Would they try to physically hold you down? That's crazy.

[rparker]

Originally Posted by mrsberman

I still don't understand how a dr can try to force something after a patient says they don't want it. Does this mean the patient has to fight with the nurses and drs the whole time?

I just went on a tour of our local L&D unit and the nurse who gave the tour said that I had the right to refuse any procedure even if it was something that other patients routinely consented to. She actually emphasized this point and said that I or my doula might have to remind some of the other nurses of a patient's right to refuse consent and that we should not hesitate to do this.

My doctor has also told me that I have the right to refuse procedures that are routine for him and/or that he thinks are in my best interest. (In this case the point we disagree on is a routine heplock, he's cool about monitoring.)

I guess a patient having the "right" to refuse might not stop some doctors and nurses from trying to verbally persuade her after she has said no, but they can't (legally) physically do anything to you.

[honeybee]

They can try emotional blackmail, tell you all kinds of crap, but in the end you always have the right to refuse. Just repeat over and over again "I do not consent to that." But also make sure you have someone paying attention to make sure they just don't automatically do something without your awareness (like an episiotomy, or put something in an IV if you get one).

[MegBoz]

Originally Posted by honeybee

They can try emotional blackmail, tell you all kinds of crap, but in the end you always have the right to refuse.

Actually I'm pretty sure the law of informed consent says you have the right to refuse "without duress." So the emotional blackmail is actually just as illegal as them doing the procedure without your consent. (Yeah, BOTH things happen all the time anyway. Just sayin' - that's the law.)

Still, I would think that having the birth plan signed-off by one doc would make the nurses somewhat more agreeable to intermittent monitoring. At least it's someone with "MD" behind his name who agreed to this plan (as opposed to just a crazy patient fighting with their standard procedures.)

In any case, I agree it'd be best to have a doula (or good NCB-experienced friend) with you, in addition to DH to run interference with nurses. You don't need the stress of being the one to have to say, "I understand want the protocols are for Dr. Continuous Monitoring AND I DON'T CARE. I'm exercising my right to bodily integrity, my right to informed consent & dissent, and declining this procedure. I'll agree to be monitored by doppler every X minutes & that's it. This decision is final."