External/Internal Fetal monitoring-- where can I learn more about this?

[texmati]

With my son, DH and I though we were well read, and we had done the bradley classes, and books, and homework etc but we were stumped by the fetal monitoring.

All we had to go on was that the nurses and doctors were saying that ds heart rate wasn't right, didn't look well, etc. I want to find out how exactly to read those strips, and what they are looking for. I am at the point where I believe the medical team, but at the time, DH and I were both suspicious that we were being railroaded. (Basically at 9pm the dr and midwife and nurse walked in and said that DS hb was too unsteady, and we needed a section, and enroute the OR, appreantly something happened with the heart rate and it became an emergancy section).

I'd really like to know what all the blips and squiggles signify, so we have a frame of reference going in to things this time around. Any resource anyone can recommend?

[GuildJenn]

This is a pretty good primer:

http://www.aafp.org/afp/990501ap/2487.html

My daughter died mostly because the nurse did not recognize the W pattern or its preceeding patterns on our ERM (Figure 6 on that page) and we also did see the next pattern (figure 7) before her heart stopped. (When we saw the tracings afterwards; at the time we had no idea.) Which was a ridiculous, ridiculous error.

You might guess I am in favour of monitoring, although my hospital allows for other monitoring provided certain criteria are met. The trick is that you are not just listening for overall heart rate but very specifically how it rises at the end of a contraction. Not that I have any training in this, I just know because of how prominently this figured in my daughter's case & our investigations afterwards. 

My son had a scalp monitor on for the end of his brief labour and he didn't actually even really have much of a scratch - quite different from what we'd heard, although I could see how there could be more of a wound.

[texmati]

GuildJenn, thank you for the response. I'm so, sorry about your daughter and how it happened with the nurse. It's just terrible.

My son also had a probe inserted in his head, and I have to agree-- not at all as horrific as my Bradley teacher made it sound.

Originally Posted by GuildJenn 

This is a pretty good primer:

http://www.aafp.org/afp/990501ap/2487.html

My daughter died mostly because the nurse did not recognize the W pattern or its preceeding patterns on our ERM (Figure 6 on that page) and we also did see the next pattern (figure 7) before her heart stopped. (When we saw the tracings afterwards; at the time we had no idea.) Which was a ridiculous, ridiculous error.

You might guess I am in favour of monitoring, although my hospital allows for other monitoring provided certain criteria are met. The trick is that you are not just listening for overall heart rate but very specifically how it rises at the end of a contraction. Not that I have any training in this, I just know because of how prominently this figured in my daughter's case & our investigations afterwards. 

My son had a scalp monitor on for the end of his brief labour and he didn't actually even really have much of a scratch - quite different from what we'd heard, although I could see how there could be more of a wound.

[GuildJenn]

Thanks. :) It was not just her error (she should have had senior nurse support, once the monitor was looked at by someone else the OB wasn't available for a section, the OB had actually said not to push past a certain time without paging him and it was over an hour later...lots of errors) but it's why I got up on some of the tracing stuff.

My guess is your son was having some variable decels and then started losing variability in his tracings - that's usually where the alarm bells really go off (from our info about 'standard of care.')

There is a reasonably new study around that EFM does increase the number of unnecessary interventions. The issue always is of course that you still don't want to miss the necessary ones. I have also heard though, that it can decrease them because OBs will let a labour go longer as long as the tracings are good. I just recently got sent home from hospital bedrest to home bedrest based on the strength of NSTs along with growth on ultrasound so they're my new BFF LOL.

I found it really helpful to have a better understanding for my son's birth. If I were putting together a wishlist for a pre-labour class geared towards hospital delivery, I think I would focus a bit less on pain management and give the parents some of this hard core info.
 

Originally Posted by texmati 

GuildJenn, thank you for the response. I'm so, sorry about your daughter and how it happened with the nurse. It's just terrible.

My son also had a probe inserted in his head, and I have to agree-- not at all as horrific as my Bradley teacher made it sound.

[texmati]

Sorry... I can't type below the box.

I agree-- I normally would have thought that more information always equal better outcomes, but i know that's not always the case with birth. At the same time, I really don't understand this attitude of learning and preparing for medical interventions is bad. Our bradley teacher sped through the class on interventions and all, and I remember her apologizing for bringing negativity to us during our pregnancy. Stuff happens, and I don't see how it's good to bury our heads in the sand about it.

I admit, the article sounds really complicated; so it will take me some time for me to digest. I'm also going to run it by dh, who actually requested that I find someinformation about this. He spent hours staring at that monitor, but in the end still couldn't understand why they were decided on a emergency birth.
 

Originally Posted by GuildJenn 

There is a reasonably new study around that EFM does increase the number of unnecessary interventions. The issue always is of course that you still don't want to miss the necessary ones. I have also heard though, that it can decrease them because OBs will let a labour go longer as long as the tracings are good. I just recently got sent home from hospital bedrest to home bedrest based on the strength of NSTs along with growth on ultrasound so they're my new BFF LOL.

I found it really helpful to have a better understanding for my son's birth. If I were putting together a wishlist for a pre-labour class geared towards hospital delivery, I think I would focus a bit less on pain management and give the parents some of this hard core info.

[starrlamia]

research shows that continuous fetal monitoring does increase intervention rates due to false positives on the readouts. Studies also show that intermittent listening is just as effective as continuous monitoring.

Internal monitoring IMO should be done very rarely, as it necessitates the rupture of membranes and increasing the risk of infection.

[MegBoz]

ITA with Starrlamia

Originally Posted by texmati 

At the same time, I really don't understand this attitude of learning and preparing for medical interventions is bad. Our bradley teacher sped through the class on interventions and all, and I remember her apologizing for bringing negativity to us during our pregnancy.

Ha - then you'd really HATE "Birthing from Within!" I'm reading it now & the author goes on & on & on about how CB classes shouldn't focus on medical issues - they shouldn't spend time with the instructor being the "source" of "facts" that are pushed out to students & how you can't control birth anyway, so you should just do artwork & spend time learning about your own feelings towards birthing. The woman actually thinks birth plans - in an form - in any situation - are a bad idea. I hate hate HATE this book.

Aaaanyway, in terms of stats & facts on EFM, "The Thinking Woman's Guide to a Better Birth" is a good source. But I'm gonna guess you've already read it. Besides, it doesn't not tell you the details on what the read-outs mean. I remember that, I think, HR under 90 is considered a problem, BUT, in the 2.5 years since my DS birth, I read that there's a lot more to it than specific numbers, like the rate at which the HR rebounds post-ctrx is important. There's even an acronym to go along with it. I think it was on the birth professionals forum where I read this.

In any case, you mention you have suspicions that you were railroaded... I'd advise choosing a team of HCPs you trust more for the next time around. While I liked 2 of the 3 CNMs in my hospital practice when I had DS, I was still highly suspicious of the hospital environment (after all, every single one of the nurses is a total stranger to me! I don't know how much time the MW will actually spend with me, etc.) I had a lot of anxiety about birthing in a hospital. Thankfully it went very well, but I accidentally did all my laboring at home! Had to fight the urge to push on the way.

This time around, I'm planning an HB. Someone recently wrote that she's also planning an HBAC & feels good knowing that if her HB MW tells her she needs a CS, she's going to know for sure that she really does need that CS. I realized I feel the exact same way and it is a huge, huge relief!! I hadn't realized truly how great it is to trust my HCP & not feel the need to get educated on every single detail so I'm ready to second-guess her.

Of course, I'm not saying ignorance is bliss! Just saying, I'm drawing the line between what I think was good CB prep for me, and what goes into midwifery-school-education that I don't feel is necessary!

I don't think I'll ever truly be able to get up to speed on all the sorts of knowledge my MW has - so I have to trust her to a certain degree. This pregnancy, I've spent a lot less time worrying about all the medical details (hence my decision to read something different like "Birthing from Within" - Blech, hopefully the next book will be better.)

I'm also not saying that means everyone should plan an HB! Just saying you should chose your HCPs wisely so you really truly feel you can trust them.

[texmati]

I apologize, the quoting thing is really not working how I want.

Yes, I do know the standard stuff about fetal monitoring-- how the probe is inserted, that it can raise intervention rates. I was looking for information on what bad vs good strip looks like. My husband was in a room with me watching that stupid monitor for 6 hours, not really understanding what it meant but thinking that everything was ok. When they called for a c-section they went back over the strip and told him that it was needed because this and that had happened hours ago. It was very odd, and we wished we had more knowledge at the time.

As for trusting your hcp, we did trust our midwife going into the birth.  I think it's natural for all moms whose birth didn't go the way that they had thought to wonder if it was really necessary. I don't think it necessarily reflects bad choices in choosing an hcp on the part of the mom. I do have some issues with the way my midwife handled some stuff-- but I'm now ok with the medical decision to move to a section.

I know for some people, 'trusting' that the hcp provider must have made the right decision is good enough.

For me, it never will be--  I actually canceled a dental surgery for my husband because the surgeon wouldn't give a good explanation as to what he was doing. I know I'm not an ob or midwife, but I'm smart enough to understand the parts of my (and my child's) care that pertain to me. And I know that only I have my best interests at heart, so I want to be involve and aware of my own care.

Quote:

Originally Posted by MegBoz 

ITA with Starrlamia

Originally Posted by texmati 

At the same time, I really don't understand this attitude of learning and preparing for medical interventions is bad. Our bradley teacher sped through the class on interventions and all, and I remember her apologizing for bringing negativity to us during our pregnancy.

Ha - then you'd really HATE "Birthing from Within!" I'm reading it now & the author goes on & on & on about how CB classes shouldn't focus on medical issues - they shouldn't spend time with the instructor being the "source" of "facts" that are pushed out to students & how you can't control birth anyway, so you should just do artwork & spend time learning about your own feelings towards birthing. The woman actually thinks birth plans - in an form - in any situation - are a bad idea. I hate hate HATE this book.

Aaaanyway, in terms of stats & facts on EFM, "The Thinking Woman's Guide to a Better Birth" is a good source. But I'm gonna guess you've already read it. Besides, it doesn't not tell you the details on what the read-outs mean. I remember that, I think, HR under 90 is considered a problem, BUT, in the 2.5 years since my DS birth, I read that there's a lot more to it than specific numbers, like the rate at which the HR rebounds post-ctrx is important. There's even an acronym to go along with it. I think it was on the birth professionals forum where I read this.

In any case, you mention you have suspicions that you were railroaded... I'd advise choosing a team of HCPs you trust more for the next time around. While I liked 2 of the 3 CNMs in my hospital practice when I had DS, I was still highly suspicious of the hospital environment (after all, every single one of the nurses is a total stranger to me! I don't know how much time the MW will actually spend with me, etc.) I had a lot of anxiety about birthing in a hospital. Thankfully it went very well, but I accidentally did all my laboring at home! Had to fight the urge to push on the way.

This time around, I'm planning an HB. Someone recently wrote that she's also planning an HBAC & feels good knowing that if her HB MW tells her she needs a CS, she's going to know for sure that she really does need that CS. I realized I feel the exact same way and it is a huge, huge relief!! I hadn't realized truly how great it is to trust my HCP & not feel the need to get educated on every single detail so I'm ready to second-guess her.

Of course, I'm not saying ignorance is bliss! Just saying, I'm drawing the line between what I think was good CB prep for me, and what goes into midwifery-school-education that I don't feel is necessary!

I don't think I'll ever truly be able to get up to speed on all the sorts of knowledge my MW has - so I have to trust her to a certain degree. This pregnancy, I've spent a lot less time worrying about all the medical details (hence my decision to read something different like "Birthing from Within" - Blech, hopefully the next book will be better.)

I'm also not saying that means everyone should plan an HB! Just saying you should chose your HCPs wisely so you really truly feel you can trust them.